能谱CT预测腰椎间盘Pfirrmann分级的初步研究

李睿; 杜春玲; 邓凯; 苏煜文; 张曼; 王路路; 李文

doi:10.15953/j.1004-4140.2022.31.05.11

能谱CT预测腰椎间盘Pfirrmann分级的初步研究

李睿^1,,
杜春玲^2a,
邓凯^2b,
苏煜文¹,
张曼¹,
王路路¹,
李文^2c, ,

1.
山东第一医科大学, 山东省千佛山医院, 济南250014
1.
护理学；山东第一医科大学第一附属医院（山东省千佛山医院）
2.
放射科；山东第一医科大学第一附属医院（山东省千佛山医院）
3.
核医学, 济南 250014 山东第一医科大学第一附属医院（山东省千佛山医院）

详细信息

作者简介:
李睿: 男，山东第一医科大学影像医学与核医学专业硕士研究生，主要从事能谱CT方面研究，E-mail：563552396@qq.com

李文: 男，山东第一医科大学第一附属医院（山东省千佛山医院）主任医师，主要从事心肌灌注显像方面研究，E-mail：0686@sdhospital.com.cn

中图分类号: R 814
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出版历程
- 收稿日期: 2021-06-23
- 网络出版日期: 2021-12-06
- 发布日期: 2022-09-30

A Preliminary Study of Spectral CT in Predicting Pfirrmann Grading of Lumbar Intervertebral Disc

LI Rui^1,,
DU Chunling^2a,
DENG Kai^2b,
SU Yuwen¹,
ZHANG Man¹,
WANG Lulu¹,
LI Wen^2c, ,

1.
Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan 250014, China
1.
The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China Department of Nursing
2.
The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China Urology Surgery
3.
The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China Nuclear Medicine

摘要

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。
- 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.
- spectral CT /
- Pfirrmann grading /
- intervertebral disc degeneration /
- lumbar disc herniation

HTML全文

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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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。

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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。

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