双源双能量CT视觉评估和定量分析对椎体骨髓水肿的诊断价值

Analysis of diagnostic efficacy of dual-source dual-energy CT in visual evaluation and quantitative analysis of vertebral bone marrow edema

目的:探讨双源双能量CT(DECT)虚拟去钙(VNCa)技术中视觉评估(VE)和定量分析对椎体骨髓水肿(BME)的诊断价值。方法:回顾性分析2020年8月至2022年4月60例胸腰椎新鲜骨折(观察组)及60例陈旧性骨折(对照组)患者的临床及影像资料。以MRI结果为参考,将DECT的VE结果与之对比,分析1.75和1.45斜率对BME的诊断效能;比较新鲜与陈旧性骨折的定量参数(vCT、rCT、CaD、FF、ΔvCT)差异并绘制ROC曲线,采用Z检验比较曲线下面积(AUC)差异;进一步评估VE与定量参数联合的诊断效能。结果:1.75与1.45斜率VE诊断新鲜与陈旧性骨折的敏感度分别为88.0%、69.3%,特异度分别为93.8%、87.5%,1.75斜率的诊断符合率为90.3%,高于1.45斜率的78.7%,差异有统计学意义(χ^(2)=7.987,P<0.05)。椎体新鲜与陈旧性骨折的vCT、rCT、FF、ΔvCT值差异均有统计学意义(P均<0.05),其中ΔvCT值的AUC值最高(0.96),诊断阈值为28.5 HU时,敏感度、特异度分别为89.3%、96.2%,与其他定量参数差异均有统计学意义(P均<0.05)。VE的Youden指数(0.82)高于vCT(0.62)而略低于ΔvCT(0.86);VE与定量参数联合的AUC值(0.95)低于ΔvCT。结论:VNCa技术VE和定量分析对椎体骨髓水肿均具有较高的诊断效能,两者联合的诊断价值不高。

Objective:The purpose of this study was to explore the value of the virtual noncalcium(VNCa)technique of dual-source dual-energy CT(DECT)in visual evaluation(VE)and quantitative analysis of vertebral bone marrow edema(BME).Methods:The data of 60 cases with fresh thoracolumbar fractures(observation group)and 60 cases with old fractures(control group)in our hospital from August 2020 to April 2022 were retrospectively analyzed.Using MRI results as a reference,the diagnostic efficacy of 1.75 and 1.45 slope to identify BME was analyzed by comparing the VE results of DECT with those of MRI;quantitative parameters(vCT,rCT,CaD,FF,ΔvCT)of fresh and old fractures were compared,and ROC curves were drawn,and AUC values were compared by Z test.The effect of VE combined with quantification was further evaluated.Results:The sensitivity and specificity of 1.75 and 1.45 slope VE were 88.0%,93.8%,69.3%,and 87.5%,respectively.The diagnostic accuracy of 1.75 slope was 90.3%,which was higher than that of 1.45 slope at 78.7%,and the difference was statistically significant(χ2=7.987,P<0.05);the values of vCT,rCT,FF andΔvCT of fresh vertebral and old vertebral fractures were statistically significant,among which the AUC ofΔvCT was the highest(0.96),the diagnostic value was 28.5HU,the sensitivity and specificity were 89.3%and 96.2%respectively,and the differences were statistically significant(P<0.05);the Youden index of VE was higher than vCT but slightly lower thanΔvCT(0.82 vs 0.62,0.86);the AUC value of VE combined with quantitative parameters(0.95)was lower thanΔvCT.Conclusion:VE and quantitative analysis of the VNCa technique have high diagnostic efficacy,but the combined diagnostic value of the VNCa technique is not high.