双层探测器光谱CT评估肢体骨肉瘤髓内浸润范围的价值  

Value of dual-layer spectral detector CT in evaluating the intramedullary invasion of limb osteosarcoma

作　　者：詹惠荔 钱占华 李远 白荣杰 程晓光 闫东 叶薇 Zhan Huili;Qian Zhanhua;Li Yuan;Bai Rongjie;Cheng Xiaoguang;Yan Dong;Ye Wei(Department of Radiology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Orthopaedic Oncology Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院放射科,北京100035 [2]首都医科大学附属北京积水潭医院骨肿瘤科,北京100035

出　　处：《中华放射学杂志》2023年第8期844-848,共5页Chinese Journal of Radiology

基　　金：中华国际医学交流基金会2021SKY北京影像科研基金(Z-2014-07-2101)。

摘　　要：目的确定双层探测器光谱CT虚拟单能量图像(VMI)显示骨肉瘤的图像质量最佳的keV值,探讨其评估骨肉瘤髓内浸润范围的价值。方法回顾性分析2021年8月至2022年8月首都医科大学附属北京积水潭医院经病理证实的57例长骨普通型骨肉瘤患者的资料,保肢术前完成光谱CT增强检查,术后获得瘤段截除标本。通过光谱CT增强检查获得常规120 kVp图像和40、50、60、70、80 keV的VMI,测量肿瘤CT值、图像噪声,计算信噪比(SNR)和对比噪声比(CNR),采用Friedman检验比较6组CT图像质量的客观评价指标,获得最佳keV值。在最佳keV的VMI上和瘤段截除标本上测量骨肉瘤髓内边界至相邻关节面的最大距离,采用Wilcoxon秩和检验比较CT测量值与标本测量值的差异,采用Spearman相关分析评价二者之间的相关性。结果40~80 keV VMI和120 kVp常规CT图像间的肿瘤CT值、图像噪声、SNR、CNR的总体差异均有统计学意义(P<0.05)。40和50 keV VMI的肿瘤CT值、SNR、CNR均高于120 kVp常规CT图像(P<0.001)。选择50 keV VMI作为最佳keV图像测量骨肉瘤髓内范围,测得的距离为103.9(80.4,131.4)mm,大体标本测得的结果为113.5(94.0,142.0)mm,差异有统计学意义(Z=-5.76,P<0.001)。51例患者的50 keV VMI测量值小于大体标本测量,低估了肿瘤范围,差异为11.1(6.6,13.8)mm。Spearman相关分析显示大体标本测量的距离与50 keV VMI测得的距离呈高度正相关(rs=0.960,P<0.001)。结论双层探测器光谱CT 50 keV VMI显示肢体骨肉瘤最佳,与大体标本相比,CT测量值低估肢体骨肉瘤髓内浸润范围约10 mm,但两者具有良好的相关性。Objective To explore the optimal keV value of the virtual monoenergetic image(VMI)for displaying the osteosarcoma by using the dual-layer spectral detector CT and to evaluate its application value in determining the extent of intramedullary invasion of osteosarcoma.Methods From August 2021 to August 2022,57 patients with conventional osteosarcoma of long bone confirmed by biopsy in Beijing Jishuitan Hospital,Capital Medical University were retrospectively analyzed.All patients completed dual-layer spectral CT enhanced examination before limb salvage surgery,and tumor segment resection specimens were obtained after surgery.Conventional 120 kVp image and VMI of 40,50,60,70 and 80 keV were obtained by spectral CT examination,and the CT values of tumors,image noise were measured and the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the corresponding images were calculated.The objective evaluation among the six groups of images were assessed with the Friedman test,and then determined the optimal keV value.The maximum distance between the intramedullary boundary of osteosarcoma and the adjacent articular surfaces was measured on the best keV VMI and the tumor segment resection specimens.The Wilcoxon signed rank test was used to find the differences and the Spearman correlation analysis was used to evaluate the correlation between the distance measured from the best keV VMI and the specimens.Results There were significant differences in CT value,image noise,SNR and CNR between 40-80 keV VMI and 120 kVp conventional CT images(P<0.05).The CT value,SNR and CNR of 40 and 50 keV VMI were better than 120 kVp(P<0.001).The 50 keV VMI was chosen as the best keV VMI to measure the intramedullary extent of osteosarcoma.The distance measured from 50 keV VMI was 103.9(80.4,131.4)mm,while the distance measured from specimens was 113.5(94.0,142.0)mm,and the difference was statistically significant(Z=-5.76,P<0.001).The 50 keV VMI measurements in 51 patients were smaller than the gross specimens,which underestimated the t

关 键 词：骨肉瘤 体层摄影术 X线计算机 双层探测器 

分 类 号：R738.1[医药卫生—肿瘤]