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目的探讨磁共振扩散加权成像(DWI)在良恶性椎体骨折中的鉴别诊断价值。方法根据临床随访和病理资料将29例椎体骨折患者分为两组,良性组(15例)为急性良性骨折,恶性组(14例)为病理性骨折,对所有患者进行脊柱DWI检查,分别记录病灶和正常椎体的表观扩散系数(ADC)值,包括最大值、最小值和平均值,计算其差值(da、di、de),分析比较两组的ADC值、差值,并绘制受试者工作特征(ROC)曲线。结果恶性组较良性组的ADC最大值(1.55×10~(-3)mm~2/s vs.1.99×10~(-3)mm~2/s,P<0.01)、ADC最小值(0.55×10~(-3)mm~2/s vs.0.79×10~(-3)mm~2/s,P<0.05)、ADC平均值(1.08×10~(-3)mm~2/s vs.1.47×10~(-3)mm~2/s,P<0.01)及最大值差值da(1.08×10~(-3)mm~2/s vs.1.58×10~(-3)mm~2/s,P<0.01)、最小值差值di(0.52×10~(-3)mm~2/s vs.0.78×10~(-3)mm~2/s,P<0.01)、平均值差值de(0.93×10~(-3)mm~2/s vs.1.32×10~(-3)mm~2/s,P<0.01)要低。绘制ROC曲线后,病灶ADC最大值、最小值、平均值及其与正常椎体ADC的差值da、di、de的曲线下面积(AUC)分别为0.809,0.791,0.864,0.821,0.824,0.880。结论定量分析ADC值有助于鉴别椎体良恶性骨折,差值de的鉴别诊断准确性最高,病灶ADC平均值其次。
Objective To investigate the differential diagnosis value of diffusion weighted imaging (DWI) in benign and malignant vertebral fractures. Methods According to the clinical follow-up and pathological data, 29 patients with vertebral fractures were divided into two groups. Benign group (15 cases) were acute benign fractures and malignant group (14 cases) were pathological fractures. Spinal DWI was performed on all patients Apparent diffusion coefficient (ADC) values of lesions and normal vertebral bodies were recorded, including the maximum value, the minimum value and the average value, and the differences (da, di, de) were calculated. Draw the receiver operating characteristic (ROC) curve. Results The ADC value of malignant group was significantly higher than that of benign group (1.55 × 10 -3 mm 2 / s vs 1. 99 × 10 -3 mm 2 / s, P <0.01) The average value of ADC (1.08 × 10 ~ (-3) mm ~ 2 / s, P <0.05) vs.1.47 × 10 -3 mm -2 / s, P <0.01), and the maximum difference (1.08 × 10 -3 mm -2 / s vs.1.58 × 10 -3) mm ~ 2 / s, P <0.01), the minimum difference di (0.52 × 10 -3 mm 2 / s vs 0.78 × 10 -3 mm 2 / s, P 0.01) , The average difference de (0.93 × 10 ~ (-3) mm ~ 2 / s vs.1.32 × 10 ~ (-3) mm ~ 2 / s, P <0.01) is lower. After plotting the ROC curve, the area under the curve (AUC) of maximum, minimum, average and their difference da, di, de with ADC of vertebral body were 0.809,0.791,0.864,0.821,0.824,0.880 . Conclusion Quantitative analysis of ADC values can help identify the benign and malignant vertebral fractures, the difference between the highest differential diagnostic accuracy, followed by the average lesion ADC.