CT和MRI在测量股骨头缺血坏死病灶体积中的应用  

Application of CT and MRI in volumetric t of necrotic lesion in patient with avascular necrosis of the femoral head

作　　者：黄振国[1] 张雪哲[1] 韦宏宇[1] 洪闻[1] 任安[1] 李子荣[1] 史振才[1] 张念非[1] 王武[1] 

机构地区：[1]中日友好医院放射,北京100029

出　　处：《中华放射学杂志》2012年第9期820-824,共5页Chinese Journal of Radiology

摘　　要：目的探讨应用CT和MR图像测量股骨头缺血坏死（ANFH）病灶体积的可行性和准确性，评价坏死病灶体积在预测股骨头塌陷中的价值。方法将18例因ANFH而行髋关节置换术的25个股骨头的CT、MR图像与大体标本剖面做对照分析，使用移水法测量坏死病灶的体积；用计算机软件分别测量CT和MR图像上坏死病灶的体积，应用单因素方差分析对CT、MRI和大体标本所测得的病灶体积行统计学比较。对行CT扫描确定的未发生股骨头塌陷的62例（92髋）ANFH患者随诊2年，观察是否出现股骨头塌陷，根据观察结果分为塌陷组和非塌陷组，应用t检验对2组的坏死病灶占股骨头体积的百分比行统计学比较，并进行ROC分析。结果CT、MRI能准确地显示ANFH大体标本上的坏死区、增生反应区和病灶外正常区。CT、MRI和大体标本所测得的坏死病灶体积分别为（20．5±5．2）、（21．4±4．8）和（20．9±5．2）cm2，三者差异无统计学意义（F=0．185，P=0．831）。随访的92髋中57髋出现股骨头塌陷，塌陷组坏死病灶占整个股骨头体积百分比明显高于非塌陷组[（34．5±9．3）％和（23．4±8．4）％；t=5．749，P=0．000]，ROC曲线下面积为0．808。结论ANFH病灶的体积是影响股骨头塌陷的重要因素，CT和MRI可直观、立体化地显示坏死病灶的形态、位置和准确测量坏死病灶的体积。Objective To investigate the feasibility and accuracy of volumetric measurement of necrotic lesion using CT and MRI, and to assess the value of necrotic lesion volume in predicting collapse of the femoral head in patients with avascular necrosis of the femoral head （ ANFH ）. Methods Comparison among CT, MRI and gross section was performed in 25 femoral heads of 18 patients who underwent total hip replacement for established ANFH. The volume of necrotic lesion was measured using fluid displacement. CT and MRI data were transferred to a computer to calculate the volume of necrotic lesion using software. One way ANOVA was used to compare the volumes of necrotic lesion measured by CT, MRI and gross section. A total of 62 patients （92 hips） who were diagnosed with ANFH but without collapse by CT were followed up 24 months. Student t-test was used to compare the ratio of the volumes of the necrotic lesion and entire femoral head in the hips with and without collapse and ROC curve analysis was carried out. Results CT and MRI coincided with gross section in the necrotic area, proliferative area and extralesional area. The volumes of the necrotic lesion measured by CT, MRI and gross section were （20. 5 ± 5.2） , （21.4 ± 4. 8 ） , （ 20. 9 ± 5.2） cm3 , respectively. There was no significant difference among the necrotic volumes measured by the three methods（F =0. 185, P =0. 831 ）. In fifty-seven out of 92 hips, collapse of the femoral head occurred during the follow-up. The ratio of the volumes of the necrotic lesion and entire femoral head was higher in hips with collapse than in hips without collapse[ （34. 5 ±9. 3）% vs. （23.4 ±8.4）% ;t =5. 749, P = 0. 000 1. The area under the ROC curve was 0. 808. Conclusions The volume of the necrotic lesion plays an important role in the collapse of femoral head in patients with ANFH. Both CT and MRI can identify the shape and location of the necrotic lesion intuitively and stereospecifically and can determine the volume of the necrotic lesion accurat

关 键 词：骨坏死 股骨头 磁共振成像 体层摄影术 X线计算机 

分 类 号：R681.8[医药卫生—骨科学]