CAJ | 학술논문

目的分析和比较磁共振双回波技术和表观扩散系数的定量分析在鉴别脊柱急性单纯性骨折和转移瘤的价值.方法 43例脊柱转移瘤患者(79个椎体,患者平均年龄68.2岁)和59例急性单纯性骨折患者(68例急性良性压缩性骨折,患者平均年龄60岁)纳入研究.选取T1WI上最大病灶面积的层面,在相应图像上测定和计算病灶的正/反回波信号强度比(反相位信号强度/同相位信号强度)和表观扩散系数,计算急性单纯性骨折和转移瘤的ADC值和SIR值,建立受试者操作特性曲线(ROC)曲线,比较这2种技术诊断能力,并进行平行试验,系列试验和logistic多指标联合的ROC分析.结果脊柱转移瘤与急性单纯性骨折的ADC值分别为(1.32±0.5)×10~(-3)mm~2/s和(2.39±0.4)×10~(-3)mm~2/s,SIR分别为1.0±0.01和0.85±0.01,差异均有统计学意义(P<0.01).SIR的ROC 曲线下面积(AUC)为0.897,ADC的ROC AUC值为0.960,两者差异有统计学意义(P=0.02),以SIR=0.97为界值时,灵敏度、特异度分别为84.81%,76.47%;以ADC=1.87×10~(-3)mm~2/s为界值时,灵敏度、特异度分别为93.67%,91.18%.平行试验可获得99.04%的灵敏度和69.73%的特异度,系列试验可获得79.44%的灵敏度和97.92%的特异度.而通过logistic回归建立联合预测因子有较高的ROC AUC.当以联合预测因子=0.55为界值时,灵敏度、特异度可达98.73%,95.59%;以AUC大小排序:联合预测因子>ADC>SIR,多重比较LSD-t检验显示各指标间差异均有统计学意义(P<0.05).结论在鉴别转移瘤与急性单纯性骨折方面,DWI的ADC和双回波的SIR技术的联合可以获得最优化的诊断效果.
목적 분석화비교자공진쌍회파기술화표관확산계수적정량분석재감별척주급성단순성골절화전이류적개치.방법 43례척주전이류환자(79개추체,환자평균년령68.2세)화59례급성단순성골절환자(68례급성량성압축성골절,환자평균년령60세)납입연구.선취T1WI상최대병조면적적층면,재상응도상상측정화계산병조적정/반회파신호강도비(반상위신호강도/동상위신호강도)화표관확산계수,계산급성단순성골절화전이류적ADC치화SIR치,건립수시자조작특성곡선(ROC)곡선,비교저2충기술진단능력,병진행평행시험,계렬시험화logistic다지표연합적ROC분석.결과 척주전이류여급성단순성골절적ADC치분별위(1.32±0.5)×10~(-3)mm~2/s화(2.39±0.4)×10~(-3)mm~2/s,SIR분별위1.0±0.01화0.85±0.01,차이균유통계학의의(P<0.01).SIR적ROC 곡선하면적(AUC)위0.897,ADC적ROC AUC치위0.960,량자차이유통계학의 의(P=0.02),이SIR=0.97위계치시,령민도、특이도분별위84.81%,76.47%;이ADC=1.87×10~(-3)mm~2/s위계치시,령민도、특이도분별위93.67%,91.18%.평행시험가획득99.04%적령민도화69.73%적특이도,계렬시험가획득79.44%적령민도화97.92%적특이도.이통과logistic회귀건립연합예측인자유교고적ROC AUC.당이연합예측인자=0.55위계치시,령민도、특이도가 체98.73%,95.59%;이AUC대소배서:연합예측인자>ADC>SIR,다중비교LSD-t검험현시각지표간차이균유통계학의의(P<0.05).결론 재감별전이류여급성단순성골절방면,DWI적ADC화쌍회파적SIR기술적연합가이획득최우화적진단효과.
Objective To evaluate the value of dual echo technique in combination with apparent diffusion coefficient(ADC) in differentiating acute benign vertebral fracture from metastasis.Methods 43 patients (mean age, 68.2 years) with 79 metastatic vertebrae and 59 patients(mean age,60) with 68 acute vertebral fractures were included in our study.The slices of largest size of lesion on T1WI were selected to measure and calculate the signal intensity ratio(SIR) and ADC of lesions.The difference of ADC values and SIR between benign acute vertebral fractures and vertebral metastasis were compared.Parallel test,serial test and receiver operating characteristic curve(ROC) analysis of logistic model were done.Results ADC values of metastasis and acute benign fracture were (1.32±0.5)×10~（-3）mm~2/s and (2.39±0.4)×10~(-3)mm~~2/s respectively,and SIR of them were 1.00±0.01 and 0.85±0.01 respectively,there were significantly different between these two entities with the two tests(P<0.05).The area under the curve(AUC) for SIR was 0.897 and for ADC was 0.960,there is significantly different between these two tests in AUC(P=0.02).When 0.97 as cut off value for SIR,the sensitivity and specificity were 84.81% and 76.47%% respectively,when 1.87×10~(-3)mm~2/s as cutoff value for ADC , the sensitivity and specificity were 93.67% and 91.18% respectively . The sensitivity and specificity were 99.04% and 69.73% respectively in the parallel tests and 79.44%,97.92% in the serial test.A combining predictor established with logistic regression model showed a high AUC:0.985,which was higher than that of ADC and SIR alone.The AUC under ROC for ADC was significantly larger than that of SIR . When 0.55 as cut off value for this combining predictor , the sensitivity and specificity were 98.73% and 95.59% respectively.Multiple comparisons were performed with LSD-t test :combining predictor>ADC>SIR,it showed that there was significantly different between indexes(P<0.05). Conclusion ADC in combination with SIR can improve the effects in differentiating benign acute vertebral fractures and vertebral metastasis.