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北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (1): 183-187. doi: 10.19723/j.issn.1671-167X.2021.01.027

• 论著 • 上一篇    下一篇

CT能谱曲线在脊柱转移瘤和感染性病变中的鉴别诊断价值

袁源,郎宁,袁慧书()   

  1. 北京大学第三医院放射科,北京 100191
  • 收稿日期:2019-02-17 出版日期:2021-02-18 发布日期:2021-02-07
  • 通讯作者: 袁慧书 E-mail:huishuy@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(81871326);国家自然科学基金(81701648)

CT spectral curve in differentiating spinal tumor metastasis and infections

YUAN Yuan,LANG Ning,YUAN Hui-shu()   

  1. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-02-17 Online:2021-02-18 Published:2021-02-07
  • Contact: Hui-shu YUAN E-mail:huishuy@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81871326);National Natural Science Foundation of China(81701648)

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摘要：

目的: 探讨CT能谱曲线在脊柱转移瘤和感染性病变中鉴别诊断的价值。方法: 收集经手术、穿刺组织病理检查或临床治疗证实的29例脊柱转移瘤和18例脊柱感染性病变的能谱CT增强静脉期扫描图像,经后处理获得单能量图像,生成病变感兴趣区(region of interest,ROI)CT能谱曲线,计算40~140 keV不同能级水平(每10 keV)下的CT值和能谱曲线斜率,同时在传统混合能量图像的同一ROI测量CT值,对所得CT值、能谱曲线斜率及其诊断效能进行统计学分析。结果: 脊柱转移瘤和感染性病变的中位年龄分别为58岁和64岁,两组差异无统计学意义(U=171,P=0.4)。40~100 keV各能级下脊柱转移瘤的CT值分别为281.79 (143.67, 446.19) HU、199.68 (100.04, 321.49) HU、151.54 (81.47, 243.49) HU、(122.64±27.72) HU、(99.90±23.88) HU、(85.82±21.61) HU、(75.94±20.27) HU,脊柱感染性疾病的CT值分别为185.29 (164.19, 277.03) HU、138.44 (124.98, 238.56) HU、105.46 (92.94, 169.53) HU、(93.77±15.55) HU、(79.15±12.84) HU、(68.99±11.75) HU、(62.22±11.71) HU。脊柱转移瘤在同一能级的CT值显著高于脊柱感染性病变(P均<0.05),110~140 keV能量水平下的CT值差异无统计学意义(P均>0.05)。混合能量图像测量的CT值差异无统计学意义(P>0.05)。脊柱转移瘤的能谱曲线斜率为2.43±0.58,高于脊柱感染性疾病的能谱曲线斜率1.50±0.40(P<0.001)。当静脉期能谱曲线斜率阈值取1.72、40 keV CT值取248.80 HU时,曲线下面积分别为0.905、0.892,灵敏度分别为88.0%、80.0%,特异度分别为76.9%、92.3%。结论: CT能谱曲线能够对鉴别脊柱转移瘤及感染性病变提供有价值的半定量信息,可以作为传统CT影像学的补充。

关键词: 脊椎肿瘤, 细菌感染, 体层摄影术, X线计算机, 诊断, 鉴别

Abstract:

Objective: To evaluate the value of CT spectral curve in differentiating spinal tumor metastasis (STM) from spinal infections (SI).Methods: In the study, 29 STM and 18 SI patients proved pathologically and clinically were examined by dual energy spectral CT (DESCT). The monochromatic images and CT spectral curves were generated automatically by GSI Viewer software. The attenuation values at different energy levels (40-140 keV, every 10 keV), the attenuation values of the lesions on the conventional polychromatic CT images and the gradients of the curve were calculated and compared between STM and SI.Results: The median age of STM and SI (58 years vs. 64 years) were not significantly different (U=171, P=0.4). The attenuation values of STM at 40-100 keV were 281.79 (143.67, 446.19) HU, 199.68 (100.04, 321.49) HU, 151.54 (81.47, 243.49) HU, (122.64±27.72) HU, (99.90±23.88) HU, (85.82±21.61) HU, and (75.94±20.27) HU, respectively, which were significantly higher than SI: 185.29 (164.19, 277.03) HU, 138.44 (124.98, 238.56) HU, 105.46 (92.94, 169.53) HU, (93.77±15.55) HU, (79.15±12.84) HU, (68.99±11.75) HU, and (62.22±11.71) HU (all P<0.05). The attenuation values at 110-140 keV and the attenuation value on the conventional CT images were not significantly different between STM and SI. The gradient of CT spectral curve of STM was 2.43±0.58, which was higher than the value of 1.50±0.40 for SI (P<0.001). Using 1.72 and 248.80 HU as the threshold value for CT spectral curve slope and the attenuation value at 40 keV, could obtain the area under receiver operating characteristic (ROC) curve of 0.905 and 0.892, sensitivity of 88.0% and 80.0%, and specificity of 76.9% and 92.3%.Conclusion: CT spectral curve provides valuable semi-quantitative information for the differential diagnosis of STM and SI, which can be used as a supplement to traditional CT imaging.

Key words: Spinal neoplasms, Bacterial infections, Tomography, X-ray computed, Diagnosis, differential

中图分类号: 

  • R738.1

图1

患者女,76岁,腰痛1月,腰椎结核"

图2

患者男,50岁,肾癌腰椎转移"

图3

脊柱转移瘤与感染性病变的CT能谱曲线"

表1

不同能量水平下脊柱转移瘤与感染性病变的CT值比较"

Group Slope 40 keV 50 keV 60 keV 70 keV 80 keV
Spinal infections/HU 1.50±0.40 185.29
(164.19, 277.03)		 138.44
(124.98, 238.56)		 105.46
(92.94, 169.53)		 93.77±15.55 79.15±12.84
Spinal metastases/HU 2.43±0.58 281.79
(143.67, 446.19)		 199.68
(100.04, 321.49)		 151.54
(81.47, 243.49)		 122.64±27.72 99.90±23.88
t or U value -5.790 290 276 274 -3.467 -2.910
P value <0.001 <0.001 <0.001 0.001 0.001 0.006
Group 90 keV 100 keV 110 keV 120 keV 130 keV 140 keV
Spinal infections/HU 68.99±11.75 62.22±11.71 57.66±11.81 54.46±12.05 51.84±12.21 48.48±13.17
Spinal metastases/HU 85.82±21.61 75.94±20.27 68.86±19.61 63.79±19.33 59.58±19.65 56.65±19.43
t or U value -2.604 -2.044 -1.882 -1.582 -1.291 -1.359
P value 0.013 0.031 0.068 0.122 0.205 0.183

表2

鉴别脊柱转移瘤和感染性病变能谱曲线各种参数的ROC曲线下面积、阈值、灵敏度和特异度"

Items AUC (95%CI) Threshold Sensitivity Specificity
Slope 0.905 (0.806, 1.000) 1.72 88.0% 76.9%
40 keV CT value 0.892 (0.780, 1.000) 248.80 80.0% 92.3%
50 keV CT value 0.849 (0.714, 0.985) 174.09 80.0% 84.6%
60 keV CT value 0.843 (0.710, 0.976) 132.36 76.0% 84.6%
70 keV CT value 0.809 (0.671, 0.948) 105.04 72.0% 84.6%
80 keV CT value 0.766 (0.617, 0.915) 91.67 64.0% 84.6%
90 keV CT value 0.738 (0.580, 0.897) 74.65 68.0% 76.9%
100 keV CT value 0.698 (0.532, 0.865) 68.55 64.0% 76.9%

图4

鉴别脊柱转移瘤和感染性病变能谱曲线相关参数的ROC曲线"

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