Value of DECT in diagnosis of bone marrow lesions in patients with knee osteoarthritis
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摘要:
目的探讨双能CT（DECT）诊断膝关节骨关节炎（KOA）患者骨髓病变的价值。 方法回顾性分析2016年12月~2018年12月收治147例KOA患者的临床资料，所有患者入院后均行膝关节MRI和DECT平扫检查，将其膝关节根据解剖结构划分为12个区域，股骨下段及胫骨上段各6个区域，分别获得MRI图像、常规CT及虚拟去钙图像。以MRI结果作为标准，比较不同对比物质相对比（Rel.CM）值下DECT检查对患者骨髓病变的诊断价值，计算灵敏度、特异度、准确率、阴性预测值和阳性预测值。采用兴趣区定量测量法检测最佳Rel.CM值下虚拟去钙图像中的CT值，对比阳性区及阴性区在DECT图像上的骨髓CT值，经ROC曲线评估DECT图像上的骨髓CT值检测对KOA患者骨髓病变的诊断效能。 结果不同Rel.CM值下DECT诊断KOA患者骨髓病变的灵敏度、特异度、准确率和阳性阴性预测值对比差异无统计学意义（P>0.05），但当Rel.CM=1.45时其灵敏度、特异度、准确率和阳性阴性预测值等均最佳；最佳Rel.CM值下不同区域内骨髓病变阳性及阴性的骨髓CT值比较均有统计学意义（P < 0.05）；ROC曲线显示，单独检测股骨下端CT及胫骨上端CT值均可作为诊断KOA患者骨髓病变的预测指标（P < 0.05）。 结论DECT技术在诊断KOA患者骨髓病变上具有较高准确率，且可通过CT值进行辅助诊断。 Abstract:ObjectiveTo explore the value of dual-energy CT (DECT) in diagnosis of bone marrow lesions in patients with Knee Osteoarthritis (KOA). MethodsThe clinical data of 147 patients with KOA admitted between December 2016 and December 2018 were retrospectively analyzed. All patients underwent knee MRI and DECT plain scan after admission, and their knee joints were divided into 12 regions according to the anatomical structure, including each 6 regions of the lower femur and upper tibia respectively. MRI images, conventional CT and virtual non-calcium images were obtained. Using MRI results as the standard, the diagnostic value of DECT examination on patients with bone marrow lesions under different contrast material relative ratio (Rel.CM) values, and the sensitivity, specificity, accuracy rate, negative predictive value and positive predictive value were calculated. The area of interest quantitative measurement method was used to detect the CT value of virtual noncalcium images under the best Rel.CM value, and the bone marrow CT values of the positive region and the negative region on the DECT images were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of bone marrow CT value on the DECT images on bone marrow lesions in patients with KOA. ResultsThere were no significant differences in the sensitivity, specificity, accuracy rate and positive and negative predictive values of DECT under different Rel.CM values in diagnosing bone marrow lesions in patients with KOA (P>0.05), but when Rel.CM value=1.45, the sensitivity, specificity, accuracy rate and positive and negative predictive values were the best. There were statistically significant differences in the bone marrow CT values of positive and negative bone marrow lesions in different regions under the best Rel.CM value (P < 0.05). ROC curves showed the CT values of the lower end of the femur and the upper end of the tibia can be used as predictive indicators for the diagnosis of bone marrow lesions in patients with KOA (all P < 0.05). Conclusion DECT technology has a high accuracy rate in diagnosing bone marrow lesions in patients with KOA, and it can be used as an auxiliary diagnosis by CT value. -
Key words:
- dual-energy CT /
- magnetic resonance imaging /
- diagnosis /
- knee osteoarthritis /
- bone marrow lesions /
- value
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图 1 膝关节骨关节炎患者膝关节MRI影像学图像
Figure 1. MRI imaging features of knee joint in patients with knee osteoarthritis.
图 2 膝关节骨关节炎患者膝关节DECT影像学图像
患者男, 56岁, 左膝骨关节炎, DECT图像中箭头所示为水肿区域.
Figure 2. DECT imaging features of knee joint in patients with knee osteoarthritis.
图 3 DECT检查骨髓CT值诊断KOA患者骨髓病变的ROC图像
Figure 3. ROC images of bone marrow lesions in patients with KOAdiagnosed by bone marrow CT values by DECT.
表 1 不同Rel.CM值下DECT检查诊断KOA患者骨髓病变结果比较
Table 1. Comparison of results of bone marrow lesions in patients with KOAdiagnosed by DECT under different Rel.CM values
检查方法 MRI 合计 阳性 阴性 DECT（Rel.CM=1.25） 阳性 281 166 447 阳性 33 1320 1353 DECT（Rel.CM=1.45） 阳性 301 80 381 阳性 13 1406 1419 DECT（Rel.CM=1.75） 阳性 286 157 443 阳性 28 1329 1357 DECT: 双能CT; Rel.CM: 不同对比物质相对比. 
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表 2 不同Rel.CM值下DECT检查的灵敏度、特异度、准确率和阳性阴性预测值
Table 2. Sensitivity, specificity, accuracy rate and positive and negative predictive values of DECT under different Rel.CM values
检查方法 灵敏度 特异度 准确率 阳性预测值 阴性预测值 Rel.CM=1.25 0.895 0.888 0.889 0.629 0.976 Rel.CM=1.45 0.959 0.946 0.948 0.790 0.991 Rel.CM=1.75 0.911 0.894 0.897 0.646 0.979
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表 3 DECT检查诊断骨髓病变阳性及阴性区骨髓CT值比较
Table 3. Comparison of bone marrow CT values between positive and negative bone marrow lesions diagnosed by DECT (Hu, Mean±SD)
组别 股骨下端 胫骨上端 阳性组（n=35） -77.26±23.14 -85.42±16.47 阴性组（n=118） -96.47±24.08 -98.14±20.47 t 4.181 3.365 P 0.000 0.001
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表 4 DECT检查骨髓CT值诊断KOA患者骨髓病变的预测效能
Table 4. Predictive efficacy of bone marrow CT values by DECT in the diagnosis of bone marrow lesions in patients with KOA
分组 最佳诊断临界点 AUC 95%CI 敏感度（%） 特异性（%） Z P 股骨下端CT值 81.74 0.721 0.643~0.791 75.42 60.00 4.589 < 0.0001 胫骨上端CT值 95.27 0.729 0.651~0.797 57.63 82.86 4.984 < 0.0001
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