Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Eur Radiol. 2024 Jan;34(1):60-68. doi: 10.1007/s00330-023-10036-0. Epub 2023 Aug 11.
To investigate measurements derived from plain and enhanced spectral CT in differentiating osteoblastic bone metastasis (OBM) from bone island (BI).
From January to November 2020, 73 newly diagnosed cancer patients with 201 bone lesions (OBM = 92, BI = 109) having received spectral CT were retrospectively enrolled. Measurements including CT values of 40-140 keV, slope of the spectral curve, effective atomic number (Z), water (calcium) density, calcium (water) density, and Iodine (calcium) density were derived from manually segmented lesions on plain and enhanced spectral CT, and then analyzed using Student t-test and Pearson's correlation. Multivariate analysis was performed to build models (plain spectral model, enhanced spectral CT model, and combined model) for the discrimination of OBM and BI with performance evaluated using receiver operator characteristics curve and DeLong test.
All features were significantly different between the BI group and OBM group (all p < 0.05), highly correlated with the corresponding features between plain and enhanced spectral CT both in OBM (r: 0.392-0.763) and BI (r: 0.430-0.544). As for the model performance, the combined model achieved the best performance (AUC = 0.925, 95% CI: 0.879 to 0.957), which significantly outperformed the plain spectral CT model (AUC = 0.815, 95% CI: 0.754 to 0.866, p < 0.001) and enhanced spectral CT model (AUC = 0.901, 95% CI: 0.852 to 0.939, p = 0.024) in differentiating OBM and BI.
In addition to plain spectral CT measurements, enhanced spectral CT measurements would further significantly benefit the differential diagnosis.
Measurements derived either from plain or enhanced spectral CT could provide additional valuable information to improve the differential diagnosis between OBM and BI in newly diagnosed cancer patients.
• We intend to investigate plain and enhanced spectral CT measurements in differentiating OBM from BI. • Both plain and enhanced spectral CT help in discriminating OBM and BI in newly diagnosed cancer patients. • Enhanced spectral CT measurements further improve plain spectral CT measurements-based differential diagnosis.
研究平扫及增强能谱 CT 各项参数在鉴别成骨性骨转移瘤（OBM）与骨岛（BI）中的价值。
回顾性分析 2020 年 1 月至 11 月间我院收治的 73 例初诊恶性肿瘤患者的 201 个病灶，其中 OBM 92 个，BI 109 个。所有患者均行平扫及增强能谱 CT 检查，于平扫及增强图像上勾画病灶，测量 40-140keV 能谱曲线斜率、有效原子序数（Z）、水（钙）密度、钙（水）密度、碘（钙）密度等参数，采用独立样本 t 检验及 Pearson 相关分析比较 OBM 与 BI 组间各参数的差异及其与平扫、增强能谱 CT 各参数间的相关性。采用受试者工作特征曲线（ROC）及 DeLong 检验评价各参数及模型对 OBM 与 BI 的鉴别效能。
BI 组与 OBM 组间各参数均有统计学差异（均 P<0.05），且与平扫、增强能谱 CT 对应参数高度相关（r 值：0.392-0.763）。诊断效能方面，联合模型的曲线下面积（AUC）最大（AUC=0.925，95%CI：0.879-0.957），显著高于平扫能谱 CT 模型（AUC=0.815，95%CI：0.754-0.866，P<0.001）和增强能谱 CT 模型（AUC=0.901，95%CI：0.852-0.939，P=0.024）。
除平扫能谱 CT 测量参数外，增强能谱 CT 测量参数有助于提高 OBM 与 BI 的鉴别诊断效能。
