腰椎体松质骨CT值在老年女性骨质疏松性骨折诊断中的价值  

The value of cancellous bone CT attenuation of lumbar vertebral in diagnosis of osteoporotic fracture in elderly women

作　　者：王冬梅[1] 朱秀芬[2] 牡丹[1] 杨献峰[1] 常莹[1] 周晋 李宝新 WANG Dong mei;ZHU Xiu fen;MU Dan;YANG Xian feng;CHANG Ying;ZHOU Jin;LI Bao xin(Department of Radiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Institute of Orthopaedic Diseases,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Radiology,Gaochun People’s Hospital,Nanjing 211300,China)

机构地区：[1]南京大学医学院附属鼓楼医院放射科,江苏省南京市210008 [2]南京大学医学院附属鼓楼医院骨科骨病研究室,江苏省南京市210008 [3]南京市高淳人民医院放射科,江苏省南京市211300

出　　处：《实用老年医学》2020年第4期331-334,338,共5页Practical Geriatrics

基　　金：南京市医学科技发展一般项目(YKK17099);国家自然科学青年基金(81601539)。

摘　　要：目的探讨基于常规腹部CT检查获得的腰椎体松质骨CT值在老年女性骨质疏松性骨折诊断中的价值。方法前瞻性纳入17例在我院行常规腹部CT平扫的60岁以上伴有骨质疏松性骨折的女性病人为骨折组,另纳入21例年龄、BMI相匹配的无骨折女性病人作为对照组。采用单ROI法获得病人L1椎体松质骨的CT值,双能X线骨密度仪(DXA)获得L1椎体的骨密度T值。比较2组L1椎体CT值和骨密度T值的差异并分析其相关性,采用ROC曲线分析松质骨CT值及骨密度T值对骨质疏松性骨折的诊断价值。结果 2组病人的L1椎体CT值与骨密度T值均呈正相关(r=0. 879、0. 452,P <0. 05)。骨折组的L1椎体CT值和骨密度T值均明显低于对照组,差异有统计学意义(P <0. 001)。L1椎体松质骨CT值诊断骨质疏松性骨折的AUC为0. 936(95%CI:0. 806~0. 989,P <0. 001),cut-off值为77 Hu,敏感度为0. 824,特异度为1. 000;骨密度T值诊断骨质疏松性骨折的AUC为0. 884(95%CI:0. 738~0. 965,P <0. 001),cut-off值为-2. 2,敏感度为0. 882,特异度为0. 905。两种方法对骨质疏松性骨折病人的鉴别诊断能力差异无统计学意义(P> 0. 05)。结论腰椎体松质骨CT值可用于鉴别诊断老年女性骨质疏松性骨折病人,具有较高的敏感性。Objective To evaluate the value of cancellous bone CT attenuation measurement of lumbar vertebral based on routine abdominal CT examination in diagnosis of osteoporotic fracture in the elderly women. Methods Seventeen female patients aged over 60 years old with osteoporotic fracture who received conventional abdominal CT plain scan in our hospital were enrolled as the fracture group,and 21 female patients without fracture matched by age and body mass index were included as the control group. CT attenuation value of cancellous bone at L1 vertebral was obtained by a single ROI measurement. T-score for bone mineral density of L1 vertebral was obtained by dual-energy X-ray absorptiometry(DXA). The differences in CT attenuation value and T-score of L1 vertebral between the two groups were compared,and the correlations between CT attenuation value and T-score in both groups were analyzed. The diagnostic values of CT attenuation value of cancellous bone and T-score for osteoporotic fracture were assessed by receiver operating characteristic(ROC)curve. Results The CT attenuation values of L1 vertebral cancellous bone were significantly correlated with T-scores in both groups(r=0. 879,0. 452,P < 0. 05). The CT attenuation value and T-score of L1 vertebral in the patients with fracture were significantly lower than those without fracture(P < 0. 001). The area under curve(AUC) of CT attenuation value of cancellous bone at L1 vertebral for diagnosis of osteoporotic fracture was 0. 936(95% CI:0. 806-0. 989,P < 0. 001),the cut-off value was 77 Hu,the sensitivity was 0. 824,and the specificity was 1. 000. The AUC of T-score for diagnosis of osteoporotic fracture was 0. 884(95% CI:0. 738-0. 965,P < 0. 001),the cut-off value was -2. 2,the sensitivity was 0. 882,and the specificity was 0. 905. There was no significant difference between the two methods in diagnosing osteoporotic fracture(P > 0. 05). Conclusions Cancellous bone CT attenuation value of lumbar vertebral has high sensitivity,which can be used to differentiate and diag

关 键 词：骨质疏松性骨折 双能X线骨密度仪 计算机断层成像 CT衰减值 

分 类 号：R814.42[医药卫生—影像医学与核医学]