双能CT虚拟去钙技术评估骨髓损伤的应用研究  

Study on assessment of bone marrow lesions by dual-energy computed tomography

作　　者：涂宁[1] 文之[1] 李洁兰[1] 杨昊[1] 刘博[2] 唐鹏[3] 周洁[4] 吴光耀[1] 

机构地区：[1]武汉大学中南医院医学影像科,上海201318 [2]西门子中国有限公司,上海201318 [3]武汉大学中南医院检验科,湖北武汉430071 [4]武汉大学中南医院干部保健处,上海201318

出　　处：《中国中西医结合影像学杂志》2016年第1期1-4,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金项目(81171315;81227902)

摘　　要：目的:探讨双能CT(dual energy CT,DECT)在评估骨髓损伤中的应用价值。方法:收集11例病史完整的急性关节损伤患者的MRI和DECT资料。由2位副高级职称的骨关节系统影像科医师(Z和X)采用双盲法对DECT虚拟去钙图像进行评级(4级法),以骨髓水肿作为骨髓损伤的图像指标,参照MRI平扫(含抑脂T2WI)图像,评级一致后纳入统计分析。结果:在11例中,纳入统计253个区域。将1级定为阳性,阅片人Z判定DECT图像对骨髓水肿诊断灵敏度、特异度、阳性预测值、阴性预测值分别为73.3%、93.8%、83.30%、89.2%,准确度为87.8%,K=0.681;阅片人X判定相应各值为67.9%、90.9%、76.8%、86.4%,准确度为83.8%,K=0.607。将1级和2级定为阳性,阅片人Z相应各值为55.7%、90.6%、83.1%、71.0%、74.7%,K=0.475;阅片人X相应各值为52.2%、88.4%、78.9%、68.9%、71.9%,K=0.418。测量各分区CT值,差异均有统计学意义(均P<0.05)。使用CT值绘制ROC曲线,若将1级图像定为阳性,则胫骨上段及股骨下段AUC值分别为0.883和0.941。若将1级和2级图像定为阳性,则胫骨上段及股骨下段AUC值分别为0.786和0.943。结论:DECT虚拟去钙技术可去除骨中的钙质,直观显示骨髓水肿,提示骨髓损伤;CT值可作为骨髓水肿程度的定量参数。Objective：To study the dual-energy CT （DECT） value in estimation of bone marrow lesions. Methods：ll patients withacute joint injuries were gathered,who were performed both magnetic resonance imaging （including T2WI with fat suppres sion sequence） and DECT scan. Two senior osteoarticular radiology doctors （Z and X）analyzed DECT images with virtual non-calcium in double-blind way （according to 4 grade criterion）,and compared with MRI images,using bone marrow edema as the image performance of bone marrow lesions. Statistical analysis included in the agreement cases. Results：In l l patients,total 253 areas were included in the statistics. As grade I was positive,the sensitivity,specificity,positive predictive value,negative predictive value from doctor Z defined the bone marrow edema in the DECT images with virtual non-calcium were 73.3%, 93.8% ,83.30% ,89.2% respectively and accuracy was 87.8% ,K=0.681. From doctor X,those were respectively 67.9% ,90.9%, 76.8%,86.4% and accuracy was 83.8%,K=0.607. As grade I and II were positive,from doctor Z,those were respectively 55.7%, 90.6%, 83.1%, 71.0%, and accuracy was 74.7%, K =0.475. From doctor X, those were respectively 52.2%, 88.4%, 78.9%, 68.9%, 71.9% ,respectively,K=0.418. Analysis of CT values showed great significance between edema group and non-edema group （P〈0.001）. With ROC curve drawn,as I grade was positive,tibia partition AUC value was 0.883;femur partition AUC value was 0.941. As grade I and II were positive,the tibia partition AUC value of 0.786;femur partition AUC value of 0.943. Conclusion：DECT with virtual non-calcium can remove bone calcium,display macroscopic bone marrow,and indicate bone marrow injury. CT value may be used as a quantitative parameter of bone marrow edema.

关 键 词：双能CT 虚拟去钙 骨髓水肿 磁共振成像 

分 类 号：R651.2[医药卫生—外科学] R816.1[医药卫生—临床医学]