Haller J, André M P, Resnick D, Miller C, Howard B A, Mitchell M J, Schils J P, Sartoris D J, Trudell D
Department of Radiology, Veterans Administration Medical Center, San Diego, California 92161.
Invest Radiol. 1990 May;25(5):523-32. doi: 10.1097/00004424-199005000-00009.
Conventional radiography in the lateral projection was used to evaluate 25 osteolytic lesions involving vertebral bodies of the thoracolumbar spine. Destruction was calculated as percentages of the maximum transverse diameter and volume of the vertebral body as measured by computed tomography (CT) and the effect of size of lesion on detection was evaluated. Areas (Az) under the receiver-operating characteristic (ROC) curves and the significance of differences were determined from the observations of four radiologists. The mean difference between areas under the ROC curve for lesions involving 32% to 60% of the transverse diameter and for larger lesions of 61% to 93% was 0.12 and significant (P less than 0.05). The effect of the presence of localized loss of vertebral body density, sclerotic bone tissue surrounding the lesion and cortical destruction was evaluated in a second session, in films with lesions the observers scored 4 (probably abnormal) or 5 (definitely abnormal). Cortical destruction was reported to be helpful for detection in 35% of lesions, sclerotic bone surrounding the lesions was helpful in 30%, and a qualitative local decrease in bone density was noted in all lesions. In comparison with the results obtained for the same four observers with experimentally produced lesions in our previous cadaveric study, the clinical lesions of comparable size were not as readily detected. The ROC area for the largest group of clinical lesions (61% to 93%, Az = 0.83 +/- 0.07) was not significantly different from that for a group of smaller cadaveric lesions (41% to 60%, Az = 0.83 +/- 0.05). The smaller clinical lesions (32% to 60%, Az = 0.71 +/- 0.08) were similar in detectability to the experimental lesions of relative diameter 26% to 40% (Az = 0.74 +/- 0.15). Caution should be exercised in the interpretation of conventional radiographs in the lateral projection if there is suspicion of vertebral body destruction.
采用腰椎侧位传统X线摄影评估25例累及胸腰椎椎体的溶骨性病变。通过计算机断层扫描（CT）测量椎体最大横径和体积，并计算破坏占比，同时评估病变大小对检测的影响。由四位放射科医生的观察结果确定受试者操作特征（ROC）曲线下的面积（Az）以及差异的显著性。累及横径32%至60%的病变与横径61%至93%的较大病变的ROC曲线下面积的平均差异为0.12，具有显著性（P小于0.05）。在第二阶段评估了椎体密度局部丧失、病变周围硬化骨组织和皮质破坏的影响，在有病变的胶片中，观察者评分为4分（可能异常）或5分（肯定异常）。据报告，35%的病变中皮质破坏有助于检测，30%的病变中病变周围的硬化骨有帮助，所有病变均发现骨密度有定性的局部降低。与我们之前尸体研究中四位观察者对实验性病变的结果相比，相同大小的临床病变不易被检测到。最大一组临床病变（61%至93%，Az = 0.83±0.07）的ROC面积与一组较小的尸体病变（41%至60%，Az = 0.83±0.05）的ROC面积无显著差异。较小的临床病变（32%至60%，Az = 0.71±0.08）在可检测性上与相对直径26%至40%的实验性病变（Az = 0.74±0.15）相似。如果怀疑椎体破坏，在解读腰椎侧位传统X线片时应谨慎。
