基于Fazekas量表CT对脑室旁白质高信号的诊断效能评价

Evaluation of CT in diagnosing paraventricular white matter hyperintensities based on Fazekas scale

目的探讨基于Fazekas量表CT对脑室旁白质高信号(PWMHs)的诊断效能。方法回顾性选取2021年1月至7月就诊于我院1周内完成头颅CT、磁共振成像(MRI)检查的病例608例。根据Fazekas量表对CT及MRI的PWMHs进行评分;测量PWMHS及同层面正常脑白质的CT值,取2次测量的平均值;应用SPSS 25.0统计学软件进行统计学分析。结果CT与MRI对PWMHs的检出率具有较高的一致性(Kappa值=0.794,P<0.01),灵敏度和特异度分别为91.29%、89.81%。2种检查方法对PWMHs分级亦具有较强的一致性(Kappa值=0.845,P<0.01),对86.02%(523/608)的PWMHs分级一致。Fazekas 0和1级、1和2级、2和3级间存在交叉重叠(重叠率分别为11.37%、5.25%、7.52%)。Fazekas 1~3级的PWMHs CT值差依次增加(P<0.01),经组间两两比较后,Fazekas 1级与Fazekas 2、3级组间差异有统计学意义(P<0.01),经ROC曲线分析,CT值差鉴别Fazekas 1级与2、3级的最佳阈值为7.9 Hu,曲线下面积(AUC)为0.661(95%CI 0.610,0.709,P<0.01),灵敏度与特异度分别为88.55%、38.30%。结论Fazekas量表同时适用于CT、MRI对PWMHs的评价,将Fazekas 0级和1级、2级和3级分别归类诊断效能更好。应用CT进行分级的主要依据为病灶的范围,CT值差值可作为参考依据。

Objective To investigate the diagnostic efficacy of CT based on the Fazekas scale for periventricular white matter hyperintensities(PWMHs).Methods A retrospective study was performed on 608 cases who were admitted to our hospital from January 2021 to July 2021 and completed head CT and MRI examinations within one week.PWMHs of CT and MRI were scored according to the Fazekas scale.CT values of periventricular white matter hyperintensities and normal white matter at the same level were measured,and the mean values of the two measurements were taken.The data were statistically analyzed by SPSS 25.0.Results CT and MRI had a high consistency in the detection of PWMHs(Kappa=0.794,P<0.01),and the sensitivity and specificity were 91.29%and 89.81%,respectively.The two methods of CT and MRI also had strong consistency in the classification of periventricular white matter hyperintensities(Kappa=0.845,P<0.01),The classification of PWMHs was consistent for 86.02%(523/608).There was overlap between Fazekas 0 and 1,1 and 2,and 2 and 3(the overlap rates were 11.37%,5.25%and 7.52%,respectively).The CT value difference of PWMHs increased with the Fazekas grade successively(P<0.01).After pairwise comparison between groups,Fazekas grade 1 and Fazekas Grade 2 or 3 showed significant statistical differences(all P<0.01).The optimal threshold of CT value difference to distinguish Fazekas grade 1 from Grade 2 and 3 was 7.9 Hu,the area under the curve(AUC)was 0.661(95%CI 0.610,0.709,P<0.01),and the sensitivity and specificity were 88.55%and 38.30%,respectively.Conclusion Fazekas scale is suitable for CT and MRI evaluation of PWMHs.The classification method based on Fazekas(0,1)and(2,3)has better diagnostic efficiency.CT classification is mainly based on the distribution of lesions,and the CT value difference can be used as a reference.