第7~9胸椎CT值对国人成年女性骨密度评估价值的研究

doi:10.3760/cma.j.cn101202-20211221-00389

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摘要目的探讨胸椎CT值在国人成年女性骨密度（BMD）值评估中的应用价值。方法回顾性研究。纳入2020年3月—2021年7月南京中医药大学附属中西医结合医院成年女性体检者287名,年龄21~84（55.8±13.6）岁。287名被试者均行胸部CT扫描,以标准算法重建图像,采用定量CT（QCT）测量软件分别测量T_7~9椎体的BMD值,计算平均BMD值;在影像存储和传输系统中测量T_7~9椎体的CT值,计算平均CT值。观察胸椎CT值与BMD值之间的相关性。将胸椎BMD值转换为腰椎BMD值,根据腰椎BMD值诊断被试者骨质状态,绘制受试者操作特征（ROC）曲线,分析依据胸椎平均CT值诊断骨质疏松（BMD<80 mg/cm³）和骨质正常（BMD>120 mg/cm³）的灵敏度、特异度和最佳阈值。结果 T₇~T₉椎体的BMD和T_7~9椎体平均BMD分别为（125.17±47.42）、（121.84±48.33）、（123.93±49.24）和（123.67±47.73） mg/cm³,T₇~T₉椎体的CT值和T_7~9椎体平均CT值分别为（157.48±56.97）、（154.92±58.37）、（158.03±60.02）和（156.81±57.78） HU。T_7~9各椎体CT值、平均CT值均与相应椎体的BMD值呈正相关（r=0.946、0.960、0.956、0.968,P值均<0.001）。287名被试者中,骨质疏松77例,骨质减少102例,骨质正常108例。ROC曲线显示：平均CT值诊断骨质疏松的曲线下面积（AUC）为0.988[95%可信区间（CI）0.997~0.999,P<0.001],平均CT值<116 HU时诊断骨质疏松的灵敏度为98.6%,特异度为92.2%;平均CT值诊断骨质正常的AUC为0.997（95%CI 0.993~1.000,P<0.001）,平均CT值>170 HU时诊断骨质正常的灵敏度为100.0%,特异度为96.1%。结论胸椎平均CT值能反映BMD的情况,对骨质疏松的诊断效能较高,胸椎平均CT值的测量可作为预测高危人群BMD情况的辅助手段。

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	李清瑶
	张宗军
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	滕剑
	王睿
	彭飞
	刘许慧

关键词 ：骨密度, 体层摄影术, 螺旋计算机, 定量CT, 胸椎

Abstract：Objective This study was performed to explore the application value of thoracic CT values on the bone mineral density (BMD) in adult Chinese women. Methods A retrospective study was used in this work. A total of 287 adult female examiners (aged 21-84 years [mean=55.8±13.6 years]) were recruited from May 2020 to July 2021 at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine. The participants underwent chest CT scan, and the images were reconstructed by standard algorithm. The BMD and CT attenuation values of the T_7-9 vertebral bodies were measured by quantitative CT (QCT) software and picture archiving and communication systems. The average BMD and CT attenuation values were calculated. The two measurements were also correlated. The BMD of the thoracic vertebra was converted into the BMD of the lumbar vertebra. Diagnosis results were obtained according to the Chinese guideline for the diagnosis criteria of osteoporosis by using QCT. Receiver operator characteristic curves were generated to analyze the sensitivity, specificity, and optimal threshold of the CT values in the diagnosis of osteoporosis (BMD <80 mg/cm³) and normal (BMD >120 mg/cm³) BMD. Results BMDs of the T_7-9 vertebra were (125.17±47.42), (121.84±48.33), and (123.93±49.24) mg/cm³, respectively, with an average value of (123.67±47.73) mg/cm³. CT attenuation values of the T_7-9 vertebra were 157.48±56.97), (154.92±58.37), (and 158.03±60.02) HU, respectively, with an average value of (156.81±57.78) HU. CT values and average CT values of each vertebral body in T_7-9 were positively correlated with the BMD of the corresponding vertebral body (r=0.946, 0.960, 0.956, and 0.968; all P values <0.001). Among the 287 examiners, 77 cases had osteoporosis, 102 cases had osteopenia, and 108 cases had normal BMD. The threshold of <116 HU was 98.6% sensitive and 92.2% specific for distinguishing osteoporosis from osteopenia and normal BMD, with area under curve (AUC) of 0.988 (95% credibility interval [CI]: 0.997-0.999; P <0.001). The threshold of >170 HU was 100% sensitive and 96.1% specific for the recognition of normal BMD, with AUC of 0.997 (95%CI: 0.993-1.000; P <0.001). Conclusion The CT attenuation value of the thoracic vertebra can predict the BMD and has a high diagnostic efficiency for BMD. The measurement of the mean thoracic CT value can be used as an adjunct to predict BMD in the high-risk population.

Key words： Bone density Tomography spiral computed Quantitative CT Thoracic vertebra

收稿日期: 2021-12-21

基金资助:江苏省卫健委老年健康科研（LK2021013）

通讯作者: 刘许慧,Email：312618871@qq.com

引用本文:

李清瑶, 张宗军, 张羽, 滕剑, 王睿, 彭飞, 刘许慧. 第7~9胸椎CT值对国人成年女性骨密度评估价值的研究[J]. 中华解剖与临床杂志, 2022, 27(7): 463-467.
Li Qingyao, Zhang Zongjun, Zhang Yu, Teng Jian, Wang Rui, Peng Fei, Liu Xuhui. Evaluation value of the bone mineral density in adult Chinese women with CT value of thoracic vertebral 7-9. Chinese Journal of Anatomy and Clinics, 2022, 27(7): 463-467.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20211221-00389 或 http://www.cjac.com.cn/CN/Y2022/V27/I7/463

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