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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (1): 183-187. doi: 10.19723/j.issn.1671-167X.2021.01.027

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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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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

CLC Number: 

  • R738.1

Figure 1

Lumbar tuberculosis in a 76-year-old women with back pain A, mixed energy images; B, the spectral curve of the region of interest (marked as the number 2) on the left image."

Figure 2

Lumbar metastasis from renal carcinoma in a 50-year-old men A, mixed energy images; B, the spectral curves of the region of interest (marked as the number 2, 4, 6) on the left image."

Figure 3

The CT spectral curve of metastases and infections in the spine"

Table 1

Comparison of the CT attenuation value between metastasis and infections in the spine at the different energy levels"

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

Table 2

Areas under the ROC curves, thresholds, sensitivities and specificities for distinguishing spinal metastasis from infections"

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%

Figure 4

ROC curves for the related parameters in differentiating spinal metastasis from infections ROC, receiver operating characteristic."

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