双能CT虚拟去钙技术在“臀坐式”骶尾椎急性损伤诊断中的价值  

The Value of Dual-energy CT Virtual Calcium Subtraction Technique in the Diagnosis of Fresh Sacrococcygeal Fractures in the“Sitting Position”

作　　者：尚晓情 陈英敏[1] 刘向 高慧敏 贾秀川[1] 暴云锋[1] SHANG Xiaoqing;CHEN Yingmin;LIU Xiang;GAO Huimin;JIA Xiuchuan;BAO Yunfeng(Department of Medical Imaging,Hebei Provincial People’s Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院医学影像科,石家庄050000

出　　处：《CT理论与应用研究（中英文）》2024年第6期725-732,共8页Computerized Tomography Theory and Applications

摘　　要：目的:使用双能CT虚拟去钙技术评估不同经验医师诊断“臀坐式”骶尾椎急性损伤的诊断效能。方法:前瞻性纳入2021年11月至2024年1月因急性外伤导致骶尾部疼痛的29例患者,共174块椎体(145块骶椎、29块尾椎),获取其MRI及DECT数据;以MRI结果为参考,3名放射科医师(诊断经验分别为1、4和10年)分别使用常规CT和VNCa彩色编码图进行分析。结果:使用VNCa技术后,3名医师诊断一致性Kappa值显著提升,分别从0.452、0.615、0.735提升至0.775、0.825、0.897,诊断正确率显著提高,分别为92.5%、94.3%和96.6%,3名医师差异无统计学意义;定量分析表明,正常骨髓的平均VNCa CT值为(-84.2±20.3) HU,骨髓水肿(BME)为(-37.4±18.8) HU,两者有显著差异;以MRI为标准,VNCa CT值区分正常骨髓和BME的AUC为0.962,最佳截断值为-57.1 HU,对应敏感性和特异性分别为91.9%和90.2%。结论:DECT VNCa技术显著提高了不同经验医师诊断骶尾椎急性损伤的效能,尤其对经验不足的医师,VNCa CT值有助于诊断。Purpose:The aim of this study was to evaluate the diagnostic performance of virtual non-calcium imaging using dual-energy computed tomography(CT)for acute sacrococcygeal injuries diagnosed by radiologists with varying levels of experience.Methods:A prospective study was employed and 29 patients presenting with acute coccygeal pain due to trauma between November 2021 and January 2024,involving a total of 174 vertebrae(145 sacral,29 coccygeal),were enrolled.Both magnetic resonance imaging(MRI)and DECT data were acquired.Three radiologists with 1,4,and 10 years of experience analyzed conventional CT and VNCa color-coded images,using MRI as the reference standard.Results:Following the application of VNCa imaging,the inter-rater agreement among the three radiologists significantly improved,with Kappa values increasing from 0.452,0.615,and 0.735 to 0.775,0.825,and 0.897,respectively.Diagnostic accuracy also notably increased to 92.5%,94.3%,and 96.6%for the three radiologists,with no statistically significant differences observed among them.Quantitative analysis revealed an average VNCa CT value of(−84.2±20.3)HU for normal bone marrow and(−37.4±18.8)HU for bone marrow edema,showing a significant difference between the two.Using MRI as the reference standard,the area under the curve for distinguishing normal bone marrow from BME based on VNCa CT values was 0.962,with an optimal cutoff of−57.1 HU,yielding a sensitivity and specificity of 91.9%and 90.2%,respectively.Conclusion:DECT VNCa imaging significantly enhances the diagnostic efficacy of radiologists with varying levels of experience in acute coccygeal injury assessment,particularly benefiting less-experienced physicians.VNCa CT values contribute substantially to diagnostic accuracy in this context.

关 键 词：双能CT 磁共振成像 虚拟去钙 骶尾骨 骨髓水肿 

分 类 号：R814.42[医药卫生—影像医学与核医学] R445.3[医药卫生—放射医学]