双源CT去钙成像评价椎体骨髓水肿  

Vertebral bone marrow edema assessed by dual-source CT noncalcium imaging

作　　者：黄伟[1] 徐益明[1] 卢道延[1] 冯宇[1] 郑纪永 柏根基[1] 张建东[1] 

机构地区：[1]南京医科大学附属淮安第一医院影像中心,江苏淮安223300

出　　处：《医学影像学杂志》2015年第3期386-390,共5页Journal of Medical Imaging

基　　金：淮安市科技支撑规划(HAZ2012015)

摘　　要：目的探讨双源CT去钙成像用于评价外伤性椎体骨髓水肿的临床价值。方法双源CT对42例胸腰椎外伤患者进行双能去钙成像,以MRI图像作为参照标准。由2名医师使用4分法分别对椎体骨髓水肿进行独立评价,使用Kappa检验评价二者间的一致性。由另一名医师在去钙图像上测量椎体骨髓密度(CT值)。使用ROC分析检验主观评分和骨髓密度值,使用t检验比较正常骨髓和水肿骨髓的密度值。结果在138个椎体中,MRI图像发现42个有骨髓水肿,2名医师在去钙图像上分别诊断44个和48个椎体有骨髓水肿,骨髓水肿主观评分的一致性较高(Kappa=0.72),主观评分的曲线下面积(areas under the curve,AUC)、敏感性、特异性、阳性预测值、阴性预测值准确性分别为0.94%和0.91%、87.5%和85.0%、94.7%和85.7%、79.5%和70.8%、94.7%和93.3%、89.9%和85.5%。水肿骨髓的密度值较正常骨髓高(57.6±23.1)HU vs(4.1±28.4)HU,(P<0.01)。骨髓密度的AUC为0.92,截断点为35HU。结论双源CT双能去钙图像可用于检测外伤性椎体骨髓水肿。Objective To evaluate the clinical value of noncalcium images obtained from dual-source CT so as to detect traumatic bone marrow edema in vertebral bodies.Methods Forty-two patients with thoracolumbar spine trauma underwent dual-energy CT（DECT）and MRI scan.Noncalcium images were obtained from DECT images.MRI served as the reference standard.Two independent doctors evaluated bone marrow edema in noncalcium images with a four-point scale.Kappa statistics was used to test inter-observer agreement.The density（CT value）of vertebral bone marrow was obtained by a third observer.The rating scores and CT values were evaluated with ROC curve analysis.T test was used to compare the CT values between normal and edematous bone marrow.Results MRI revealed 42 vertebral bodies with bone marrow edema in 138 vertebral bodies.Two raters detected 44 and 48vertebral bodies with bone marrow edema in noncalcium images,respectively.A good interobserver agreement was demonstrated（kappa=0.72）.Areas under the curve（AUC）,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of subjective ratings were 0.94 and 0.91,87.5% and 85.0%,94.7%and 85.7%,79.5%and 70.8%,94.7%and 93.3%,89.9%and 85.5%for rater1 and 2,respectively.The density of edematous bone marrow was higher than normal bone marrow（57.6±23.1）HU vs（4.1±28.4）HU,P〈0.01）.AUC of CT values was 0.92 with a cut-off value of 35 HU.Conclusion DECT noncalcium images can be used to diagnose traumatic bone marrow edema in vertebral bodies.

关 键 词：体层摄影术 X线计算机 脊柱 骨髓 

分 类 号：R814.42[医药卫生—影像医学与核医学]