改良CT窗技术在鉴别新鲜和陈旧骨质疏松性椎体压缩骨折中的应用价值

Application value of modified CT window technique in distinguishing fresh and old osteoporotic vertebral compression fractures

目的 评估改良CT窗技术鉴别诊断新鲜与陈旧骨质疏松性椎体压缩骨折的临床应用价值。方法 纳入自2018-01—2021-04行椎体强化手术治疗的129例骨质疏松性椎体压缩骨折,MRI检查确诊新鲜骨折椎体153个,其中胸椎72个,腰椎81个;确诊陈旧性骨折椎体266个,其中胸椎118个,腰椎148个。采用常规CT窗(W:1 500,C:500)与改良CT窗(W:400,C:214)技术进行双盲回顾性阅片分析,最后将两种窗技术的诊断结果与MRI诊断进行比较分析。结果 改良CT窗技术均可显示常规CT窗技术确诊的105个新鲜骨质疏松性椎体压缩骨折,而且改良CT窗组阅片时间明显短于常规CT窗组,差异有统计学意义(t=50.423,P<0.001)。改良CT窗技术诊断新鲜骨质疏松性椎体压缩骨折的敏感性(χ^(2)=18.466,P<0.001)、特异性(χ^(2)=39.218,P<0.001)、准确性(χ^(2)=60.123,P<0.001)均高于常规CT窗技术,差异有统计学意义(P<0.05)。结论 基于新鲜骨质疏松性椎体压缩骨折后的骨髓水肿会导致伤椎松质密度异常增高的原理,在PACS系统中预设改良CT窗技术可凸显其鉴别细微密度差异的能力,在不增加检查时间、检查费用并缩短阅片时间的同时显著提高鉴别新鲜和陈旧骨质疏松性椎体压缩骨折的敏感性和准确性,适宜在未配置MRI的基层医疗机构中应用。

Objective To evaluate the clinical application value of modified CT window technique in the dfferential diagnosis of fresh and old osteoporotic vertebral compression fractures.Methods A total of 129 patients with osteoporotic vertebral com-pression fractures who underwent intensive vertebral body surgery from January 2018 to April 2021 were included.MRI con-firmed 153 fresh fractured vertebrae,including 72 thoracic vertebrae and 81 lumbar vertebrae.Two hundred and sixty-six ver-tebral bodies with old fracture were confirmed,including 118 thoracic and 148 lumbar vertebrae.Conventional CT window(W:1500,C:500)and modified CT window(W:400,C:214)were used for double-blind retrospective analysis.Finally,the diag-nostic results of the two window techniques were compared with MRI diagnosis.Results The modified CT window technique could display 105 fresh osteoporotic vertebral compression fractures confirmed by conventional CT window technique,and the film reading time of the modified CT window group was significantly shorter than that of the conventional CT window group,with statistical significance(t=50.423,P<0.001).The sensitivity(x^(2)=18.466,P<0.001),specificity(x^(2)=39.218,P<0.001)and accuracy(x^(2)=60.123,P<0.001)of the modified CT window technique in the diagnosis of fresh osteoporotic vertebral compression fracture were higher than those of conventional CT window technique,and the difference was statistically significant(P<0.05).Conclusion Based on the theory that bone marrow edema after fresh osteoporotic vertebral compression fractures can lead to abnormal increase in cancellous density in the injured vertebral body,the modified CT window technology in the PACS system can enhance its visual ability to identify subtle density differences.It can significantly improve the sensitivity and accuracy of distinguishing fresh and old osteoporotic vertebral compression fractures without increasing examination time,examination cost and shorteni film reading time,and is suitable for popularization and application in primary medical institutions without MRI.