骨质疏松老年妇女股骨近端16层螺旋CT的定量研究  

Quantitative study on proximal femoral of osteoporotic elderly women with 16-slice CT

作　　者：吴胜勇[1] 祁吉[1] 王斌[1] 温连庆[1] 李景学[1] 

机构地区：[1]天津医科大学附属第一中心医院放射科,天津300192

出　　处：《医学影像学杂志》2005年第10期885-889,共5页Journal of Medical Imaging

摘　　要：目的:通过16层螺旋CT中vQCT技术对骨质疏松性椎体骨折及无骨折老年妇女股骨近端进行多个容积性BMD指标的测量,比较两组妇女股骨近端小梁骨、皮质骨和整体骨容积性BMD的差异,评价骨质疏松性椎体骨折对股骨近端骨密度的影响程度.方法:将26例骨质疏松性椎体骨折病人归为第一组,年龄与第一组匹配的无脊椎骨折的30例骨质疏松老年妇女归为第二组.应用GE公司LightSpeed 16型螺旋CT对56例病人股骨近端行容积扫描,行薄层重建图像,层厚1.25mm,在3D-VR影像中沿左股骨颈长轴方向确定数个与之相垂直的平面作为固定的解剖学标记,选取左侧股骨近端整体骨、股骨颈及粗隆间测量兴趣体积(VOI),经Sun ADW4.0计算机工作站直方图(histogram)功能测量左侧股骨颈3D小梁骨BMD(N-TRAB)、3D整体骨BMD(N-INTGL),左侧粗隆间3D小梁骨BMD(T-TRAB)、3D整体骨BMD(T-INTGL),左侧股骨近端 3D小梁骨BMD(FEM-TRAB)、3D皮质骨BMD(FEM-CORT)和3D整体骨BMD(FEM-INTGL)值.所有病人双能X线吸收仪(GE-Lunar公司DPX型)测量指标为左侧股骨颈(NECK)及粗隆间BMD(TROCH).比较两组老年妇女间9项BMD指标差异采用协方差分析.结果:两组老年妇女间股骨近端容积性BMD数值除FEM-CORT一项指标外其差异存在统计学意义,在调节年龄和体型因素后仍然在差异,第一组老年妇女比第二组容积性BMD值下降程度为14%～18%,且vQCT技术中股骨近端容积性BMD的测量精度较高;两组间DXA指标中BMD值的差异在调节年龄和体型因素后无统计学意义:在TTRAB指标中第一组老年妇女比第二组的BMD值下降幅度达17.7%,高于N-TRAB中BMD值的下降度14.3%.结论:首次应用16层螺旋CT进行股骨近端vQCT测量,证实此项技术比DXA更全面地反应骨质疏松性椎体骨折比无骨折老年妇女股骨近端骨密度的下降状况,且不受体型大小和骨形态变化因素的影响.Objective：To determine the differences of trabecula, cortical and intergral bone mineral density （BMD） measurements obtained in the proximal femur by 16-slice CT scans and vQCT technique in osteoporotic elderly women with and without fracture, and to asseas the effect of vertebral fracture status on volumetric BMD of proximal femur. Methods： 16-slice CT scans of proximal femur （GE LightSpeedl6,pitch 1.375： 1 ） were acquired in a cohort of 56 DXA （GE-Lunar DPX） diagnosed osteoporotic women, of whom 26 had radiographically confirmed atraumatic vertebral fractures belonged group one and 30 were nonfractured control subjects belonging group two. Reconstructed image slice-thickness was 1 .25mm. The three-dimensional images of left hip proximal femur were processed using ADW 4.0 Workstation） to make measurements of left proximal femurs, including femoral neck trabecular/integral （N-TRAB, N-INTGL）, trochanteric trabecular/integral （ T-TRAB , T-INTGL）, and total femur trabecular/cortical and integral （ FEM-TRAB, FEM-CORT and FEM-INTGL） volumetric BMD. BMD measurements with DXA were also obtained in left femoral neck （NECK） and trochanteric （TROCH） region. The differences of all 9 indexes between the subjects with and without vertebral fractures were analysed by ANOVA. Results： In all the volumetric BMD indexes except the index of FEM-CORT, there were statistically significant differences （the decrements 14%-18% ） between group one and group two, even after the correction of age, height and weight, while values in DXA measurements had no statistically significant differences after the correction of age, height and weight. The decrement of T-TRAB between group one and group two was 17.7%, more than of N-TRAB. Conclusion： vQCT measurements by 16-slice CT scan of proximal femur can be confirmed as a better technique in assessing the changes of proximal femoral BMD than DXA between osteoporotic elderly women with and without vertebral fracture independent on BMI and geometry of

关 键 词：骨质疏松 骨密度 体层摄影术 X线计算机 容积性QCT 双能X线吸收仪 

分 类 号：R592[医药卫生—老年医学] R814.42[医药卫生—内科学]