CT值用于鉴别成骨性骨转移与骨岛的价值研究

摘要

目的 通过分析成骨性转移瘤和骨岛患者CT值的不同表现,探讨CT值用于鉴别脊柱成骨性转移瘤和脊柱骨岛的应用价值.方法 回顾性分析2017年1月—2018年5月脊柱成骨性转移瘤患者40 例共67 个病灶.选取同时间段经CT随访确诊的脊柱骨岛患者47 例,病灶58 个.测量所有病灶的平均CT值、最大CT值及最小CT值,采用独立样本t检验进行统计学分析.对差异具有统计学意义的变量进行ROC曲线分析,评估其用于鉴别成骨性骨转移瘤和骨岛的诊断效能.结果 成骨性转移瘤病灶和骨岛病灶的平均CT值(P＝0.000)、最大CT值(P＝0.000)和最小CT值(P＝0.000)之间差异均有统计学意义.ROC曲线分析显示:平均CT值、最大CT值和最小CT值的曲线下面积分别为0.933,0.951,0.937.当平均CT值为868 HU时,病灶诊断为骨岛的敏感性为94.8%,特异性为88.1%.当最大CT值为922 HU时,病灶诊断为骨岛的敏感性为94.8%,特异性为91.0%.当最小CT值为732 HU时,病灶诊断为骨岛的敏感性为93.1%,特异性为83.6%.结论 平均CT值、最大CT值及最小CT值在鉴别成骨性转移瘤和骨岛时有较好的诊断效能.%Objective To investigate the application value of CT attenuation values in differentiating osteogenic metastases and enostoses by analyzing the different manifestations of CT attenuation values in osteogenic metastases and enostoses patients. Methods Assessment of 67 lesions from 40 cases which were diagnosed as tumor with osteogenic metastasis was done. 58 enostoses from 47 patients were also chosen for further analysis. Average, max and minimum CT values of lesions were measured and analyzed using t test. A ROC curve was then utilized to calculate the approximate probability of diagnosis at different ranges of measurement values for each of the parameter studied. Results Average, max and minimum CT values from metastases and enostoses were found to have significant statistical difference (P＝0.000, 0.000, 0.000). In ROC curve analysis, the AUC of average CT value was 0.933, the AUC of max CT value was 0.951, the AUC of minimum CT value was 0.937. Threshold average CT value of 868 HU had a sensitivity of 94.8% and specificity of 88.1%. Threshold max CT value of 922 HU had a sensitivity of 94.8% and specificity of 91.0%. Threshold minimum CT value of 732 HU had a sensitivity of 93.1% and specificity of 83.6%. Conclusion The average, max and minimum CT values are considered to be metrics that can be used to differentiate between osteogenic metastasis and enostoses.