中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2892-2896.doi: 10.12307/2023.310

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

椎体CT值鉴别新鲜与陈旧骨质疏松性椎体压缩骨折的可行性

冯宁宁1,姜国正1,俞  兴2,赵  赫2,杨永栋2,关健斌1,马昱堃1,王舒阳1   

  1. 1北京中医药大学,北京市   100029;2北京中医药大学附属东直门医院,北京市   100700
  • 收稿日期:2022-04-10 接受日期:2022-05-26 出版日期:2023-06-28 发布日期:2022-09-19
  • 通讯作者: 俞兴,博士,主任医师,北京中医药大学附属东直门医院,北京市 100700
  • 作者简介:冯宁宁,女,1997年生,陕西省宝鸡市人,汉族,北京中医药大学在读硕士,主要从事脊柱外科方面的研究。
  • 基金资助:
    潍坊奥精仿生骨多中心临床研究项目(横向课题) ,项目名称:仿生矿化胶原人工骨在脊柱疾病及骨折治疗中的疗效观察,项目负责人:俞兴

Feasibility of vertebral CT value in differentiating fresh and old osteoporotic vertebral compression fractures

Feng Ningning1, Jiang Guozheng1, Yu Xing2, Zhao He2, Yang Yongdong2, Guan Jianbin1, Ma Yukun1, Wang Shuyang1   

  1. 1Beijing University of Traditional Chinese Medicine, Beijing 100029, China; 2Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Beijing 100700, China
  • Received:2022-04-10 Accepted:2022-05-26 Online:2023-06-28 Published:2022-09-19
  • Contact: Yu Xing, MD, Chief physician, Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Beijing 100700, China
  • About author:Feng Ningning, Master candidate, Beijing University of Traditional Chinese Medicine, Beijing 100029, China
  • Supported by:
    Weifang Aojing Biomimetic Bone Multi-Center Clinical Research Project (to YX)

摘要:

文题释义:
椎体CT值:是CT 图像中各组织与X射线衰减系数相一致的对应值,在常规骨窗(窗宽1 500 HU,窗位500 HU)下测量相应椎体获得的数值(HU值),能够准确反映椎体松质骨骨含量,近几年已被应用于腰椎融合内固定术后骨质疏松性相关并发症或骨质疏松其他相关性临床研究。
骨质疏松性椎体压缩骨折:是指骨质疏松患者在不同程度轻微创伤或者无明显创伤的情况下,出现脊柱椎体,包括颈、胸、腰椎不同部位的疼痛感,可以出现后凸畸形、驼背、活动受限等主症。临床上对于骨质疏松性椎体压缩骨折新鲜与陈旧骨折的鉴别,影响着患者治疗方法的选择。

背景:骨质疏松性椎体压缩骨折的发病率逐年递增,临床上区分新鲜或陈旧骨折决定了患者治疗方案的选择。对于没有相关检查设备的医院以及MRI和单光子发射计算机断层成像全身骨扫描有禁忌证的患者,寻找一种可以鉴别骨质疏松性椎体压缩骨折性质的简便快速方法具有重要的临床意义。
目的:对比分析椎体CT值与MRI鉴别新鲜与陈旧骨质疏松性椎体压缩骨折的一致性,探讨应用椎体CT值诊断新鲜骨质疏松性椎体压缩骨折的可行性。
方法:回顾性分析2018年1月至2021年10月在北京中医药大学附属东直门医院因骨质疏松性椎体压缩骨折住院且具有完整MRI、CT检查资料的患者40例,年龄55-89岁,平均(74.63±9.71)岁。根据MRI影像明确椎体骨折性质:MRI压脂像出现骨髓水肿像的高信号影诊断新鲜骨折;椎体形态楔形变化但压脂像未见信号异常则诊断陈旧骨折。对相应椎体及上下邻椎分别测得椎体CT值,目标椎体CT值明显高于邻椎CT值诊断为新鲜骨折,目标椎体CT值与邻椎CT值无明显差异诊断为陈旧性骨折。采用Wilcoxon秩和检验对比MRI与椎体CT值判定的新鲜骨折及陈旧骨折的一致性。
结果与结论:①40例患者共累及55个椎体,MRI诊断新鲜骨折椎体42个,陈旧骨折椎体13个;②测量相应椎体CT值,骨质疏松性椎体压缩骨折新鲜骨折椎体CT值(139.99±49.69) HU高于正常邻椎CT值(60.44±34.74) HU,差异有显著性意义(P < 0.01);陈旧性骨折椎体CT值(55.65 ±31.31) HU与正常邻椎CT值(55.07±29.47) HU均值相差约6.19 HU(1.09-14.51 HU),但差异无显著性意义(P > 0.05);③利用椎体CT值诊断新鲜骨折椎体41个,陈旧骨折椎体14个;④Wilcoxon秩和检验MRI与椎体CT值在鉴别骨质疏松性椎体压缩骨折新鲜和陈旧骨折上具有高度的一致性(Kappa值=0.951);⑤提示椎体CT值在诊断骨质疏松性椎体压缩骨折新鲜骨折与陈旧骨折上与MRI具有较高的一致性,通过对比目标椎体与邻椎的CT值能够准确区分新鲜骨折或陈旧骨折,可为临床快速确定骨质疏松性椎体压缩骨折性质提供一种MRI以外的简便检查方法;对于难以定性的骨折,椎体CT值联合MRI可明显提高其诊断的准确性。

https://orcid.org/0000-0001-6464-3599 (冯宁宁)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 椎体CT值, 骨质疏松性椎体骨折, 新鲜骨折, 陈旧骨折

Abstract: BACKGROUND: The incidence of osteoporotic vertebral compression fracture is increasing year by year. Clinical differentiation of fresh or old fractures determines the choice of treatment for patients. It is of great clinical significance to find a simple and rapid method to identify the properties of osteoporotic vertebral compression fracture in hospitals without relevant examination facilities and in patients with contraindications to MRI and single photon emission computed tomography whole-body bone scanning.  
OBJECTIVE: To analyze and compare the consistency between vertebral CT values (Hounsfield units value, HU) and MRI in differentiating fresh and old osteoporotic vertebral compression fractures and to explore the feasibility of using vertebral CT values to diagnose fresh osteoporotic vertebral compression fractures.
METHODS:  A retrospective analysis was performed on 40 patients, aged 55-89 (74.63±9.71) years, diagnosed as osteoporotic vertebral compression fracture with complete MRI and CT examination in Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine from January 2018 to October 2021. The nature of vertebral fractures was determined based on MRI images: Diagnostic criteria of fresh osteoporotic vertebral compression fracture based on MRI were high signal intensity of bone marrow edema on fat-suppression images, whereas normal signal of MRI on the vertebral body with wedge-shaped was diagnosed as old osteoporotic vertebral compression fracture. The vertebral CT values of target vertebrae with its adjacent level were measured separately. The CT value of target vertebra significantly higher than adjacent vertebra was diagnosed as fresh osteoporotic vertebral compression fracture but similar CT value as old osteoporotic vertebral compression fracture. Wilcoxon rank-sum test was used to compare the consistency of fresh and old vertebral fractures determined by MRI and vertebral CT values.  
RESULTS AND CONCLUSION: (1) A total of 55 vertebral bodies were involved in 40 patients; 42 fresh fractures and 13 old fractures were diagnosed via MRI. (2) The Hu of fresh fractured osteoporotic vertebral compression fracture vertebral body (139.99±49.69 HU) was significantly higher than that of normal adjacent vertebral body (60.44 ±34.74 HU) (P < 0.01). The Hu of old fractured vertebral body (55.65±31.31 HU) was 6.19 HU (1.09-14.51 HU) from that of normal adjacent vertebral body (55.07±29.47 HU), and there was no statistical difference (P > 0.05). (3) The vertebral body CT value was used to diagnose 41 fresh fractured vertebral bodies and 14 old fractured vertebral bodies. (4) Wilcoxon rank-sum test showed that MRI and CT were highly consistent in differentiating fresh and old fractures in osteoporotic vertebral compression fracture (Kappa value=0.951). (5) It is concluded that the CT has high consistency with MRI in differentiating fresh and old fracture of osteoporotic vertebral compression fracture. By comparing the CT values of the target and adjacent vertebrae, fresh or old fractures can be accurately distinguished, which can provide a simple examination method other than MRI for rapid clinical decision making. For fractures that are difficult to determine, the combination of vertebral CT values and MRI can markedly improve the diagnostic accuracy.

Key words: vertebral CT value, osteoporotic vertebral fracture, fresh fracture, old fracture

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