宫颈癌患者放射性骨损伤影响因素及其与骨转移的影像学鉴别诊断  

Analysis of influencing factors and imaging diagnostic differentiation of radiation-induced bone injury in patients with cervical cancer

作　　者：赵方林 修雨婷 孟凡旭[2] 于鸿[3] 王蕴龙 韩雨霏 孙宝胜[2] ZHAO Fanglin;XIU Yuting;MENG Fanxu;YU Hong;WANG Yunlong;HAN Yufei;SUN Baosheng(Changchun University of Traditional Chinese Medicine,Changchun 130117,China;Department of Radiotherapy,Tumor Hospital of Jilin Province,Changchun130012,China;Jilin Province Institute of Cancer Prevention and Treatment,Jilin Province Cancer Hospital,Changchun 130012,China)

机构地区：[1]长春中医药大学,吉林长春130117 [2]吉林省肿瘤医院放疗科,吉林长春130012 [3]吉林省肿瘤防治研究所,吉林长春130012

出　　处：《中国实验诊断学》2025年第4期382-388,共7页Chinese Journal of Laboratory Diagnosis

基　　金：2024年吉林省预算内基本建设资金(创新能力建设)(2024C017-6)。

摘　　要：目的分析宫颈癌患者放疗后骨盆发生放射性骨损伤的影响因素及其与骨转移的影像学鉴别诊断。方法回顾性分析184例宫颈癌患者经放疗后发生的骨盆病灶变化情况,分析各种临床指标对放射性骨损伤发生率的影响。测量新出现的骨病变表观扩散系数(apparent diffusion coefficient,ADC)值参数,计算ADCmax、ADCmin、ADCmean、ADCstd值。构建ADC参数联合诊断Logistic回归模型并评估其对放射性骨损伤和骨转移的诊断效能。结果影响放射性骨损伤发生的临床因素包括年龄、绝经情况、放疗方式、有无淋巴结加量照射、骨盆最小受照射剂量、骨盆V10、V20、放疗后血清钙、血清磷水平及钙磷乘积(均P<0.05)。发生骨转移患者的4个ADC参数值均显著低于放射性骨损伤患者(均P<0.05)。ADC参数联合诊断模型的受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积(area under the curve,AUC)高于单个参数,达到0.942,敏感度90%、特异度87.5%。结论影响放射性骨损伤发生的危险因素较多。多参数ADC联合诊断对鉴别放射性骨损伤和骨转移具有潜在指导价值。Objective To analyze the influencing factors of radiation-induced pelvic bone injury in patients with cervical cancer after radiotherapy and the diagnostic imaging parameters for differentiation from bone metastases.Methods A retrospective analysis of 184cervical cancer patients was conducted to assess the alterations in pelvic lesions following radiotherapy.The impact of various clinical indicators on the incidence of radiation-induced bone injury was evaluated.Apparent diffusion coefficient(ADC)values of newly emerged bone lesions were measured,including calculations of ADCmax,ADCmin,ADCmean,and ADCstd.A logistic regression model combining ADC parameters was developed to assess its diagnostic efficacy for differentiating between radiation-induced bone injury and bone metastases.Results The clinical factors affecting the occurrence of radiation-induced bone injury included age,menopause,radiotherapy pattern,with or without lymph node boost irradiation,minimum pelvic irradiation dose,pelvic V10and V20,serum calcium levels,serum phosphorus levels,and calcium-phosphorus product after radiotherapy(all P<0.05).The values of 4 ADC parameters in patients with bone metastasis were significantly lower than those with radiation-induced bone injury(all P<0.05).The area under the receiver operating characteristic curve(AUC)of the combined diagnostic model with ADC parameters was higher than that of a single parameter,reaching 0.942,with a sensitivity of 90%and specificity of 87.5%.Conclusion There are many risk factors influencing the occurrence of radiation-induced bone injury.The combined diagnostic model of multiple ADC parameters has potential directorial value in differentiating radiation-induced bone injury from bone metastases.

关 键 词：宫颈癌 放射治疗 放射性骨损伤 危险因素 骨转移 

分 类 号：R737.33[医药卫生—肿瘤]