基于MRI和(或)CT的颈椎退变性疾病术前骨质量评估方法及其诊断效能  

Research on the MRI/CT-based pre-operative bone quality assessment method for patients with cervical degenerative diseases and validation of its diagnostic efficacy

作　　者：黄伟博 龚兆阳 李泽煜 夏新雷 马晓生 吕飞舟 王洪立 姜建元 Huang Weibo;Gong Zhaoyang;Li Zeyu;Xia Xinlei;Ma Xiaosheng;Lyu Feizhou;Wang Hongli;Jiang Jianyuan(Department of Orthopaedics,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2023年第11期697-704,共8页Chinese Journal of Orthopaedics

基　　金：国家重点研发计划(2020YFC2004900)。

摘　　要：目的探讨基于MRI和(或)CT测量及其联合测量对颈椎退变性疾病患者术前骨质量评估的诊断效能及其可行性。方法回顾性分析2020年9月至2022年3月复旦大学附属华山医院骨科收治的因颈椎退变性疾病行手术治疗且具有术前X线、CT、MRI及双能X线骨密度测量(dule energy X-Ray absorptiometry,DEXA)结果的患者。进行基于颈椎MRI T1WI的骨质量评估(vertebral bone quality score,VBQ)及CT Hounsfiled(HU)值测量,通过二分类变量logistic回归方法构建联合诊断公式。将患者分为正常骨量组(T≥-1.0)与低骨量组(T<-1.0)。比较两组患者的年龄、性别、BMI、合并症、DEXA T值、颈椎VBQ值及CT HU值,应用Pearson相关分析DEXA T值、颈椎VBQ值及CT HU值间的关系。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)分析颈椎VBQ值、CT HU值及其联合诊断的诊断效能、灵敏度和特异度。结果共纳入71例患者(正常骨量组17例,低骨量组54例)。正常骨量组VBQ值为2.90±0.70,小于低骨量组的3.83±0.83,差异有统计学意义(t=4.23,P<0.001);正常骨量组CT HU值为370.26±85.38,大于低骨量组的295.20±67.96,差异有统计学意义(t=3.73,P=0.002)。颈椎VBQ值及CT HU值在ROC曲线下的面积(area under curve,AUC)分别为0.81和0.75,以二者为基础构建联合诊断的AUC为0.85,表明以上方法具有较好的诊断效能。若单独应用颈椎VBQ评估,其诊断灵敏度为80%、特异度为70%;而采用颈椎VBQ及CT HU联合诊断的灵敏度为90%、特异度为75%。Pearson相关分析结果显示DEXA T值、颈椎VBQ值及CT HU值两两间均有相关性,线性回归方程为DEXA T值=-0.63×颈椎VBQ值+0.64(r=-0.55,P<0.001)、CT HU值=-40.20×颈椎VBQ值+458.40(r=-0.45,P<0.001)、DEXA T值=0.006×CT HU值-3.47(r=0.45,P<0.001)。结论应用颈椎VBQ值、CT HU值及联合诊断评估颈椎退变性疾病患者术前骨质量具有初步可行性,有望成为术前骨质量评估的工具之一。Objective To investigate the diagnostic efficacy of MRI-based or CT-based measurements and the combined evaluation methods for preoperative bone quality assessment in patients with cervical degenerative diseases.Methods Patients who underwent spine surgery for cervical degenerative diseases at the Department of Orthopedics,Huashan Hospital,Fudan University from September 2020 to March 2022 with available preoperative X-ray,CT,MRI and dule energy X-Ray absorptiometry(DEXA)data were included in this study.Vertebral bone quality score(VBQ)based on MRI T1-weightedimages and CT Hounsfiled unit(HU)values of the cervical spine were measured,and a combined diagnostic formula based on the binary logistic regression was constructed.The patients were divided into normal bone mass(T≥-1.0)and osteopenia/osteoporosis groups(T<-1.0).The student's t-test and Chi-square test were performed for comparisons between groups.The Pearson correlation coefficient was also used to investigate the correlation between DEXA-T scores,cervical VBQ and CT HU values.In addition,receiver operating characteristic curve(ROC)were plotted to explore the diagnostic efficacy of VBQ,CT HU and their combined diagnosis.Meanwhile,the corresponding sensitivity and specificity were obtained.Results A total of 71 patients were included in this study(17 in the normal group and 54 in the osteopenia/osteoporosis group).The student's t-test showed that VBQ(2.90±0.70 vs.3.83±0.83,t=4.23,P<0.001)and CT HU values(370.26±85.38 vs.295.20±67.96,t=3.73,P=0.002)were significantly different between the two groups.The area under the ROC curve(AUC)for VBQ and CT values of the cervical spine were 0.81 and 0.75,respectively,and the AUC for the combined diagnostic value constructed on the basis of both was 0.85.Applying VBQ scores alone had a diagnostic sensitivity of 80%and a specificity of 70%,and the combined diagnosis with VBQ and CT HU had a sensitivity of 90%and a specificity of 75%.Person correlation analysis showed a significant correlation between DEXA T value,c

关 键 词：颈椎 椎间盘退行性变 骨密度 骨质疏松 普查 

分 类 号：R687.3[医药卫生—骨科学] R816.8[医药卫生—外科学] R445.2[医药卫生—临床医学]