第三代双源双能CT虚拟去钙骨髓成像在椎体成骨性骨转移瘤评价中的价值

Value of third generation dual-source dual-energy CT virtual decalcified bone marrow imaging in the evaluation of vertebral osteogenic bone metastases

    摘要
  • 摘要:
    目的 探讨第三代双源双能CT虚拟去钙骨髓成像（简称骨髓成像）用于评价椎体成骨性骨转移瘤的临床价值。
    方法 回顾性分析2017年11月至2018年9月在山西医科大学第一医院就诊的48例骨外恶性肿瘤患者男性27例、女性21例，年龄（62.4±10.5）岁的椎体骨转移情况，所有患者同期均行双源双能CT成像与 99Tcm-亚甲基二膦酸盐（MDP）全身骨显像，以临床随访诊断或病理诊断结果为标准，比较 99Tcm-MDP全身骨显像、常规CT及骨髓成像3种方法在椎体成骨性骨转移瘤中的诊断价值。在骨髓成像图像上测量骨髓密度（CT值），3种方法诊断椎体成骨性骨转移瘤的灵敏度、特异度、阳性预测值、阴性预测值和准确率的比较采用χ2检验，采用t检验比较椎体转移灶的骨髓CT值和正常椎体的骨髓CT值，采用受试者工作特征曲线分析骨髓CT值。
    结果 48例患者共计598个椎体，确诊成骨性骨转移瘤的椎体135个。99Tcm-MDP全身骨显像诊断数为127个，常规CT诊断数为119个，骨髓成像诊断数为129个，骨髓成像诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为95.56%、94.82%、84.31%、98.65%和94.98%。99Tcm-MDP全身骨显像、常规CT、骨髓成像的阴性预测值（98.17%、96.60%、98.65%）和准确率（92.81%、95.82%、94.98%）间的差异均无统计学意义（χ2=4.891、5.591，P=0.087、0.061）；99Tcm-MDP全身骨显像与骨髓成像的灵敏度（94.07% vs. 95.56%）、特异度（92.44% vs. 94.82%）及阳性预测值（78.40% vs. 84.31%）间的差异均无统计学意义（χ2=0.301、2.190、1.811，P=0.583、0.139、0.178）；病变椎体转移灶的骨髓密度较正常椎体的骨髓密度低（−588.96±332.37） HU vs.（−55.03±75.62） HU，差异有统计学意义（t=31.906，P=0.000）。骨髓密度的曲线下面积为0.99，临界值为−119.6 HU（灵敏度和特异度分别为97.80%和96.50%）。
    结论 第三代双源双能CT虚拟去钙骨髓成像可用于检测椎体成骨性骨转移瘤。

     

    Abstract:
    Objective To investigate the clinical value of third-generation dual-source dual-energy CT virtual decalcification bone marrow imaging in evaluating vertebral osteogenic bone metastases.
    Methods A retrospective analysis was conducted on 48 patients with malignant tumor 27 males and 21 females, aged (62.4±10.5) years hospitalized in the First Hospital of Shanxi Medical University from November 2017 to September 2018. All patients underwent dual-source dual-energy CT imaging and 99Tcm-methylenediphosphonate (MDP) whole-body bone imaging simultaneously. On the basis of clinical follow-up or pathological diagnosis, the diagnostic value of three methods of whole-body bone imaging, conventional CT, and bone marrow imaging in vertebral osteogenic bone metastases were compared and studied. Bone marrow density (CT value) was measured through bone marrow imaging. First, the sensitivity, specificity, positive and negative predictive values, and accuracy of the three methods for diagnosis of vertebral osteogenic bone metastases were compared through χ2 test. Second, the bone marrow CT value of vertebral metastases was compared with that of the normal vertebral body through t-test. Third, the subjective score and bone marrow CT value were analyzed through receiver operating characteristic curve analysis.
    Results A total of 48 patients with 598 vertebral bodies were examined in this study, where in 135 vertebral bodies were diagnosed with osteogenic bone metastases. 99Tcm-MDP whole-body bone imaging was diagnosed in 127 cases, conventional CT was diagnosed in 119 cases, and bone marrow imaging was diagnosed in 129 cases. The sensitivity, specificity, positive and negative predictive values, and accuracy rate of bone marrow imaging diagnosis were 95.56%, 94.82%, 84.31%, 98.65%, and 94.98%, respectively. The negative predictive values (98.17%, 96.60%, and 98.65%) and accuracy (92.81%, 95.82%, and 94.98%) of the three methods had no statistical significance (χ2=4.891, 5.591; P=0.087, 0.061). Sensitivity (94.07% vs. 95.56%), specificity (92.44% vs. 94.81%), and positive predictive value (78.40% vs. 84.31%) of whole-body bone and bone marrow imaging were not statistically different (χ2= 0.301, 2.190, 1.811; P =0.583, 0.139, 0.178). The bone marrow density of the metastatic focus of the diseased vertebral body was lower than that of the normal vertebral body (−588.96±332.37) HU vs. (−55.03±75.62) HU (t=31.906, P=0.000). The AUC of bone marrow density was 0.99 with a cut-off value of −119.6 HU (sensitivity and specificity were 97.80% and 96.50%, respectively).
    Conclusion The third-generation dual-source dual-energy CT virtual decalcified bone marrow imaging can be used for detecting osteogenic bone metastases of vertebral bodies.

     

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