Diagnostic Value Of Vertebral Body Bone Marrow Attenuation Value Evaluated Quantitatively By Multi-slice Spiral CT In Occult Osteoporotic Fracture Vertebral Body

Object:In this study,multi-slice spiral CT was used to quantitatively evaluate the bone marrow attenuation value(CT value)of freshly fractured vertebral cancellous bone,determine the CT value of vertebral bone marrow edema and the critical value of the difference,in order to effectively and reliably detect and conceal Osteoporotic fracture-related bone marrow edema,and analyze the diagnostic value of this method for occult fractures of the vertebral body.Methods:A retrospective analysis of the imaging data of 49 patients with lumbar osteoporotic fractures in our hospital from September 2019 to September 2020.Two spine surgeons with more than two years of clinical work experience and professional training conducted observations and measurements on the CT and MRI images of the lumbar spine.Two doctors measured the CT values of 240 vertebral cancellous bones,and evaluated the consistency of the measurement results,the distribution status of the measurement data and the reliability of the measurement method through the intra-group correlation coefficient and Bland-Altman analysis.Then determine the vertebral body with the lowest CT value for each patient,and calculate the difference between each vertebral body and the lowest CT value.Finally,the CT value and the difference of CT value were analyzed by receiver operating characteristic curve to determine the double critical value.And using the responsible vertebrae diagnosed by MRI as the reference standard,the diagnostic sensitivity,specificity,accuracy and other indicators of the quantitative evaluation method of multi-slice spiral CT and the visual evaluation method were compared.Results:The intra-group correlation coefficients of CT value and ROI volume measured by two doctors were 0.987 and 0.726,respectively,indicating that the measurement results have good consistency and the measurement method has good repeatability;the area under the ROC curve of the CT value is 0.877,The difference in CT value is 0.932,and the interactive scatter plot shows that the difference between the CT value of 90.1HU and the CT value of 30.4HU can be used as the critical value for diagnosing occult osteoporotic fractures of the vertebral body,which can be detected and occult The accuracy of bone marrow edema associated with osteoporotic fracture is 95%,while the accuracy of multi-slice spiral CT visual assessment is 90.4%.18 out of 55 occult fractures could not be detected by visual assessment alone.Multi-slice spiral CT quantitative evaluation method improved the diagnostic sensitivity of occult osteoporotic fractures from 67.3% to 89.1%,the misdiagnosis rate was reduced to 3.2%,and the missed diagnosis rate was reduced to 10.9%.Conclusions:Comparing the CT value of vertebral cancellous bone marrow with double cutoff values(90.1HU and 30.4HU)to quantitatively assess bone marrow edema is an effective and reliable method for detecting occult osteoporotic fracture vertebral bone marrow edema.This method effectively improves the sensitivity and specificity of conventional CT visual assessment methods in diagnosing occult osteoporotic fractures of the vertebral body,and can better help clinicians to make a preliminary diagnosis.And it may not be necessary to use MRI and other techniques for further examination to determine the fracture situation,especially for patients and medical units who cannot use MRI and nuclear medicine examinations.