CT三维重建及薄层扫描联合...性和恶性脊柱骨折的价值分析_张庭庭.pdf

161CHINESE JOURNAL OF CT AND MRI,FEB.2023,Vol.21,No.02 Total No.160【第一作者】张庭庭，女，主治医师，主要研究方向：四肢关节影像。E-mail：【通讯作者】刘广保，男，副主任医师，主要研究方向：骨关节影像。E-mail：论 著Analysis of the Value of CT Three-Dimensional Reconstruction and Thin-Slice Scanning Combined with MRI Apparent Diffusion Coefficient in the Quantitative Diagnosis of benign and Malignant Spinal Fractures*ZHANG Ting-ting1,BAI Man-mo2,JI Si-xuan1,CHEN Ming-wei1,LIU Guang-bao1,*.1.Medical imaging department,Sanya Hospital of traditional Chinese medicine,Sanya 572000,Hainan Province,China2.Department of Orthopedics and Traumatology of Traditional Chinese Medicine,Sanya 572000,Hainan Province,ChinaABSTRACTObjective To investigate the value of CT three-dimensional reconstruction and thin-slice scanning combined with the apparent diffusion coefficient of magnetic resonance in the quantitative diagnosis of benign and malignant spinal fractures.Methods The clinical data of 85 patients with spine fractures were selected for retrospective analysis.The selection time was from May 2018 to June 2020.A total of 50 cases of benign spine fractures and 35 cases of malignant spine fractures were pathologically diagnosed.CT and magnetic Resonance examination,comparing positive and negative predictive values,analyzing the imaging characteristics of benign and malignant spine fractures,comparing the ADC value of benign and malignant,evaluating CT plain scan,CT three-dimensional reconstruction and thin-slice scan,magnetic resonance,two combined diagnosis of benign and malignant spine The AUC value,sensitivity,specificity and Youden index of fracture.Results The positive predictive value of 85 patients with spinal fractures after CT plain scan was 73.47%,and the negative predictive value was 61.11%;the positive predictive value after CT three-dimensional reconstruction and thin-slice scan was 81.63%,and the negative predictive value was 72.22%.After the magnetic resonance test,the positive predictive value was 90.00%,and the negative predictive value was 85.71%;after the two combined tests,the positive predictive value was 96.00%and the negative predictive value was 94.23%.CT imaging features showed that there were 43 cases of benign spinal fractures with high signal on T2WI.The shape of the vertebral body was more wedge-shaped,the posterior edge of the vertebral body was more often angled,and the paravertebral soft tissue was ring-shaped thickened;malignant spinal fractures appeared.In 34 cases with high signal intensity on T2WI,the vertebral body was mainly wedge-shaped or inverted wedge-shaped,the posterior edge of the vertebral body was swollen,and the paravertebral soft tissues were nodular masses.The ADC value of the benign group was higher than that of the malignant group(P0.05).ROC curve analysis showed that the AUC values of CT plain scan,CT three-dimensional reconstruction,thin-slice scan,magnetic resonance,and two combined diagnosis of benign and malignant spinal fractures were(0.674/0.771/0.897/0.951,P0.05);the sensitivity was respectively They are 72.00%,80.00%,90.00%,96.00%;the specificity is 62.90%,74.30%,85.70%,94.30%,respectively.Conclusion CT three-dimensional reconstruction and thin-slice scanning combined with magnetic resonance apparent diffusion coefficient quantitative diagnosis is beneficial to increase the detection rate of benign and malignant spinal fractures and reduce the misdiagnosis rate.Keywords:CT;Three-Dimensional Reconstruction;Thin-Slice Scan;Magnetic Resonance;Benign;Malignant;Spine Fracture经流行病学调查1发现，脊柱骨折发生率约占全身骨折的5.06.0，虽然脊柱骨折可发生在任何年龄段，但仍以青壮年多见，且发病无男女差异。根据其骨折原因的不同可为良性与恶性，其中，良性通常是因骨质疏松所引起，譬如长期使用糖皮质激素易增加骨质疏松几率，诱发脊柱骨折；而恶性是由脊柱肿瘤所造成，当患者合并脊柱肿瘤，则会引发病理性骨折2。并且骨折原因的不同，所予以的治疗方案及预后效果也会存在较大差异。基于此，鉴别两者的不同显得十分必要，对治疗方案的制定和预后的改善至关重要。有学者3建议行CT三维重建及薄层扫描；也有学者4建议在其基础上加用磁共振表观扩散系数定量，以此提高诊断确诊率，但临床上关于上述两种方法联合检测的相关文献报道较少，故本次选取85例脊柱骨折患者的临床资料进行回顾性分析，旨在探讨CT三维重建及薄层扫描联合磁共振表观扩散系数定量诊断良性和恶性脊柱骨折的价值。现将其报告如下。1 资料与方法1.1 临床资料 回顾性分析2018年5月至2020年6月诊治的85例脊柱骨折患者的临床资料。经病理确诊为良性脊柱骨折50例、恶性脊柱骨折35例。CT三维重建及薄层扫描联合磁共振表观扩散系数定量诊断良性和恶性脊柱骨折的价值分析*张庭庭1 白曼莫2 吉思璇1陈明玮1 刘广保1,*1.海南省三亚市中医院医学影像科 (海南 三亚 572000)2.海南省三亚市中医院中医骨伤科 (海南 三亚 572000)【摘要】目的 探讨CT三维重建及薄层扫描联合磁共振表观扩散系数定量诊断良性和恶性脊柱骨折的价值。方法 选取85例脊柱骨折患者的临床资料进行回顾性分析，选取时间为2018年5月至2020年6月，经病理确诊为良性脊柱骨折共50例、恶性脊柱骨折共35例，且予以CT、磁共振检查，对比阳、阴性预测值，分析良恶性脊柱骨折的影像学特征，比较良恶性的ADC值，评估CT平扫、CT三维重建及薄层扫描、磁共振、两项联合诊断良恶性脊柱骨折的AUC值、敏感度、特异度及约登指数。结果 85例脊柱骨折患者经CT平扫后，阳性预测值73.47%，阴性预测值61.11%；经CT三维重建及薄层扫描后阳性预测值为81.63%，阴性预测值为72.22%。经磁共振检测后，阳性预测值为90.00%，阴性预测值85.71%；经两项联合检测后，阳性预测值96.00%，阴性预测值94.23%。CT影像学特征显示，良性脊柱骨折出现T2WI高信号共43例，椎体形态以楔形占比更多，椎体后缘以成角多见，椎旁软组织呈环形增厚样；恶性脊柱骨折出现T2WI高信号34例，椎体形态以楔形或倒楔形为主，椎体后缘呈膨隆，椎旁软组织呈结节肿块。良性组的ADC值高于恶性组(P0.05)。ROC曲线分析显示，CT平扫、CT三维重建及薄层扫描、磁共振、两项联合诊断良恶性脊柱骨折的AUC值分别为(0.674/0.771/0.897/0.951，P0.05)；敏感度分别为72.00%、80.00%、90.00%、96.00%；特异度分别为62.90%、74.30%、85.70%、94.30%。结论 CT三维重建及薄层扫描联合磁共振表观扩散系数定量诊断，有利于提高良恶性脊柱骨折检出率及降低误诊率。【关键词】CT；三维重建；薄层扫描；磁共振；良 性；恶性；脊柱骨折【中图分类号】R445.3【文献标识码】A【基金项目】海南省卫生计生行业科研项目 (19A200142)DOI:10.3969/j.issn.1672-5131.2023.02.054162中国CT和MRI杂志2023年02月 第21卷 第02期 总第160期纳入标准：认知功