腰椎松质骨CT值在绝经后女性骨质疏松性骨折诊断的应用价值

Application value of lumbar spinal cancellous bone CT value in diagnosis of osteoporosis fractures in postmenopausal women

目的探讨基于腰椎CT检查所得图像中腰椎松质骨定量CT值在绝经后女性骨质疏松性骨折的诊断价值。方法回顾性分析2021年1月—2023年1月在本院行腰椎CT检查与双能骨密度仪(DXA)检查的绝经后女性患者47例的临床资料,其中20例为60岁以上伴有腰椎骨质疏松性骨折的女性,设为骨折组,27例为年龄、BMI相匹配的无骨折女性患者设为对照组。通过ROI曲线获得腰1椎体松质骨的CT值,双能X线骨密度仪获得腰1椎体的骨密度T值(T-score),比较两组腰1椎体松质骨CT值与T-score值的差异并分析其相关性,采用受试者工作曲线(ROC曲线)分析腰椎松质骨CT值及骨密度仪T值对绝经后女性骨质疏松性骨折的诊断价值。结果骨折组腰1松质骨CT值及BMD-T值均显著低于对照组,差异均具有统计学意义(P<0.001)。两组患者腰1椎体松质骨与BMD-T值呈正相关(r=0.874、0.463,P<0.05)。腰1椎体松质骨CT值及BMD-T值骨质疏松性骨折的诊断价值ROC曲线分析获得腰1椎体松质骨CT值诊断骨质疏松性骨折的AUC为0.967(95%置信区间:0.816~1.118,P=0.008),cut-off value=80 Hu,敏感度0.876,特异度0.998;BMD-T值诊断骨质疏松性骨折的AUC为0.882(95%置信区间:0.748~0.941,P=0.007),cut-off value=-2.3,敏感度0.884,特异度0.912。结论腰椎松质骨CT值具有鉴别诊断绝经后女性骨质疏松性骨折的能力,较DXA方法测量敏感性高。

Objective To explore the diagnostic value of lumbar cancellous bone quantitative CT based on CT images in postmenopausal women with osteoporotic fractures.Methods A total of 47 postmenopausal women who underwent lumbar CT examination and dual-energy bone densimeter(DXA)examination in our hospital from January 2021 to January 2023 were selected,and the clinical data were analyzed retrospectively,among them 20 female patients over 60 years old with osteopretic bone fractures were selected as the fracture group,and 27 female patients with no fractures matched in age and BMI were selected as the control group.The ROI curve was outlined to obtain the CT value of L1 vertebral cancellous bone,and the bone density T-score of L1 vertebral bone was obtained by dual-energy X-ray bone densitometry.The difference in CT value and T-score value of L1 vertebral cancellous bone between the two groups was compared and the correlation was analyzed.Receiver operating curve(ROC curve)was used to analyze the diagnostic value of lumbar cancellous bone CT value and T value of bone densitometer in postmenopausal women with osteoporotic fractures.Results The CT and BMD-T values of L1 cancellous bone in the fracture group were significantly lower than those in the control group,with statistical significance(P<0.001).The cancellous bone of L1 vertebral body was positively correlated with BMD-T values in both groups(r=0.874,0.463,P<0.05).The diagnostic value of CT value and BMD-T value of lumbar vertebral cancellous bone for osteoporosis fracture was analyzed by ROC curve.The AUC of lumbar vertebral cancellous bone CT value for diagnosing osteoporosis fracture was 0.967(95% confidence interval:0.816~1.118,P=0.008),cut-off value was 80Hu,the sensitivity was 0.876,and the specificity was 0.998.The AUC of BMD-T value for diagnosing osteoporotic fractures was 0.882(95% confidence interval:0.748~0.941,P=0.007),cut-off value was-2.3,the sensitivity was 0.884,and the specificity was 0.912.Conclusions Lumbar cancellous bone CT value presents the ability of diagnosing osteoporotic fractures in postmenopausal women,and the determine sensitivity of the CT value is higher compared to that of DXA method.