MSCT灌注成像参数对股骨头坏死预后不良的预测价值  

Predictive value of MSCT perfusion imaging parameters for poor prognosis in patients with osteonecrosis of the femoral head

作　　者：吴丰宇 汪禾青 周建军 WU Fengyu;WANG Heqing;ZHOU Jianjun(Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital(Xiamen Branch),Fudan University,Xiamen 361015,Fujian,China)

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]复旦大学附属中山医院厦门医院放射诊断科,厦门361015

出　　处：《中国临床医学》2024年第6期977-983,共7页Chinese Journal of Clinical Medicine

摘　　要：目的探讨多层螺旋计算机体层成像(multi-slice spiral computed tomography,MSCT)灌注成像参数对股骨头坏死(osteonecrosis of the femoral head,ONFH)预后不良的预测价值。方法选择2022年5月至2023年5月在某三甲医院就诊的118例ONFH患者作为研究对象。患者均行3D打印导板辅助坏死灶刮除联合陶瓷棒植入术。根据1年随访情况,将其分为预后良好组(n=94)与预后不良组(n=24)。比较两组患者基线资料,MSCT灌注成像参数[对比剂平均通过时间(mean transit time,MTT)、血流量(blood flow,BF)、血容积(blood volume,BV)]。分析MTT、BF、BV与患者病情及预后不良的相关性。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估MSCT灌注成像参数对ONFH预后的预测价值。结果两组患者坏死部位、坏死体积、国际骨循环研究协会(Association Research Circulation Osseous,ARCO)分期差异均有统计学意义(P<0.05)。预后不良组MTT、BF、BV短于或小于预后良好组(P<0.001)。MTT、BF、BV与坏死体积、ARCO分期均负相关(P<0.001)。MTT缩短、BF减小、BV减小是ONFH患者预后不良的独立因素(P<0.001)。三者联合预测预后不良的AUC为0.918,优于各参数独立预测AUC(P<0.05)。结论MSCT灌注成像参数与ONFH患者病情及预后相关,有助于临床早期预测ONFH患者预后。Objective To investigate the predictive value of perfusion imaging parameters of multi-slice spiral computed tomography(MSCT)for the poor prognosis in patients with osteonecrosis of the femoral head(ONFH).Methods A total of 118 patients with ONFH who were treated in a hospital from May 2022 to May 2023 were selected as the research subjects.All patients received 3D printing guide plate assisted with curettage of necrotic focus combined with ceramic rod implantation.According to the one-year follow-up results,patients were divided into a good prognosis group(n=94)and a poor prognosis group(n=24).Baseline data and MSCT perfusion imaging parameters(mean transit time[MTT],blood flow[BF],blood volume[BV])were compared between the two groups.The correlations of MTT,BF and BV with the severity and prognosis of ONFH were analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of MSCT perfusion imaging parameters for the prognosis of ONFH patients.Results There were significant differences in the necrosis site,necrosis volume and Association Research Circulation Osseous(ARCO)staging between the two groups(P<0.05).The MTT was shorter,BF was less and BV was less in the poor prognosis group than those in the good prognosis group(P<0.001).MTT,BF and BV were negatively correlated with necrosis volume and ARCO staging(P<0.001).Decreased MTT,BF,and BV were independent risk factors for poor prognosis in ONFH patients(P<0.001).The AUC of the combination of these three parameters for predicting poor prognosis was 0.918,which was significantly better than that of independent parameter(P<0.05).Conclusions The parameters of MSCT perfusion imaging are closely related to the condition and prognosis of ONFH patients,and are help of predicting the prognosis of ONFH patients.

关 键 词：股骨头坏死 多层螺旋计算机体层成像 预后 预测价值 

分 类 号：R681.8[医药卫生—骨科学]