第3代双源双能量CT虚拟去钙技术检测胸腰椎骨髓水肿的临床研究

Clinical study of virtual non-calcium technique based on the third generation dual energy CT to evaluate bone marrow edema of thoracolumbar vertebra

目的:探讨第3代双源双能量CT(DECT)虚拟去钙技术在胸腰椎骨髓水肿检测中的应用价值。方法:采集24名胸腰椎外伤患者的DECT和MR图像。在syngo via后处理工作站中使用Bone Marrow软件对椎体骨髓水肿进行检测和评分,同时测量椎体虚拟去钙后的CT值(VNCa)和常规CT值(rCT),并测量椎体MR信号强度与椎间盘信号强度的比值(VDR)。以MR图像作为"金标准",评估主观评分(VS)和各测量结果对胸腰椎骨髓水肿的检测能力。结果:共分析了147个椎体,骨髓水肿和无骨髓水肿椎体的VNCa、rCT间存在显著差异(均为P=0.00),各CT测量参数均与VDR呈显著相关并存在线性关系(均为P=0.00)。VS、VNCa、rCT均可诊断胸腰椎骨髓水肿,其中VS、VNCa的检测效能高于rCT,其差异有统计学意义(P=0.00、0.04),VS、VNCa对椎体骨髓水肿的检测效能间无显著性差异(P=0.68)。结论:第3代DECT虚拟去钙技术可显示胸腰椎椎体内的骨髓水肿,从而为临床区分椎体陈旧性或新鲜骨折提供参考。

Objective:To evaluate the diagnostic value of virtual non-calcium(VNC)technique based on the third generation dual energy CT(DECT)in the detection of thoracolumbar vertebral marrow edema.Methods:A total of twenty-four patients with thoracolumbar injuries were enrolled and underwent DECT and MR examinations.The data of vertebral marrow edema were analyzed by Bone Marrow Software on syngo via workstation for image post-processing.Data of CT value of virtual non-calcium technology(VNCa),regular CT value(rCT),and ratio of MR signal intensity of vertebral body to disc(VDR)were simultaneously collected.Both the DECT scan results and visual score(VS)were compared with MR images which are regarded as gold standard for detecting bone marrow edema.Results:147 vertebras were analyzed in total.There were significant differences in both VNCa and rCT values between vertebral marrow edema group and no edema group according to MR images(P=0.00 for all).There was a liner relation between VNCa value and VDR,which was also found between rCT value and VDR(P=0.00 for all).VS,VNCa,rCT all had diagnostic values for bone marrow edema of thoracolumbar vertebra.The detection efficiencies of VS and VNCa were higher than those of rCT with significant differences(P=0.00,0.04),while there was no significant difference between VS and VNCa(P=0.68).Conclusion:Virtual non-calcium technique based on the third generation DECT can detect the bone marrow edema of thoracolumbar vertebra,which can provide clinical reference for identification of fresh and old vertebral fractures.