双层光谱CT、QCT及DXA在骨质疏松诊断中的精确性与效能比较  

Comparative Study of the Accuracies and Efficiencies of Dual-layer Spectral CT,QCT,and DXA for Osteoporosis Diagnosis

作　　者：王盟盟 张磊 周凤云 程晓光 WANG Mengmeng;ZHANG Lei;ZHOU Fengyun;CHENG Xiaoguang(Department of Radiology,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

出　　处：《CT理论与应用研究（中英文）》2024年第6期717-724,共8页Computerized Tomography Theory and Applications

基　　金：北京市医院管理中心临床医学发展专项(ZYLX202107)。

摘　　要：目的:本研究旨在比较双层光谱CT、QCT和DXA在骨质疏松症诊断中的精确性与效能。方法:回顾性收集2023年1月至2023年10月北京积水潭医院脊柱外科门诊患者30例(男15例,年龄(56.6±8.31)岁;女性15例,年龄(65.13±7.16)岁)。所有患者均接受过腰椎双层光谱CT扫描(包括QCT)以及DXA扫描。测量纳入所有患者的L1~L3椎体体积骨密度值和基于DXA扫描的面积骨密度值;依据腰椎QCT和DXA诊断骨质疏松症的标准将研究对象分为骨量正常组、骨量异常组(低骨量组和骨质疏松组);使用Fisher确切概率法对双层光谱CT、QCT和DXA测量的骨密度诊断骨质疏松的准确率进行比较以及使用ROC曲线计算双层光谱CT测量的体积骨密度值诊断骨质疏松的敏感度和特异性。结果:3种方法测量的L1~L3平均骨密度值之间都有极好的相关性(0.751~0.971);双层光谱CT、QCT以及DXA诊断骨质疏松的准确率在男性中分别为66.7%(10/15)、53.3%(8/15)和40%(6/15);在女性中分别为93.3%(14/15)、86.7%(13/15)和60%(9/15),差异有统计学意义。双层光谱CT分别以QCT和DXA为参考标准诊断骨质疏松的曲线下面积分别0.995(灵敏度88.9%;特异度90.5%)和0.784(灵敏度60%;特异度93.3%)。结论:基于双层光谱CT测量的体积骨密度值在骨质疏松诊断中与QCT相当,其诊断效能优于DXA。Objective:In this study,we aimed to compare the accuracies and efficiencies of dual-layer spectral computed tomography(CT),quantitative CT(QCT),and dual-energy X-ray absorptiometry(DXA)in diagnosing osteoporosis.Methods:From January to October,2023,30 outpatients,including 15 males(age(56.6±8.31)years old)and 15 females(age(65.13±7.16)years old),at the spine surgery department of Beijing Jishuitan Hospital were retrospectively analyzed.All patients underwent bilayer spectral CT,QCT,and DXA of the lumbar spine.Additionally,bone mineral density(BMD)values for the L1~L3 vertebral bodies and areal BMD values were measured using DXA.Based on the diagnostic criteria for osteoporosis using lumbar spine QCT and DXA,the study participants were divided into three groups:normal bone mass,abnormal/low bone mass,and osteoporosis groups.Accuracies of dual-energy spectral CT,QCT,and DXA for BMD measurements to diagnose osteoporosis were compared using Fisher’s exact test.Moreover,sensitivity and specificity of dual-energy spectral CT to measure volumetric BMD values for osteoporosis diagnosis were calculated using receiver operating characteristic curves.Results:A strong correlation was observed among the average BMD values for L1~L3 measured using all three methods(0.751~0.971).Accuracies of osteoporosis diagnosis using dual-energy spectral CT,QCT,and DXA were 66.7%(10/15),53.3%(8/15),and 40%(6/15),respectively,in males and 93.3%(14/15),86.7%(13/15),and 60%(9/15),respectively,in females,with statistically significant differences.Dual-energy spectral CT showed area under the curve values of 0.995(sensitivity:88.9%;specificity:90.5%)and 0.784(sensitivity:60%;specificity:93.3%)with QCT and DXA as reference standards,respectively,for osteoporosis diagnosis.Conclusion:Volumetric BMD values measured using dual-energy spectral CT were comparable to those measured using QCT for osteoporosis diagnosis,and both outperformed DXA in terms of diagnostic efficiency.

关 键 词：双层光谱CT 双能X线骨密度仪 体积骨密度 骨质疏松 腰椎 

分 类 号：R814[医药卫生—影像医学与核医学] R681.5[医药卫生—放射医学]