断层合成摄影术在骨肿瘤和肿瘤样病变评估中的诊断性能：与 X 线摄影的比较。

Diagnostic performance of tomosynthesis for evaluation of bone tumors and tumor-like lesions: a comparison with radiography.

机构信息

Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea.

Department of Radiology, 220312Pusan National University Hospital, Pusan National University Hospital, Biomedical Research Institute, Busan, Republic of Korea.

出版信息

Acta Radiol. 2022 Aug;63(8):1086-1092. doi: 10.1177/02841851211032436. Epub 2021 Jul 14.

DOI:10.1177/02841851211032436

PMID:34260321

Abstract

BACKGROUND

Even though radiologic diagnosis of bone tumors and tumor-like lesions is usually based on radiographs, radiographically faint imaging features sometimes remain challenging due to overlapping anatomical structures.

PURPOSE

To compare tomosynthesis with radiography for the evaluation of bone tumors and tumor-like lesions.

MATERIAL AND METHODS

Forty-seven bone tumors and tumor-like lesions were assessed with radiographs and tomosynthesis images. Two radiologists independently analyzed imaging features of lesions, including margin, periosteal reaction, cortical thinning, matrix mineralization, cortical destruction (such as pathologic fracture), and extraosseous soft-tissue extension. Computed tomography (CT) imaging was used as a reference method. Diagnostic performances of radiography and tomosynthesis were analyzed and compared based on sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Effective radiation dose was compared among the three imaging modalities by phantom studies.

RESULTS

Inter-observer variability (kappa value) for imaging features was slight to moderate on radiography (0.167-0.588), whereas it was nearly perfect on tomosynthesis (0.898-1.000) except for extraosseous soft-tissue extension (0.647 vs. 0.647). Tomosynthesis showed significantly higher sensitivity than radiography in evaluating the margin for bone tumors or tumor-like lesions (1.00 vs. 0.85; = 0.016), and significantly higher accuracy than radiography in evaluating the margin and matrix mineralization for those (1.00 vs. 0.85; = 0.016 and 0.91 vs.0.77; = 0.023, respectively). In phantom studies, mean effective radiation doses were highest in order of CT, tomography, and radiography.

CONCLUSION

Tomosynthesis increases sensitivity and accuracy of the margin as well as accuracy of the matrix mineralization of bone tumors and tumor-like lesions compared to radiography.

摘要

背景

尽管骨肿瘤和肿瘤样病变的放射诊断通常基于 X 线摄影，但由于重叠的解剖结构，影像学上的一些微弱表现仍然具有挑战性。

目的

比较断层合成摄影与 X 线摄影在骨肿瘤和肿瘤样病变评估中的作用。

材料与方法

对 47 例骨肿瘤和肿瘤样病变进行 X 线摄影和断层合成摄影图像评估。两位放射科医生独立分析了病变的影像学特征，包括边缘、骨膜反应、皮质变薄、基质矿化、皮质破坏（如病理性骨折）和骨外软组织延伸。使用计算机断层扫描（CT）成像作为参考方法。基于敏感性、特异性、准确性、阳性预测值和阴性预测值，分析并比较 X 线摄影和断层合成摄影的诊断性能。通过体模研究比较了三种成像方式的有效辐射剂量。

结果

X 线摄影的影像学特征观察者间变异系数（kappa 值）为轻度至中度（0.167-0.588），而断层合成摄影的观察者间变异系数几乎为完美（0.898-1.000），除了骨外软组织延伸（0.647 与 0.647）。断层合成摄影在评估骨肿瘤或肿瘤样病变的边缘方面比 X 线摄影具有更高的敏感性（1.00 与 0.85； = 0.016），在评估边缘和基质矿化方面具有更高的准确性（1.00 与 0.85； = 0.016 和 0.91 与 0.77； = 0.023）。在体模研究中，按顺序，CT、断层合成摄影和 X 线摄影的平均有效辐射剂量最高。