A Preliminary Study of Spectral CT in Predicting Pfirrmann Grading of Lumbar Intervertebral Disc
-
摘要: 目的：探讨能谱CT物质分离技术对腰椎间盘退行性病变Pfirrmann分级的预测价值。方法：回顾性分析2020年10月至2021年2月我院腰椎间盘突出患者30例，分别行能谱CT扫描及MRI扫描，将Pfirrmann分级中1～3级归入低级别组，4～5级归入高级别组。利用能谱后处理分析软件在相同ROI下分别测得椎间盘的水（钙）浓度、水（HAP）浓度、钙（水）浓度、HAP（水）浓度及Eff-Z。采用独立样本t检验比较各参数之间有无差异，并进一步绘制ROC曲线，利用曲线下面积衡量诊断效能并选择最佳诊断阈值。结果：低级别椎间盘的水（钙）浓度、水（HAP）浓度高于高级别椎间盘水（钙）浓度、水（HAP）浓度，低级别钙浓度、HAP浓度及Eff-Z低于高级别椎间盘钙浓度、HAP浓度及Eff-Z，差异具有统计学意义。ROC曲线显示水（钙）浓度、水（HAP）浓度对区分低级别与高级别椎间盘的诊断效能较低；钙浓度具有一定的诊断效能；HAP及Eff-Z具有较高的诊断效能，尤其以Eff-Z为著，AUC为0.97，以7.69为标准区分低级别与高级别椎间盘的敏感性及特异性分别为96.20％ 和94.12％。结论：能谱CT多参数定量分析对区分低级别与高级别椎间盘具有一定价值。
-
关键词:
- 能谱CT /
- Pfirrmann分级 /
- 腰椎间盘退行性变 /
- 腰椎间盘突出症
Abstract: Objective: To investigate the predictive value of material separation technology of spectral CT in Pfirrmann grading of lumbar intervertebral disc degeneration. Methods: Retrospective analysis was performed on 30 patients with lumbar disc herniation in our hospital from October 2020 to February 2021. Spectral CT scan and MRI scan were performed respectively. Grade 1-3 of Pfirrmann grading was classified into low grade group, while grade 4-5 was classified into high grade group. Water (calcium) concentration, water (HAP) concentration, calcium (water) concentration, HAP (water) concentration and Eff-Z of intervertebral disc were measured by spectral post-processing analysis software in the same ROI. Independent sample t est was used to compare the differences among parameters, furthermore, the ROC curve was drawn. The area under the curve was used to evaluate the diagnostic efficiency and select the optimal diagnostic threshold. Results: The concentrations of water (calcium) and water (HAP) in low-grade intervertebral discs were higher than those in high-grade intervertebral discs, while the concentrations of water (calcium), water (HAP) and Eff-Z in low-grade intervertebral discs, were lower than those in high-grade intervertebral discs, which held statistical significance. The ROC curve showed that water (calcium) concentration and water (HAP) concentration were less effective in diagnosing the difference between low-grade and high-grade discs. Calcium concentration holds certain diagnostic efficacy. HAP and Eff-Z hold high diagnostic efficacy. while Eff-Z shows better diagnostic efficacy with AUC of 0.97. Taking 7.69 as the standard, the sensitivity and specificity of differentiating low-grade and high-grade intervertebral discs are respectively 96.25% and 96.00%. Conclusion: Spectral CT with multi-parameters quantitative analysis holds certain value in distinguishing low grade and high grade intervertebral discs. -
-
![]()
图 1 男，23岁，L1-2椎间盘单能量图像及MRI矢状位图
（a）～（e）所测得数值分别为1071.41、1069.56、0.69和3.12 mg/mL、7.64；（f）为MRI矢状位图像，Pfirrmann分级2级，归入低级别组。
Figure 1. Male, 23 years old, monoenergetic CT images and MRI sagittalimage of L1-2 intervertebral disc
![]()
图 2 男，73岁，L2-3椎间盘单能量图像及MRI矢状位图
（a）～（e）所测得数值分别为1058.75、1052.77、4.43和9.61 mg/mL、7.81；（f）为MRI矢状位图像，Pfirrmann分级4级，归入高级别组。
Figure 2. Male, 73 years old, monoenergetic CT images and MRI sagittalimage of L2-3 intervertebral disc
表 1 低级别与高级别椎间盘能谱CT各参数比较（
$ \bar x \pm s $ ）Table 1 Comparison of spectral CT parameters between low-grade and high-grade intervertebral discs (
$ \bar x \pm s $ )级别 例数 水（钙）/（mg/mL） 水（HAP）/（mg/mL） 钙浓度/（mg/mL） HAP浓度/（mg/mL） Eff-Z 低级别 51 1066.71±7.50 1063.19±8.01 2.16±1.38 4.93±2.65 7.62±0.06 高级别 79 1061.57±9.87 1055.18±12.98 4.92±1.90 10.51±3.23 7.94±0.16 t 3.18 4.35 -8.97 -10.31 -15.88 P 0.002 <0.001 <0.001 <0.001 <0.001 注：HAP：羟基磷灰石；Eff-Z：有效原子序数。 
下载: 导出CSV
表 2 能谱CT各参数鉴别低级别与高级别椎间盘的诊断效能
Table 2 Diagnostic efficacy of energy spectrum CT parameters in differentiating low-grade and high-grade intervertebral discs
能谱CT参数 AUC 最佳阈值 敏感度/％ 特异度/％ 水（钙）浓度/（mg/mL） 0.65 1059.30 43.04 84.31 水（HAP）浓度/（mg/mL） 0.69 1049.61 34.18 100.00 钙浓度/（mg/mL） 0.88 2.96 89.87 78.43 HAP浓度/（mg/mL） 0.92 7.89 82.28 94.12 Eff-Z 0.97 7.69 96.20 94.12 注：HAP：羟基磷灰石；Eff-Z：有效原子序数；AUC：ROC曲线下面积。
下载: 导出CSV
-
[1] HALL J A, KONSTANTINOU K, LEWIS M, et al. Systematic review of decision analytic modelling in economic evaluations of low back pain and sciatica[J]. Applied Health Economics and Health Policy, 2019, 17(4): 467−491. DOI: 10.1007/s4058-019-00471-w.
[2] GE J, CHENG X, YAN Q, et al. Calcitonin inhibits intervertebral disc degeneration by regulating protein kinase C[J]. Journal of Cellular and Molecular Medicine, 2020, 24(15): 8650−8661. DOI: 10.1111/jcmm.15496.
[3] GUO Z, SU W, ZHOU R, et al. Exosomal MATN3 of urine-derived stem cells ameliorates Intervertebral disc degeneration by antisenescence effects and promotes NPC proliferation and ECM synthesis by activating TGF-β[J]. Oxidative Medicine and Cellular Longevity, 2021. http://dx.doi.org/10.1155/2021/5542241.
[4] 崔运能, 李绍林, 张晓东, 等. 腰椎间盘CT真空现象与MR高信号区对椎间盘退变的诊断价值[J]. 临床放射学杂志, 2019,38(6): 1097−1102. DOI: 10.13437/j.cnki.jcr.2019.06.036. Cui Y N, Li S L, Zhang X D, et al. The vacuum phenomenon on CT and high intensity zone on MRI in diagnosis of lumbar disc degeneration[J]. Journal of Clinical Radiology, 2019, 38(6): 1097−1102. DOI: 10.13437/j.cnki.jcr.2019.06.036. (in Chinese).
[5] DEANE J A, LIM A K P, MCGREGOR A H, et al. Understanding the impact of lumbar disc degeneration and chronic low back pain: A cross-sectional electromyographic analysis of postural strategy during predicted and unpredicted postural perturbations[J]. PLoS One, 2021, 16(4): e0249308. DOI: 10.1371/journal.pone.0249308.
[6] 祁艳梅, 邓兴, 陈晓飞, 等. 3.0T MR IDEAL和T_2mapping成像在腰椎间盘早期退变中的应用[J]. 临床放射学杂志, 2020,39(11): 2287−2292. DOI: 10.13437/j.cnki.jcr.2020.11.032. QI Y M, DENG X, CHEN X F, et al. Research progress on intervertebral disc calcification[J]. Journal of Clinical Radiology, 2020, 39(11): 2287−2292. DOI: 10.13437/j.cnki.jcr.2020.11.032. (in Chinese).
[7] VIOLANTE F S, ZOMPATORI M, LOVREGLIO P, et al. Is age more than manual material handling associated with lumbar vertebral body and disc changes? A cross-sectional multicentre MRI study[J]. BMJ Open, 2019, 9(9): e029657. DOI: 10.1136/bmjopen-2019-029657.
[8] RIESTER S M, LIN Y, WANG W, et al. RNA sequencing identifies gene regulatory networks controlling extracellular matrix synthesis in intervertebral disk tissues[J]. Journal of Orthopaedic Research, 2018, 36(5): 1356−1369. DOI: 10.1002/jor.23834.
[9] 徐增, 孙斌, 吴卉乔, 等. 椎间盘钙化研究进展[J]. 中国脊柱脊髓杂志, 2019,29(10): 936−939. DOI: 10.3969/j.issn.1004-406X.2019.10.11. XU Z, SUN B, WU H Q, et al. Research progress on intervertebral disc calcification[J]. Chinese Journal of Spine and Spinal Cord, 2019, 29(10): 936−939. DOI: 10.3969/j.issn.1004-406X.2019.10.11. (in Chinese).
[10] SHAO J, YU M, JIANG L, et al. Differences in calcification and osteogenic potential of herniated discs according to the severity of degeneration based on Pfirrmann grade: A cross-sectional study[J]. BMC Musculoskeletal Disorders, 2016, 17: 191. DOI: 10.1186/s12891-016-1015-x.
[11] KARAMOUZIAN S, ESKANDARY H, FARAMARZEE M, et al. Frequency of lumbar intervertebral disc calcification and angiogenesis, and their correlation with clinical, surgical, and magnetic resonance imaging findings[J]. Spine (Phila Pa 1976), 2010, 35(8): 881−886. DOI: 10.1097/BRS.0b013e3181b9c986.
[12] 邓治强, 汤敏. 食管胃结合部癌病理型别的能谱CT鉴别诊断效果分析[J]. CT理论与应用研究, 2019,28(2): 247−254. DOI: 10.15953/j.1004-4140.2019.28.02.11. DENG Z Q, TANG M. Analysis of CT differential diagnosis of esophageal and gastric syndromes with different pathological types[J]. CT Theory and Applications, 2019, 28(2): 247−254. DOI: 10.15953/j.1004-4140.2019.28.02.11. (in Chinese).
-
期刊类型引用(14)
1. 丁晓凌，李春海. MRI、CTA单独及联合检查对急性缺血性脑卒中患者颈动脉病变的诊断价值. 医学临床研究. 2025(02): 333-335 . 
百度学术
2. 陈育锋，程影，祁良. 老年脑梗死颅内动脉狭窄的数字减影血管造影、CT血管成像影像特征及诊断价值比较分析. 中国医药导报. 2022(10): 151-154 . 百度学术
3. 万宏燕，杨瑜，韩媛媛. 颈部血管超声联合CT血管造影对脑梗死患者颈动脉斑块的诊断价值. 实用心脑肺血管病杂志. 2022(06): 98-101 . 百度学术
4. 毕文君. 超声与磁共振血管成像对脑卒中颈部血管狭窄性病变的诊断价值分析. 中国实用医药. 2022(16): 100-102 . 百度学术
5. 王文峰，郭晓莲，常叶，牟荣骥. SMI技术联合CTA在缺血性脑卒中患者颈动脉狭窄中应用及影像学特征. 中国老年学杂志. 2022(17): 4142-4145 . 百度学术
6. 傅国萍，马黎，周峰，刘荣荣，徐玲佳. 急性缺血性脑卒中伴脑白质疏松与颅内外动脉狭窄的相关性研究. 中国基层医药. 2022(10): 1452-1456 . 百度学术
7. 丁芳，吴穹宇，葛芳清，王卫霞. 高血压对颈动脉斑块的影响及斑块特点与血管狭窄的关系. 南通大学学报(医学版). 2022(04): 336-339 . 百度学术
8. 邓雁秀，黎冠东，李伟，刘壮盛. 探讨双源高分辨螺旋CT颈部血管造影对脑梗死的诊断价值. 承德医学院学报. 2021(02): 119-122 . 百度学术
9. 王碧昊，王保平，段燕东，焦向锋，肖雁，张建芳. 血流储备分数CT成像对冠状动脉旁路移植术后的影像学评价. CT理论与应用研究. 2021(03): 361-369 . 本站查看
10. 路远. CTA诊断颈动脉狭窄效能分析. 医药论坛杂志. 2021(10): 44-46 . 百度学术
11. 谢绪峰. 低剂量CT血管造影应用于临床颈动脉狭窄程度分级中的效果体会. 影像研究与医学应用. 2021(09): 121-122 . 百度学术
12. 严德星，熊伟坚，白奕斌，叶峰，陈龙. 64排多层螺旋CT血管内成像在颈动脉狭窄诊断中的应用. 海南医学. 2021(17): 2234-2237 . 百度学术
13. 郑纬. 头颈结合CT血管造影应用在头颈动脉狭窄中的效果分析. 影像研究与医学应用. 2021(21): 50-51 . 百度学术
14. 朱慧萍，辛剑锋. 超声、CT血管造影对颈动脉狭窄患者颈动脉粥样硬化斑块数量、分布、性质及颈动脉狭窄程度的评估价值. 中外医疗. 2021(35): 195-198 . 百度学术
其他类型引用(0)
计量
- 文章访问数: 397
- HTML全文浏览量: 227
- PDF下载量: 29
- 被引次数: 14
