双能CT虚拟去钙技术诊断腕关节类风湿性关节炎骨髓水肿的价值  

Dual-Energy CT Virtual Noncalcium Technique in Diagnosing Bone Marrow Edema of Wrist in Patients with Rheumatoid Arthritis

作　　者：徐国栋 王艳[1] 丁宇晨 陈映池 李星灿 贾中正[1] XU Guodong;WANG Yan;DING Yuchen;CHEN Yingchi;LI Xingcan;JIA Zhongzheng(Department of Medical Imaging,the Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学附属医院医学影像科,江苏南通226001

出　　处：《中国医学影像学杂志》2023年第1期72-76,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨双能CT虚拟去钙技术诊断腕关节类风湿性关节炎骨髓水肿的价值。资料与方法前瞻性选取2021年1月—2022年5月南通大学附属医院30例类风湿性关节炎活动期腕关节受累患者,进行双能CT和MRI检查,对双能CT图像进行功能重建获得虚拟去钙彩色编码图像,分别测量骨髓水肿与正常骨髓的CT值。比较虚拟去钙图像与MRI诊断骨髓水肿的差异,比较常规CT图像与虚拟去钙图像CT值诊断骨髓水肿和正常骨髓的差异,评价虚拟去钙图像CT值对骨髓水肿的诊断效能;评估骨髓水肿的虚拟去钙图像评分、MRI评分与类风湿性关节炎活动度的相关性。结果虚拟去钙图像和MRI诊断骨髓水肿差异无统计学意义(P=0.073)。在虚拟去钙图像中,骨髓水肿的CT值大于正常骨髓(Z=-18.619,P<0.001),曲线下面积为0.939,当截断值取-54.8 Hu时,诊断敏感度、特异度及准确度分别为91.9%、93.4%及92.9%。在常规CT图像中,骨髓水肿与正常骨髓的CT值差异无统计学意义(Z=-1.831,P=0.067)。骨髓水肿的虚拟去钙图像评分与MRI评分(r=0.947,P<0.001)和类风湿性关节炎活动度(r=0.370,P<0.05)呈正相关。结论双能CT虚拟去钙技术不仅可以诊断类风湿性关节炎活动期患者腕关节骨髓水肿,而且有助于评估类风湿性关节炎的活动度。Purpose To explore the value of dual-energy CT virtual noncalcium technique in diagnosing bone marrow edema of wrist in patients with rheumatoid arthritis.Materials and Methods Thirty patients with wrist involvement in active rheumatoid arthritis in the Affiliated Hospital of Nantong University from January 2021 to May 2022 were prospectively underwent dual-energy CT and MRI.Dualenergy CT images were functionally reconstructed to obtain virtual noncalcium color-coded images,then the CT values of bone marrow edema and normal bone marrow were measured.The difference between virtual noncalcium and MRI in the diagnosis of bone marrow edema was compared.The difference in CT value from conventional CT and virtual noncalcium images for the diagnosis of bone marrow edema and normal bone marrow was compared.The efficacy of virtual noncalcium images CT values in diagnosing bone marrow edema was evaluated.The correlations between virtual noncalcium images score,MRI score and rheumatoid arthritis activity were evaluated,respectively.Results There was no significant difference between virtual noncalcium images and MRI in the diagnosis of bone marrow edema(P=0.073).In virtual noncalcium images,the CT values of bone marrow edema were significantly higher than those of normal bone marrow(Z=-18.619,P<0.001),and the area under curve was 0.939.When the cutoff value was-54.8 Hu,the diagnostic sensitivity,specificity and accuracy were 91.9%,93.4%and 92.9%,respectively.In conventional CT images,there was no significant difference in CT values between bone marrow edema and normal bone marrow(Z=-1.831,P=0.067).The virtual noncalcium images score of bone marrow edema was positively correlated with MRI score(r=0.947,P<0.001)and rheumatoid arthritis activity(r=0.370,P<0.05).Conclusion Dual-energy CT virtual noncalcium technique can diagnose wrist bone marrow edema in patients with active rheumatoid arthritis,and evaluate the activity of rheumatoid arthritis.

关 键 词：关节炎 类风湿 骨髓水肿 体层摄影术 X线计算机 虚拟去钙 

分 类 号：R593.22[医药卫生—内科学] R445.2[医药卫生—临床医学]