CT联合3.0T超导磁共振成像诊断评估脊柱骨压缩性骨折良恶性的价值研究

The value of CT combined with the diagnosis of 3.0T superconductive MRI in assessing the benign and malignant compression fracture of spine

目的:探讨CT联合3.0T超导磁共振成像诊断评估脊柱骨压缩性骨折良恶性的价值。方法:选取医院收治的经穿刺活检和随访一年证实的90例单个椎体压缩性骨折患者,依据良恶性结果将其分为良性骨质疏松性压缩骨折的良性组(46例)和恶性压缩骨折的恶性组(44例),两组患者均行CT、3.0T超导磁共振成像及两者联合检查,对比3种诊断方法的MRI征象、CT征象、表观弥散系数(ADC)值,以及诊断符合率及灵敏度、特异度和一致性。结果:两组患者椎体压缩程度、椎体病变范围、病灶位置、椎体压缩后形态、椎弓根形态、椎体软组织、椎体静脉形态及信号改变的MRI征象比较,差异有统计学意义(x^(2)=38.639,x^(2)=15.548,x^(2)=5.239,x^(2)=4.586,x^(2)=50.094,x^(2)=27.957,x^(2)=6.619,x^(2)=63.707;P<0.05),两组ADC值比较,差异有统计学意义(t=33.241,P<0.05)。CT诊断良性骨质疏松性压缩骨折准确率高于恶性压缩骨折(x^(2)=6.727,P=0.014);CT联合MRI诊断符合率、灵敏度及特异性均高于两者单独诊断;经Kappa检验,3种诊断方法的一致性极好,Kappa值分别为0.95、0.914和0.876。结论:CT联合3.0 T超导磁共振成像在评估脊柱骨压缩性骨折良恶性中具有较高的诊断符合率、灵敏度及特异度,在脊柱压缩骨折患者临床诊断中具有重要的鉴别意义。

Objective:To explore the value of CT combined with the diagnosis of 3.0T superconductive magnetic resonance imaging(MRI)in assessing the benign and malignant compression fractures of spine.Methods:90 patients with compression fractures at single centrum who were confirmed by undergoing aspiration biopsy and follow-up visit of 1 year were selected.They were divided into benign group(46 cases)with compression fracture of benign osteoporotic vertebra and malignant group(44 cases)with compression fracture of malignant osteoporotic vertebra according to the benign and malignant results.Both two groups underwent the examinations of CT,3.0T superconductive MRI and the combination of them.The MRI signs,CT signs and apparent diffusion coefficient(ADC)values of three kinds of diagnoses were compared,and the diagnostic accordance rate,sensitivity,specificity and consistency among them also were compared.Results:The differences of MRI signs of vertebral compression degree,vertebral lesions range,lesions position,morphology after vertebral compression,morphology of vertebral pedicle,vertebral soft tissue,vertebral vein morphology and signal changes between two groups were significant(x^(2)=38.639,x^(2)=15.548,x^(2)=5.239,x^(2)=4.586,x^(2)=27.957,x^(2)=6.619,x^(2)=50.094,x^(2)=71.146,x^(2)=63.707,P<0.05),respectively.And the difference of ADC value between the two groups was statistically significant(t=33.241,P<0.05).The accuracy rate of compression fracture of benign osteoporosis as CT diagnosis was significantly higher than that of malignant osteoporosis(x^(2)=6.727,P=0.014).The diagnostic accordance rate,sensitivity and specificity of the combined diagnosis of CT and MRI were significantly higher than those of single diagnosis of each one,and the consistency of the three diagnostic methods was favorable by Kappa test,and the Kappa values of them were 0.95,0.914 and 0.876,respectively.Conclusion:CT combined with 3.0T superconducting MRI has higher diagnostic accordance rate,sensitivity and specificity in assessing the benign and malignant fracture of compression fracture of spine,and it has important identification significance in the clinical diagnosis of spinal compression fracture of patients.