CT、MRI对椎体压缩骨折患者良恶性的鉴别价值及其影像学征象研究

The Value of CT and MRI in Differentiating Benign from Malignant Vertebral Compression Fractures and the Study of Their Imaging Features

目的探讨电子计算机断层扫描(CT)、磁共振成像(MRI)对椎体压缩骨折患者良恶性的鉴别价值及其影像学征象。方法回顾性选取150例2020年1月~2022年10月我院收治的椎体压缩骨折患者作为研究对象,均行病理、CT及MRI检查。以病理结果为金标准,统计CT、MRI检查对椎体压缩骨折的检出情况,采用受试者工作特征曲线(ROC)分析CT、MRI检查对恶性椎体压缩骨折的诊断价值,并分析椎体压缩骨折患者的CT、MRI影像征象特点。结果病理结果显示,150例椎体压缩骨折患者中有96例恶性,有54例良性。CT检查结果显示,恶性87例,良性42例,误诊12例,漏诊9例。MRI检查结果显示,恶性75例,良性50例,误诊4例,漏诊21例。ROC曲线分析结果显示,CT、MRI检查诊断恶性椎体压缩骨折的曲线下面积(AUC)值分别为0.842、0.854,二者比较差异无统计学意义(P>0.05);CT检查诊断恶性椎体压缩骨折的敏感度为90.63%,高于MRI检查的78.13%(P<0.05),特异度为77.78%,低于MRI检查的92.59%(P<0.05)。椎体压缩骨折患者的CT、MRI影像征象均以辐条车轮状高密度征、椎旁软组织影、骨质破坏、骨膜反应、充气征、双边征为主,其中良性椎体压缩骨折患者辐条车轮状高密度征的出现率为74.07%,高于恶性椎体压缩骨折患者的5.21%(P<0.05)。结论CT、MRI对椎体压缩骨折良恶性的鉴别价值均较高,其中CT检查诊断恶性椎体压缩骨折的敏感度较高,而MRI检查诊断恶性椎体压缩骨折的特异度较高,另辐条车轮状高密度征可作为鉴别椎体压缩骨折良恶性的关键征象,临床可结合椎体压缩骨折患者的症状表现及CT、MRI影像特点对其进行诊断,以提高其诊断率。

Objective To investigate the value of computed tomography(CT)and magnetic resonance imaging(MRI)in differentiating benign from malignant vertebral compression fractures and the study of their imaging features.Methods A total of 150 patients with vertebral compression fracture admitted to our hospital from January 2020 to October 2022 were retrospectively selected as the research object,and all patients were examined by pathology,CT and MRI.The diagnostic value of CT and MRI in malignant vertebral compression fracture was analyzed by receiver operating characteristic curve(ROC).The CT and MRI imaging features of the patients with vertebral compression fracture were analyzed.Results Pathological results showed that 96 of 150 patients with vertebral compression fractures were malignant and 54 were benign.The results of CT showed that 87 cases were malignant,42 cases were benign,12 cases were misdiagnosed and 9 cases were missed.The results of MRI showed that 75 cases were malignant,50 cases were benign,4 cases were misdiagnosed and 21 cases were missed.ROC curve analysis showed that the area under the curve(AUC)values of CT and MRI in the diagnosis of malignant vertebral compression fractures were 0.842 and 0.854 respectively,and there was no significant difference between them(P>0.05).The sensitivity of CT in the diagnosis of malignant vertebral compression fractures was 90.63%,higher than that of MRI(78.13%)(P<0.05),and the specificity was 77.78%,lower than that of MRI(92.59%)(P<0.05).The main CT and MRI signs of vertebral compression fracture were spoke wheel sign,paravertebral soft tissue shadow,bone destruction,periosteal reaction,air inflation sign and bilateral sign.The occurrence rate of spoke wheel sign in benign vertebral compression fracture was 74.07%,which was higher than that in malignant vertebral compression fracture(5.21%,P<0.05).Conclusion CT and MRI had high value in differentiating benign and malignant vertebral compression fractures.The sensitivity of CT examination in the diagnosis of malignant vertebral compression fracture was higher,while the specificity of MRI examination in the diagnosis of malignant vertebral compression fracture was higher.Spoke wheel high density sign could be used as a key sign in differentiating benign and malignant vertebral compression fractures.Clinical diagnosis can be made by combining the symptoms of patients with vertebral compression fractures and the characteristics of CT and MRI imaging features to improve the diagnostic rate.