多层螺旋CT联合动态对比增强磁共振成像对脊柱结核的评估分析

Evaluation and Analysis of Multi-slice Spiral CT Combined with Dynamic Contrast-enhanced Magnetic Reso⁃nance Imaging for Spinal Tuberculosis

目的:探讨多层螺旋CT(MSCT)联合动态对比增强磁共振成像(DCE—MRI)对脊柱结核的评估价值。方法:选择2018年8月—2021年8月新乡市第二人民医院收治的90例高度疑似脊柱结核患者作为研究对象,所有患者入院时接受MSCT、DCE—MRI检查,择期进行手术治疗,以术后病理结果为“金标准”,分析MSCT联合DCE—MRI对脊柱结核的评估价值。结果:90例高度疑似脊柱结核患者经术后病理检查,确诊43例,86个患椎,其中椎体破坏86个(100.00%)、椎间盘受累59个(68.60%)、死骨形成36个(47.37%)、椎旁脓肿63个(82.89%)、椎管受累35个(46.05%)。MSCT联合DCE-MRI诊断脊柱结核的敏感度、准确度均高于MSCT、DCE-MRI单独检查,差异有统计学意义(χ^(2)=12.627、0.108、6.860,P<0.05)。MSCT、DCE-MRI诊断脊柱结核与术后病理结果一致性一般(Kappa=0.576、0.620),二者联合检查诊断脊柱结核与术后病理结果一致性较好(Kappa=0.845)。联合检查对椎体破坏、椎间盘受累、死骨形成及椎管受累检出率高于MSCT、DCE—MRI单独检查。绘制决策曲线,结果显示,当高风险阈值为0~0.80时,净受益率大于0,有临床意义,且高风险阈值取值越小,净受益率越大,在阈值0.2~0.8范围内,联合MSCT、DCE-MRI的预测模型评估脊柱结核的净收益率高于单纯MSCT或单纯DCE—MRI。结论:MSCT联合DCE—MRI诊断脊柱结核的敏感度及准确度较高,与病理结果一致性好,同时可有效检测脊柱结核患者病理特征。

Objective: To investigate the evaluation value of multi-slice spiral CT(MSCT) combined with dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) in spinal tuberculosis. Methods: 90 patients with highly suspected spinal tuberculosis treated in the hospital from August 2018 to August 2021 were selected as the research subjects. All patients underwent MSCT and DCE-MRI examinations on admission, and elective surgery was performed. The postoperative pathological results were taken as the “gold standard”, and the evaluation value of MSCT combined with DCE-MRI for spinal tuberculosis was analyzed.Results: After postoperative pathological examination, 43 of the 90 patients with highly suspected spinal tuberculosis were diagnosed, and 86 vertebrae were affected. Among them, 86(100.00%) had vertebral body destruction, 59(68.60%) had intervertebral disc involvement, 36(47.37%) had sequestrum, 63(82.89%) had paravertebral abscess, and 35(46.05%) had spinal canal involvement. The sensitivity and accuracy of MSCT combined with DCE-MRI in the diagnosis of spinal tuberculosis were higher than those of MSCT and DCE-MRI alone, and the difference was statistically significant(χ;=12.627, 0.108, 6.860, P<0.05). MSCT,DCE-MRI diagnosis of spinal tuberculosis and postoperative pathological results were generally consistent(Kappa=0.576, 0.620).The combination of the two examinations showed a good consistency between the diagnosis of spinal tuberculosis and the postoperative pathological results(Kappa=0.845). The detection rate of vertebral body destruction, intervertebral disc involvement, sequestrum formation, and spinal canal involvement in combined examination was higher than that in MSCT and DCE-MRI alone, and the difference was statistically significant(P<0.05). The decision curve was drawn, and the results showed that when the high-risk threshold was between 0 and 0.80, the net benefit rate was greater than 0, which was clinically meaningful. And the smaller the high-risk threshold value, the greater the net benefit rate. Within the threshold range of 0.2-0.8, the combined prediction model of MSCT and DCE-MRI had a higher net return on spinal tuberculosis than pure MSCT or pure DCE-MRI. Conclusion: MSCT combined with DCE-MRI has high sensitivity and accuracy in the diagnosis of spinal tuberculosis, and is consistent with the pathological results, and can effectively detect the pathological characteristics of spinal tuberculosis patients.