Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.
Department of Radiology, Mayo Clinic, Rochester, MN.
AJR Am J Roentgenol. 2021 Apr;216(4):1022-1030. doi: 10.2214/AJR.20.24029. Epub 2021 Feb 17.
CT attenuation thresholds that accurately distinguish enostoses from untreated osteoblastic metastases have been published. In the Mayo Clinic practices, these thresholds have been applied more broadly to distinguish benign sclerotic bone lesions other than enostoses from osteoblastic metastases. The purpose of this article is to determine if CT attenuation thresholds allow the distinguishing of benign sclerotic bone lesions from osteoblastic metastases in patients undergoing bone biopsy. A retrospective search was conducted to identify sclerotic lesions described on CT between October 7, 1998, and July 15, 2018, that underwent subsequent biopsy. Two musculoskeletal radiologists recorded lesions' maximum and mean attenuation. Using previously published attenuation thresholds, sensitivity and specificity for differentiating benign sclerotic lesions from osteoblastic metastases were calculated. ROC curve analysis was performed to determine if more appropriate attenuation thresholds exist. Intraclass correlation coefficients (ICCs) were computed. A total of 280 patients met inclusion criteria. Of those, 162 had malignant biopsy results and 118 had benign biopsy results. Of the 162 malignant lesions, 81 had received prior treatment. Maximum and mean attenuation were not significantly different between benign and malignant lesions for either reader (all > .05). For reader 1, to distinguish benign from malignant lesions, a maximum attenuation threshold of more than 1060 HU resulted in sensitivity of 23.7%, specificity of 87.0%, and accuracy of 60.6%. A mean attenuation threshold of greater than 885 HU resulted in sensitivity of 19.5%, specificity of 90.7%, and accuracy 60.7%. ROC curve analysis showed AUCs for mean and maximum attenuation thresholds of 51.8% and 54.6%, respectively. Subgroup analyses of benign versus malignant and treated versus untreated lesions had similar results. Similar findings were obtained for reader 2. The two readers' ICC was 0.946 for maximum attenuation and 0.918 for mean attenuation. Published attenuation thresholds for distinguishing enostoses from osteoblastic metastases had slightly decreased specificity and markedly decreased sensitivity when applied to the differentiation of benign sclerotic lesions from osteoblastic metastases in our sample of biopsy-proven lesions. ROC analysis showed no high-performing attenuation threshold alternative. Published CT attenuation thresholds intended for distinguishing enostoses from osteoblastic metastases should not be used more broadly. More accurate alternative thresholds could not be derived.
已经发表了能够准确区分内生骨软骨瘤和未经治疗的成骨性转移瘤的 CT 衰减阈值。在 Mayo 诊所的实践中，这些阈值被更广泛地应用于区分除内生骨软骨瘤以外的良性硬化性骨病变和成骨性转移瘤。本文的目的是确定 CT 衰减阈值是否可以区分接受骨活检的患者的良性硬化性骨病变和成骨性转移瘤。进行了回顾性搜索，以确定 1998 年 10 月 7 日至 2018 年 7 月 15 日期间 CT 描述的后续进行了活检的硬化性病变。两位肌肉骨骼放射科医生记录了病变的最大和平均衰减。使用先前发表的衰减阈值，计算了区分良性硬化性病变和成骨性转移瘤的敏感性和特异性。进行了 ROC 曲线分析，以确定是否存在更合适的衰减阈值。计算了组内相关系数（ICC）。共有 280 名患者符合纳入标准。其中，162 名患者的活检结果为恶性，118 名患者的活检结果为良性。在 162 个恶性病变中，81 个病变接受了先前的治疗。对于两位读者，良性和恶性病变之间的最大和平均衰减均无显著差异（均>.05）。对于读者 1，要区分良性和恶性病变，最大衰减阈值大于 1060 HU 时，敏感性为 23.7%，特异性为 87.0%，准确性为 60.6%。平均衰减阈值大于 885 HU 时，敏感性为 19.5%，特异性为 90.7%，准确性为 60.7%。ROC 曲线分析显示平均和最大衰减阈值的 AUC 分别为 51.8%和 54.6%。良性与恶性病变以及治疗与未治疗病变的亚组分析得出了类似的结果。对于读者 2 也得到了类似的结果。两位读者的最大和平均衰减 ICC 分别为 0.946 和 0.918。用于区分内生骨软骨瘤和成骨性转移瘤的已发表的衰减阈值在我们的活检证实病变样本中用于区分良性硬化性病变和成骨性转移瘤时，特异性略有降低，敏感性明显降低。ROC 分析显示没有表现出色的替代衰减阈值。用于区分内生骨软骨瘤和成骨性转移瘤的已发表的 CT 衰减阈值不应更广泛地使用。无法得出更准确的替代阈值。
