多b值DWI序列ADC值在脊柱骨质疏松性压缩骨折与椎体转移瘤病理性压缩骨折鉴别诊断中的价值研究  

Clinical value of multi-b value DWI sequence ADC value in differential diagnosis of pathologic compression fracture of osteoporotic compression fracture of spine and vertebral metastases

作　　者：王振兴[1] 薛伟[1] 魏萌[1] 康少英[1] 张英民[1] WANG Zhen-xing;XUE Wei;WEI Meng;KANG Shao-ying;ZHANG Ying-min(Department of Orthopaedics,Western District of Handan Central Hospital,Handan,Hebei 056001,China)

机构地区：[1]邯郸市中心医院西区骨三科,河北邯郸056001

出　　处：《颈腰痛杂志》2023年第2期179-182,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：河北省2017年度医学科学研究重点课题计划(编号:20170474)。

摘　　要：目的探讨多b值弥散加权成像(diffusion weighted imaging,DWI)序列ADC值用于鉴别脊柱骨质疏松性压缩骨折与椎体转移瘤病理性压缩骨折的价值。方法回顾性分析2009年1月~2019年12月本院收治的脊柱骨质疏松性压缩骨折68例(A组)及椎体转移瘤病理性压缩骨折患者74例(B组),分别测量其多b值DWI下的ADC值,并进行组间比较;采用曲线下面积(area under curve,AUC)分析多b值DWI鉴别两者的价值。结果脊柱骨质疏松性压缩骨折形态多为楔形及凹陷形、椎体后缘成角,椎体内可见残留正常骨髓信号,多b值DWI以等或低信号为主;椎体转移瘤病理性压缩骨折形态多为倒楔形及扁平形、可见椎体附件受累及椎旁软组织肿块,多b值DWI以高信号为主。两组患者的ADC值均随着b值增加而下降,但A组的ADC值显著高于B组(P<0.05);b值分别取0、100、200、400、600、800 s/mm^(2)时,鉴别二者的AUC值分别为0.671、0.706、0.897、0.918、0.743、0.712;当多b值DWI取400 s/mm^(2)时的诊断效能最佳(P<0.05),其准确度、特异度、敏感度、阳性预测值、阴性预测值、约登指数分别为90.12%、86.34%、91.37%、73.85%、72.17%及77.71%。结论MRI形态学对于鉴别脊柱骨质疏松性压缩骨折与椎体转移瘤病理性压缩骨折有一定的帮助,而多b值DWI取400 s/mm^(2)时,具有最佳的诊断效能。Objective To investigate the clinical value of multi-b-value diffusion weighted imaging(DWI)sequence ADC values in differential diagnosis of osteoporotic compression fractures of spine from pathologic compression fractures of metastatic tumors of the vertebral body.Methods A retrospective analysis was conducted in 68 patients with osteoporotic compression fractures of the spine(group A)and 74 patients with pathological compression fractures of vertebral metastases(group B),who admitted to our hospital from January 2009 to December 2019.The ADC values under DWI were measured and compared between the two groups.Area under curve(AUC)was used to analyze the value of multi b value DWI in identifying these two diseases.Results Spinal osteoporosis compressibility fracture showed morphology for the wedge and the concave shape,vertebral rear angulation and vertebral body visible residual normal bone marrow signal,b value of DWI was mainly in equal or low signal.The morphology of vertebral metastatic tumor pathological compression fracture was an inverted wedge and flat shape,visible attachment involved vertebral bodies and soft tissue mass of vertebral side,b value of DWI mainly in high signal.The ADC value of patients in both two groups decreased with the increase of b value,but the ADC value of group A was significantly higher than that of group B(P<0.05).When the b values were 0,100,200,400,600 and 800 s/mm^(2),the AUC values were 0.671,0.706,0.897,0.918,0.743 and 0.712,respectively.When the multi b value DWI was taken as 400 s/mm^(2),the diagnostic efficiency was the best(P<0.05).The accuracy,specificity,sensitivity,positive predictive value,negative predictive value,and Jorden index were 90.12%,86.34%,91.37%,73.85%,72.17%and 77.71%in the diagnosis of vertebral osteoporotic compression fracture and pathological compression fracture of vertebral metastases.Conclusion MRI morphology is helpful in differentiating vertebral osteoporotic compression fractures from pathological compression fractures caused by vertebral meta

关 键 词：多b值DWI ADC值 脊柱压缩性骨折 骨质疏松 椎体转移瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学]