双能CT检测椎体压缩性骨折患者骨髓水肿的视觉和定量分析

Vision and quantitative analysis of bone marrow edema in patients with vertebral compression fractures by dual energy CT

目的:评估双能CT虚拟去钙(VNCa)技术对椎体压缩性骨折患者骨髓水肿的诊断性能。方法:2015年10月至2016年5月,筛选我院22名椎体压缩性骨折患者,所有患者都进行了双能CT检测,且接受双能CT(90 kV和150 kV带锡滤波器)和3-T磁共振(MR)成像。两名阅片者通过使用彩色编码图在视觉上评估所有椎体(n=163)是否存在VNCa图像上的异常骨髓衰减,并对VNCa图像上的CT值进行定量分析,即以MR图像作为参考标准对CT值进行受试者特性分析。结果:所有患者成功地进行了双能CT和MRI检查。在22名患者中,总共有163个椎骨(120个胸椎和43个腰椎)被列入评估,除非图像质量达不到诊断要求,否则所有的椎骨都不能被排除在评估之外。包括6例患者从胸1到胸12段椎体共52个椎骨,5例患者从胸9到腰5段的45个椎骨,5例患者从胸10到腰5段的40个椎骨,2例患者从胸11到腰5段的2个椎骨,4例病人从胸12到腰5段的24个椎骨。MRI显示共有10例患者的27个椎骨(16. 6%)骨髓水肿及12个患者的136个椎骨(83. 4%)为正常信号。双能CT发现了9例病人的24个椎骨(14. 7%)为骨髓水肿和13例患者的139个椎骨(85. 3%)为正常信号。结论:双能VNCa图像的视觉和定量分析能够显示对椎体压缩性骨折创伤性骨髓水肿的良好诊断。

Objective:To evaluate the diagnostic performance of dual-energy CT virtual calcium removal(VNCa)technique for bone marrow edema in patients with vertebral compression fractures.Methods:During the period from October 2015 to May 2016,22 patients with spinal fractures were diagnosed in our hospital.All patients underwent dual-energy CT and MRI.Our study excluded two patients with non-traumatic pathological fractures,which were caused by biologically confirmed tumor infiltration.All patients underwent dual-energy CT(90 kV and 150 kV tin-loaded filters)and 3-T magnetic resonance(MR)imaging.Two readers visually evaluated whether all vertebral bodies(n=163)had abnormal bone marrow attenuation on the VNCa image using a color-coded map and quantified the number of CTs on the VNCa image.The MR image wass used as a reference standard.Subject characterization was performed on CT numbers to calculate cutoff values.Results:All patients successfully underwent dual-energy CT and MRI.Of the 22 patients,a total of 163 vertebrae(120 thoracic vertebrae and 43 lumbar vertebrae)were included in the assessment,and all vertebrae could not be excluded except non-diagnostic image quality.The vertebrae included 52 vertebrae of 6 cases from level T1 to T12,45 vertebrae of 5 cases from T9 to L5,40 vertebrae of 5 cases from T10 to L5,2 vertebrae of2 cases from level T11 to L5,and 24 vertebrae in 4 cases from T12 to L5.According to the vertebra problem scoring system,70 vertebral bodies were classified as grade 0,53 vertebral bodies as grade1,20 vertebral bodies as grade 2 and 20 vertebral bodies were in grade 3.MRI showed edema in 27 vertebrae(16.6%)of 10 patients and 136 vertebrae(83.4%)with normal signal pattern in 12 patients.Dual energy CT found edema in 24 vertebrae(14.7%)of 9 patients and 139 vertebrae(85.3%)of 13 patients without bone marrow edema.Conclusion:Visual and quantitative analysis of dual-energy VNCa images can provide a good diagnosis of traumatic bone marrow edema in vertebral compression fractures.