双能CT水-羟基磷灰石分离技术对胸腰椎骨折诊断的影响:不同年资放射科医生间的比较  

Efficacy of dual-energy CT water-hydroxyapatite decomposition technique for diagnosing acute vertebral fractures

作　　者：杨李 姚容 余含笑 于桐泊 朱雪娥 YANG Li;YAO Rong;YU Hanxiao;YU Tongbo;ZHU Xuee(Department of Radiology,BenQ Medical Center,The Affiliated BenQ Hospital of Nanjing Medical University,Jiangsu 210019,China)

机构地区：[1]南京明基医院南京医科大学附属明基医院放射科,江苏南京210019

出　　处：《影像诊断与介入放射学》2024年第4期290-297,共8页Diagnostic Imaging & Interventional Radiology

基　　金：南京市卫生科技发展专项资金项目(ZKX23064)。

摘　　要：目的探讨双能CT(DECT)水-羟基磷灰石(HAP)分离技术能否提高椎体新鲜压缩性骨折的检出率,并研究其诊断效能与放射科医生经验水平的相关性。方法回顾性分析50例创伤后接受胸腰椎DECT和MRI检查的患者资料,DECT获得常规混合能量CT平扫图和水-HAP重建图像。四名放射科医生独立盲法阅片,该四名医生分别具有1年、5年、8年和12年工作经验,首先根据CT平扫判断是否存在椎体骨折及骨折的新旧,再结合DECT水-HAP图来判断有无骨折及骨折的新旧。以MR T2脂肪抑制图像为金标准,进行DECT诊断效能的敏感度、特异度、准确度、阳性预测值、阴性预测值分析以及CT平扫与结合水-HAP图结果配对分析。结果MRI共发现54节新鲜骨折,38节陈旧性骨折。与常规CT平扫相比,结合水-HAP图像提高了所有医生的诊断效能。四名医生结合水-HAP图像后,准确度分别由常规CT的0.76、0.75、0.82、0.84提升至0.87、0.89、0.92、0.93;敏感度和特异度分别由0.83、0.83、0.89、0.87,0.66、0.63、0.71、0.79提升至0.93、0.94、0.98、0.94,0.79、0.82、0.84、0.92;阳性预测值和阴性预测值分别由0.78、0.76、0.81、0.85,0.74、0.73、0.82、0.81提升至0.86、0.88、0.90、0.94,0.88、0.91、0.97、0.92;被评为“不确定”椎体的数量分别由23、21、19、12节下降到7、5、5、1节。与常规CT平扫相比,DECT水-HAP分离技术提高了所有医生诊断新鲜椎体骨折的准确度,配对分析差异具有统计学意义(P<0.05)。水-HAP分离技术使患者也受益,四名医生结合水-HAP图像后,需要进一步MRI检查的患者数量分别由14、13、14、11人下降到4、3、3、1人。结论DECT水-HAP分离技术可提高不同经验水平放射科医生基于CT诊断椎体新鲜压缩性骨折的能力。Objective To evaluate the efficacy of dual-energy CT(DECT)water-hydroxyapatite(HAP)decomposition technique for detecting acute vertebral fractures.Methods Fifty consecutive patients who underwent both DECT and MRI of the thoracolumbar spine after trauma were retrospectively enrolled.Conventional linear-blended CT scans and corresponding water-HAP reconstructions were obtained.Four radiologists with 1,5,8 and 12 years of experience independently evaluated the gray-scale CT for the presence of fractures and their suspected age.The water-HAP images were then blindly assessed by the same readers to detect bone marrow edema.Findings were compared with those from fat-suppressed T2-weighted MRI as the standard.Sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV)analyses for diagnostic performance and matched pair analyses were performed.Results Fifty-four fractures were classified as acute and 38 as chronic on MRI.The diagnostic performance of all readers in the detection of acute fractures improved from 0.76,0.75,0.82,and 0.84 with conventional CT alone to 0.87,0.89,0.92,and 0.93 in combination with water-HAP images,respectively.The diagnostic sensitivity increased from 0.83,0.89,0.66,and 0.71 to 0.93,0.98,0.79,and 0.84 whereas the specificity increased from 0.83,0.87,0.63,and 0.79 to 0.94,0.94,0.82,and 0.92,respectively.The PPV increased from 0.78,0.81,0.74,and 0.82 to 0.86,0.90,0.88,and 0.97 whereas the NPV increased from 0.76,0.85,0.73,and 0.81 to 0.88,0.94,0.91,and 0.92,respectively.The number of vertebrae rated as uncertain vertebral fracture decreased from 23,21,19,and 12 to 7,5,5,and 1,respectively.The accuracy improved significantly with the water-HAP decomposition technique(P<0.05)and the number of patients potentially referred to MRI decreased from 14,13,14,and 11 to 4,3,3,and 1,respectively.Conclusion DECT based water-HAP decomposition technique can improve the diagnostic confidence of radiologists in acute vertebral compression fractures.

关 键 词：双能CT 体层摄影术 X线计算机 椎体压缩性骨折 水-羟基磷灰石分离技术 骨髓水肿 

分 类 号：R814.42[医药卫生—影像医学与核医学] R683.2[医药卫生—放射医学]