双能量CT虚拟单能量成像在鉴别脊柱急慢性压缩骨折中的应用价值

目的：探讨双能量CT虚拟单能量成像在鉴别脊柱急慢性压缩骨折中的应用价值。方法：收集85例脊柱压缩性骨折患者行双能量CT及MRI检查并进行回顾性分析，其中50例急性压缩性骨折（共60个椎体）、35例慢性压缩性骨折（共48个椎体）。所有病灶椎体均有MRI诊断结果作为参照。将双能量CT图像数据进行虚拟单能量重建，分别得到40~120 keV的9组图像。对双能量CT虚拟单能量不同能级图像质量进行评分，作Kappa检验评价观察者间一致性。测量脊柱急慢性压缩骨折椎体在双能量CT虚拟单能量不同能级CT值，作Mann-Whitney U检验比较两者CT值之间差异性。通过ROC曲线分析虚拟单能量成像不同能级对脊柱急慢性压缩性骨折的鉴别诊断效能。结果：两名观察者对图像质量主观评估一致性较好（Kappa=0.805）且在虚拟单能量80 keV能级下图像质量评分最高。脊柱急慢性椎体在虚拟单能量不同能级下CT值之间差异有统计学意义，P值均<0.05。ROC曲线分析显示在120 keV时AUC值最高为0.72，相应敏感性为86.7%。结论：相较于常规CT，双能量虚拟单能量成像能通过形态学特征及不同能级定量值进行综合评估，更好地鉴别脊柱急慢性压缩性骨折，从而帮助指导临床治疗决策及改善患者预后质量。

The Application Value of Dual-Energy CT Virtual Monoenergetic Imaging in the Differential Diagnosis of acute and Chronic Spinal Compression Fractures

Objective: To explore the value of dual-energy CT virtual monoenergetic imaging in the differential diagnosis of acute and chronic spinal compression fractures. Methods: A total of 85 patients with spinal compression fractures were underwent DECT examination and retrospective analyzed, including 50 acute spinal compression fractures(60 vertebral bodies) and 35 chronic spinal compression fractures(48 vertebral bodies). All lesions were diagnosed by surgical pathology or clinical follow-up. The dual-energy CT virtual monoenergetic images were reconstructed into 9 groups(40~120 ke V). Two radiologists scored the image quality of the dual energy CT virtual monoenergetic imaging at different energy levels. Kappa test was used to evaluate the consistency between observers. A senior radiologist measured the CT values of spinal vertebral bodies with acute and chronic compression fractures under different energy levels of dual-energy CT virtual monoenergetic imaging. The Mann-Whitney U test was used to compare the differences between CT values. The ROC curve was used to analyze the differential diagnostic performance of virtual monoenergetic imaging for acute and chronic spinal compression fractures. Results: The subjective assessment of image quality between the two observers was consistent(Kappa = 0.805), and the image quality score was highest at 80 ke V virtual monoenergetic level. There were statistically significant differences in CT values between spinal acute and chronic vertebral bodies at different levels of virtual monoenergetic imaging, with P values < 0.05. ROC curve analysis showed that the highest AUC value at 120 ke V was 0.72, and the corresponding sensitivity was 86.7%. Conclusion: Compared with conventional CT, dual-energy virtual single-energy imaging can perform qualitative and quantitative comprehensive evaluation through morphological features and CT values. It can better identify acute and chronic compression fractures of the spine, which can help guide clinical treatment decisions and improve patient prognosis.