Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Med Radiat Sci. 2021 Sep;68(3):220-227. doi: 10.1002/jmrs.463. Epub 2021 Feb 19.
Bone lesions are sometimes detected on computed tomography studies, and biopsies are performed to evaluate whether these are malignant. The aim of the study is to evaluate whether chemical-shift imaging (CSI) and diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) are more informative than the CT attenuation for predicting malignancy.
Retrospective analysis of 86 patients who underwent both diagnostic CT, CSI MRI and DWI MRI within 6 weeks prior to bone biopsy at a tertiary care academic institution between 01/01/2010 and 03/01/2020. The CT attenuation, signal intensity on in-phase sequences (SIIP), signal intensity on out-of-phase sequences (SIOP), signal intensity ratio (SIR = SIOP/SIIP) and the apparent diffusion coefficient (ADC) of the lesions over the region of the biopsy tract were measured.
A threshold CT attenuation of 157 Hounsfield Units (HU) had a sensitivity of 47.7%, specificity of 83.3% and area under the curve (AUC) of 0.59. A threshold ADC of 793 × 10 mm /s had a sensitivity of 75.8%, specificity of 85.7% and AUC of 0.83 to predict whether a bone biopsy would detect malignancy. A threshold SIR of 0.949 had a sensitivity of 77.8%, specificity of 77.8% and AUC of 0.81 to predict whether a bone biopsy would detect malignancy. ADC (P = 0.029) and SIR (P = 0.009) were significantly better than CT attenuation. There was no predictive difference between SIR and ADC (P = 0.742).
The CT attenuation of a lesion is a poor predictor of malignancy in bone lesions. CSI and DWI are significantly better for predicting malignancy.
在计算机断层扫描研究中有时会发现骨病变，并且进行活检以评估这些病变是否为恶性。本研究旨在评估化学位移成像（CSI）和弥散加权成像（DWI）磁共振成像（MRI）是否比 CT 衰减更能提供信息，以预测恶性肿瘤。
回顾性分析了 2010 年 1 月 1 日至 2020 年 3 月 1 日期间，在一家三级保健学术机构中，86 例患者在进行骨活检前 6 周内同时进行了诊断 CT、CSI MRI 和 DWI MRI。测量了活检道区域的病变 CT 衰减、同相位序列信号强度（SIIP）、反相位序列信号强度（SIOP）、信号强度比（SIR = SIOP/SIIP）和表观扩散系数（ADC）。
阈值 CT 衰减为 157 个亨氏单位（HU）时，灵敏度为 47.7%，特异性为 83.3%，曲线下面积（AUC）为 0.59。阈值 ADC 为 793×10 mm /s 时，灵敏度为 75.8%，特异性为 85.7%，AUC 为 0.83，用于预测骨活检是否会检测到恶性肿瘤。阈值 SIR 为 0.949 时，灵敏度为 77.8%，特异性为 77.8%，AUC 为 0.81，用于预测骨活检是否会检测到恶性肿瘤。ADC（P = 0.029）和 SIR（P = 0.009）明显优于 CT 衰减。SIR 和 ADC 之间没有预测差异（P = 0.742）。
病变的 CT 衰减是骨病变恶性程度的一个较差预测因子。CSI 和 DWI 对预测恶性肿瘤明显更好。
