摘要
目的探讨正电子发射计算机断层显像(PET)/CT表现、腰椎定量计算机断层扫描(QCT)、磁共振成像(MRI)同反相位信号比值与恶性椎体压缩性骨折的关系及联合鉴别骨质疏松、恶性骨折的效能。方法选取86例骨质疏松性椎体压缩性骨折(OVCF)患者(OVCF组)及86例恶性椎体压缩性骨折患者(恶性组),比较两组一般资料、PET/CT表现、腰椎骨矿物质密度(BMD)、脂/水像、反相位/同相位信号比值,采用Logistic回归方程分析恶性椎体压缩性骨折的相关影响因素,采用受试者工作特征(ROC)曲线分析其鉴别骨质疏松、恶性骨折的效能。结果两组软组织肿块影、病变椎体附件受累分布比较,差异有统计学意义(P<0.05);OVCF组BMD、反相位/同相位信号比值低于恶性组,脂/水像信号比值高于恶性组(P<0.05);Logistic回归方程分析显示软组织肿块影、病变椎体附件受累、BMD、脂/水像、反相位/同相位信号比值均与恶性椎体压缩性骨折有关(P<0.05);单独诊断中病变椎体附件受累鉴别OVCF和恶性骨折的ROC曲线下面积(AUC)最大,其次是腰椎QCT BMD、反相位/同相位、脂/水像、软组织肿块影,而软组织肿块影联合反相位/同相位诊断的AUC为0.974,大于任一指标单独诊断(P<0.05)。结论恶性椎体压缩性骨折在影像学诊断中可见软组织肿块影,常累及病变椎体附件,且可造成BMD、脂/水像及反相位/同相位信号比值异常,软组织肿块影联合反相位/同相位诊断可提高鉴别诊断效能,以指导临床制定治疗方案。
Objective To investigate the diagnostic efficacies of positron emission tomography(PET)/CT findings, quantitative computed tomography(QCT) of lumbar spine, magnetic resonance imaging(MRI) in-phase and opposed-phase sequences in differentiating osteoporotic and malignant vertebral fractures, so was the efficacy of combination detection. Methods 86 patients with osteoporotic vertebral compression fracture(OVCF group) and 86 patients with malignant vertebral compression fracture(malignant group) were selected. General data, PET/CT findings, lumbar vertebra bone mineral density(BMD), lipid/water image, opposed-phase/in-phase signal ratio were compared between the two groups. Logistic regression equation was used to analyze the correlated factors of malignant vertebral compression fracture. Receiver operating characteristic curve(ROC) was used to analyze the efficacy of differential diagnosis between osteoporosis and malignant fracture. Results There were statistically significant differences between the two groups in the distribution of soft tissue mass and affected vertebral appendages(P<0.05). The BMD and opposed-phase/in-phase signal ratio in OVCF group were significantly lower than those in malignant group, and the MRI signal ratio of lipid/water in OVCF group was significantly higher than that in malignant group(P<0.05). Logistic regression equation analysis showed that mass of soft tissue, involvement of disaffected vertebral appendages, BMD, lipid/water image, opposed-phase/in-phase signal ratio were all correlated to malignant vertebral compression fracture(P<0.05). Using the single factor in diagnosis, the AUC of differentiating OVCF from malignant fracture were the largest by involvement of the disaffected vertebral appendages, followed by QCT BMD of the lumbar spine, opposed-phase/in-phase signal ratio, lipid/water image, and soft tissue mass. The AUC of combined diagnosis was 0.974, which was significantly higher than that of all index alone(P<0.05). Conclusion In the diagnosis of malignant vertebral compression fracture, soft tissue mass can be observed, which often involves the pathological vertebral appendages;and abnormal BMD, lipid/water image, and opposed-phase/in-phase signal ratio are also be observed. Combined diagnosis can improve the efficacy of differential diagnosis and guide the clinical treatment plan.
作者
刘培举
杜开广
肖章
LIU Pei-ju;DU Kai-guang;XIAO Zhang(Department of Radiology,General Hospital of Pingmei Shenma Medical Group,Pingdingshan 467000,Henan,China;不详)
出处
《广东医学》
CAS
2022年第2期221-225,共5页
Guangdong Medical Journal
基金
河南省医学科技攻关计划项目(201804216)。
关键词
正电子发射计算机断层显像
CT
磁共振成像
椎体压缩性骨折
受试者工作特征曲线
positron emission tomography
computed tomography
magnetic resonance imaging
vertebral compression fracture
receiver operating characteristic curve
