van der Star Simone, Harlianto Netanja I, de Lange Stéphanie V, Verlaan Jorrit-Jan, Schilham Arnold M R, Kok Madeleine, de Jong Pim A, Foppen Wouter
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht & Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
Department of Orthopedic Surgery, University Medical Center Utrecht & Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
Skeletal Radiol. 2025 Sep 6. doi: 10.1007/s00256-025-05023-z.
To evaluate whether dual-layer spectral computed tomography, compared with conventional CT, improves diagnostic accuracy for osteolytic vertebral metastases. Furthermore, to investigate the influence of dual-layer CT on the subjective visibility of metastases.
In this single-center retrospective study, consecutive patients with an untreated primary tumor who underwent dual-layer CT and either MRI or PET-CT as reference standard within 14 days were included. Two independent observers, blinded to the reference, performed two scorings. First, the conventional CT was scored and the results were recorded. Subsequently, Calcium suppression, monoenergetic (monoE40 and monoE200), and Z-effective reconstructions were added. Subjective visibility was compared to conventional CT using a 5-point Likert scale. Diagnostic accuracy measures were calculated with 95% confidence intervals. Sensitivity and specificity were compared using the McNemar's test.
Fourteen patients (63 ± 8 years; 64.3% female) and 189 vertebrae were included, with 46 vertebrae showing 58 metastases with a mean diameter of 18 mm (range 5-53 mm). For conventional CT, the sensitivity, specificity, and diagnostic accuracy for observer A and B were, respectively, 57% and 57%, 96% and 90%, 85% and 81%. The diagnostic performance did not improve when using the dual-layer CT reconstructions in addition to conventional CT (p ≥ 0.13). MonoE40 improved the subjective visibility of metastases. Interobserver agreement was moderate for conventional CT (ĸ:0.48), and dual-layer CT reconstructions (ĸ:0.41-0.51).
Dual-layer CT reconstructions did not improve diagnostic accuracy for osteolytic vertebral metastases compared with conventional CT, although subjective visibility was improved on low monoenergetic reconstructions.
评估与传统CT相比，双层光谱计算机断层扫描是否能提高溶骨性椎体转移瘤的诊断准确性。此外，研究双层CT对转移瘤主观可见性的影响。
在这项单中心回顾性研究中，纳入了连续的未经治疗的原发性肿瘤患者，这些患者在14天内接受了双层CT检查，并以MRI或PET-CT作为参考标准。两名独立的观察者在不知道参考标准的情况下进行了两次评分。首先，对传统CT进行评分并记录结果。随后，增加了钙抑制、单能量（单能量40和单能量200）和有效原子序数（Z-effective）重建。使用5点李克特量表将主观可见性与传统CT进行比较。计算诊断准确性指标的95%置信区间。使用McNemar检验比较敏感性和特异性。
纳入了14名患者（63±8岁；64.3%为女性）和189个椎体，其中46个椎体显示有58个转移瘤，平均直径为18mm（范围5-53mm）。对于传统CT，观察者A和B的敏感性、特异性和诊断准确性分别为57%和57%、96%和90%、85%和81%。除传统CT外，使用双层CT重建时诊断性能并未改善（p≥0.13）。单能量40改善了转移瘤的主观可见性。传统CT的观察者间一致性为中等（κ：0.48），双层CT重建的观察者间一致性为中等（κ：0.41-0.51）。
与传统CT相比，双层CT重建并未提高溶骨性椎体转移瘤的诊断准确性，尽管低单能量重建改善了主观可见性。
