绝经后妇女腰椎骨密度容积性定量CT测量研究  

Evaluation of bone mineral density measurement of lumbar vertebrae by volumetric quantitative CT in postmenopausal women

作　　者：蔡跃增[1] 王立英[1] 吴胜勇[2] 兰静[1] 李景学[1] 

机构地区：[1]天津医科大学总医院放射科,300052 [2]天津市第一中心医院放射科

出　　处：《中华放射学杂志》2009年第2期119-125,共7页Chinese Journal of Radiology

摘　　要：目的应用容积性定量CT（vQCT）技术和双能X线吸收测量（DXA）仪测量绝经后妇女腰椎容积性骨密度（BMD），评价2种检查方法区分骨质疏松伴椎体骨折与骨质疏松不伴骨折的差异。方法选取绝经后妇女118名[平均年龄（62．1±7．0）岁]，按照所行胸腰椎X线平片检查结果及腰椎DXA测量的参数[前后位BMD（AP-SPINE）]值分组，〉均值-1个标准差（x^--1s）为正常组、x^--1s～x^--2s为骨量减少组、〈x^--2s不伴椎体骨折为骨质疏松组，〈x^--2s且有椎体骨折者为骨质疏松伴骨折组，共4组。应用MSCT对L2～4椎体行横断面扫描和容积扫描，用配套定量CT（QCT）软件经传统二维法测量椎体骨小梁BMD（2D—TRAB），另将容积扫描数据传输到ADW4．2工作站行容积再现及MPR处理，利用直方图功能测量三维（3D）容积性BMD，包括整体骨BMD（3D—INTGL）、皮质骨BMD（3D—CORT）、小梁骨BMD（3D—TRAB）。测量CT值分别为60HU、80HU、100HU、120～400HU的骨小梁容积比例，作为表观骨容量／总容量（AppBV／TV％）。对所获数据进行协方差分析及相关分析，计算决定系数（R^2）值。结果2D-TRAB、3D—INTGL、3D—TRAB、App60BV／TV％、App80BV／TV％、App100BV／TV％、App120BV／TV％各参数在骨质疏松伴骨折组分别为（48．8±24．9）mg／cm^3、（94．4±20．2）mg／cm^3、（59．3±28．0）mg／cm^3、（56．1±22．8）％、（43．2±22．2）％、（31．3±19．4）％、（21．3±15．6）％，明显低于骨质疏松组[分别为（74．9±21．0）mg／cm^3、（115．0±14．3）mg／cm^3、（82．0±23．7）mg／cm^3、（75．2±16．8）％、（62．6±20．5）％、（48．8±21．7）％、（35．5±20．1）％]、骨量减少组[分别为（89．2±23．8）mg／cm^3、（126．9±12．9）mg／cm^3、（97．8±25．2）mg／cm^3、（85．1±13．7）％、（75．1±17．9）％、（62．8±20．9）％、（49．2±21．9）％]�Objective To demonstrate the validity of volumetric QCT and dual energy X-ray absorptiometry（DXA） in bone mineral density （BMD） measurement and compare the difference in discriminating osteoporotic postmenopausal women with and without vertebral fracture. Methods One hundred and eighteen postmenopausal women [ mean age （ 62. 1 ± 7. 0 ） years ] who received thoracolumbar radiographic examination were enrolled and divided into four groups （ normal, osteopenia, osteoporotic and osteoporotic fractured group） also based on their BMD value of lumbar vertebra（AP-SPINE） measured by DXA： 〉x^- -1s,x^-- 1s-x^- -2s, 〈x^--2s without and with osteoporotic vertebral fracture. The second to four lumbar vertebrae were performed axial scan （for conventional 2D trabecular BMD measurement, 2D-TRAB by corresponding QCT software） and volumetric scan using MSCT. The volumetric data were transferred to the workstation ADW4. 2 for VR and MPR processing, and volumetric BMD were obtained based on the histogram of CT value, including integral BMD （3D-INTGL）, cortical BMD （3D-CORT） and trabecular BMD （3D-TRAB）, with the unit of mg/cm^3. Apparent bone volume to total volume ratio （App BV/TV% ） was calculated on the base of trabecular bone whose CT values were among 60 HU, 80 HU, 100 HU, 120- 400 HU, respectively. Analysis of covariance （ANCOVA） and calculation of coefficient of determination （R^2） were performed for each parameter among the 4 groups. Results The values of 2D-TRAB, 3D- INT, 3D-TRAB, App60 BV/TV%, App80 BV/TV%, App100 BV/TV% and App120 BV/TV% in osteoporotic fractured group [（48.8 ±24.9） mg/cm^3, （94.4 ±20.2） mg/cm^3, （59.3 ±28.0） mg/cm^3, （56. 1 ± 22. 8） %, （43.2 ± 22. 2） %, （31.3 ± 19. 4） %, （21.3 ± 15.6） % ] were significantly lower than those in osteoporotic group [ （74.9 ± 21.0） mg/cm^3, （ 115.0 ± 14. 3 ） mg/cm^3 , （ 82. 0 ± 23.7） mg/cm^3, （75.2 ± 16.8）%, （62.6 ±20.5）%, （48.8 ±21.7）%, （35.5 ±20.1）%],

关 键 词：骨质疏松 绝经后 骨密度 体层摄影术 X线计算机 腰椎 

分 类 号：R686[医药卫生—骨科学]