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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."

[1] Lee SH, Lee JM, Kim KW, et al. Dual-energy computed tomography to assess tumor response to hepatic radiofrequency ablation: potential diagnostic value of virtual noncontrast images and iodine maps[J]. Invest Radiol, 2011,46(2):77-84.
doi: 10.1097/RLI.0b013e3181f23fcd pmid: 20856125
[2] Lang N, Yuan H, Yu HJ, et al. Diagnosis of spinal lesions using heuristic and pharmacokinetic parameters measured by dynamic contrast-enhanced MRI[J]. Acad Radiol, 2017,24(7):867-875.
doi: 10.1016/j.acra.2016.12.014 pmid: 28162875
[3] Babic M, Simpfendorfer CS. Infections of the Spine[J]. Infect Dis Clin North Am, 2017,31(2):279-297.
doi: 10.1016/j.idc.2017.01.003 pmid: 28366222
[4] Dong Y, Zheng S, Machida H, et al. Differential diagnosis of osteoblastic metastases from bone islands in patients with lung cancer by single-source dual-energy CT: advantages of spectral CT imaging[J]. Eur J Radiol, 2015,84(5):901-907.
doi: 10.1016/j.ejrad.2015.01.007 pmid: 25661696
[5] Ko JP, Brandman S, Stember J, et al. Dual-energy computed tomography: concepts, performance, and thoracic applications[J]. J Thorac Imaging, 2012,27(1):7-22.
doi: 10.1097/RTI.0b013e31823fe0e9 pmid: 22189245
[6] Flais J, Coiffier G, Brillet E, et al. Atypical presentation of spine bone metastasis in prostate cancer mimicking Pott’s disease[J]. Clin Cases Miner Bone Metab, 2017,14(2):239-240.
doi: 10.11138/ccmbm/2017.14.1.239 pmid: 29263741
[7] 袁源, 张艳, 郎宁, 等. CT能谱曲线鉴别诊断脊柱肿瘤及肿瘤样病变[J]. 中国医学影像技术, 2015,31(4):600-603.
[8] Avrin DE, Macovski A, Zatz LE. Clinical application of Compton and photo-electric reconstruction in computed tomography: preliminary results[J]. Invest Radiol, 1978,13(3):217-222.
doi: 10.1097/00004424-197805000-00007 pmid: 711396
[9] Dilmanian FA. Computed tomography with monochromatic X rays[J]. Am J Physiol Imaging, 1992,7(3/4):175-193.
[10] Riederer SJ, Mistretta CA. Selective iodine imaging using K-edge energies in computerized X-ray tomography[J]. Med Phys, 1977,4(6):474-481.
doi: 10.1118/1.594357 pmid: 927384
[11] Silva AC, Morse BG, Hara AK, et al. Dual-energy (spectral) CT: applications in abdominal imaging[J]. Radiographics, 2011,31(4):1031-1050.
doi: 10.1148/rg.314105159 pmid: 21768237
[12] 雷立昌, 陈建宇. 能谱CT的临床应用与研究进展[J]. 中国医学影像技术, 2013,29(1):146-149.
[13] 林晓珠, 沈云, 陈克敏. CT能谱成像的基本原理与临床应用研究进展[J]. 中华放射学杂志, 2011,45(8):798-800.
[14] 张靖, 周新社. 脊柱肿瘤的诊断和外科分期研究进展[J]. 中华全科医学, 2011,9(2):277-279.
[15] Go SW, Lee HY, Lim CH, et al. Atypical disseminated skeletal tuberculosis mimicking metastasis on PET-CT and MRI[J]. Intern Med, 2012,51(20):2961-2965.
doi: 10.2169/internalmedicine.51.8347 pmid: 23064577
[16] Mittal S, Khalid M, Sabir AB, et al. Comparison of magnetic resonance imaging findings between pathologically proven cases of atypical tubercular spine and tumour metastasis: A retrospective study in 40 patients[J]. Asian Spine J, 2016,10(4):734-743.
doi: 10.4184/asj.2016.10.4.734 pmid: 27559455
[17] Sezgin B, Atilganoglu U, Yigit O, et al. Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis[J]. Indian J Dermatol, 2008,53(3):149-153.
doi: 10.4103/0019-5154.43208 pmid: 19882018
[18] Chang DS, Rafii M, McGuinness G, et al. Primary multifocal tuberculous osteomyelitis with involvement of the ribs[J]. Skeletal Radiol, 1998,27(11):641-645.
doi: 10.1007/s002560050451 pmid: 9867183
[19] Lang N, Su MY, Yu HJ, et al. Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI[J]. Eur Spine J, 2015,24(8):1729-1737.
doi: 10.1007/s00586-015-3851-z pmid: 25749725
[20] Zheng S, Dong Y, Miao Y, et al. Differentiation of osteolytic metastases and Schmorl’s nodes in cancer patients using dual-energy CT: Advantage of spectral CT imaging[J]. Eur J Radiol, 2014,83(7):1216-1221.
doi: 10.1016/j.ejrad.2014.02.003 pmid: 24820064
[21] Gupta S, Wagner-Bartak N, Jensen CT, et al. Dual-energy CT of pancreatic adenocarcinoma: Reproducibility of primary tumor measurements and assessment of tumor conspicuity and margin sharpness[J]. Abdom Radiol (NY), 2016,41(7):1317-1324.
[22] Ramon A, Bohm-Sigrand A, Pottecher P, et al. Role of dual-energy CT in the diagnosis and follow-up of gout: systematic analysis of the literature[J]. Clin Rheumatol, 2018,37(3):587-595.
doi: 10.1007/s10067-017-3976-z pmid: 29350330
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