| Objective:To determine whether the specific bone marrow virtual non-calcium(VNCa)technology of third-generation dual-source dual-energy CT(DSDECT)can be used to accurately identify the vertebral metastases which are not easily recognized on the standard single-energy CT.Methods:The MRI(or PET-CT),CT and DECT data of 21 patients with vertebral metastases in our hospital from May 2019 to December 2019were collected,and the interval between imaging examinations was limited in two weeks.This prospective study has been approved by the hospital ethics committee,and all patients have signed informed consent.Two radiologists independently evaluated the standard CT images under random double-blind conditions.After an interval of 2 months,the two radiologists re-evaluated the VNCa images of vertebral metastases(0=normal bone marrow;1=metastasis),the image can be zoomed and adjusted at will.The third radiologists measures the CT values of vertebral metastases and normal vertebrae from standard CT and VNCa images respectively,then calculates the average CT values of 3 ROIs as the CT values of the disease or normal vertebrae(the area of each ROI is maintained within0.1mm~2-1.0mm~2according to the size of the lesion).All MRI(or PET-CT)images are evaluated by two senior radiologists without any information on clinical and CT(0=normal bone marrow;1=metastasis).Take all eligible vertebrae within the DECT scan range as the research object,and use MR(or PET-CT)as the reference standard to calculate the sensitivity,specificity,PPV,NPV and accuracy under standard CT and dual-energy CTVNCa image,then compare the diagnostic performance of these two different methods for vertebral metastases.Results:There were a total of 232 vertebrae of all 21 patients.The number of vertebrae included in our study was 205,40 vertebrae were diagnosed with osteoclastic metastasis,and 42 vertebrae were diagnosed with osteoblastic metastasis.Standard CT and DECT VNCa images correctly diagnosed 33 and 35 osteoclast vertebral metastases,missed 7 and5,and misdiagnosed 5 and 3 respectively;the sensitivity,specificity,PPV,NPV and accuracy of standard CT and DECT VNCa images for the diagnosis of osteoclastic vertebral metastases were 82.5%、95.9%、86.8%、94.4%、92.6%vs 87.5%、97.6%、92.1%、96.0%、95.1%,respectively.Standard CT and DECT VNCa images correctly diagnosed 35 and 39osteoblast vertebral metastases,missed 7 and 3,and misdiagnosed 6 and 4respectively;the sensitivity,specificity,PPV,NPV and accuracy of standard CT and DECT VNCa images for the diagnosis of osteoclastic vertebral metastases were83.3%、95.1%、85.4%、94.4%、92.1%vs 92.9%、96.7%、90.7%、97.5%、95.8%.On standard CT,there was no significant difference in CT values between normal vertebrae and osteoclastic metastatic vertebrae(P>0.05),but the difference in CT values between normal vertebrae and osteoblastic metastatic vertebrae was statistically significant(P<0.05);on VNCa images,the difference in CT values between normal vertebrae and osteoclastic metastatic vertebrae was statistically significant(P<0.05),and the difference in CT values between normal vertebrae and osteoblastic metastatic vertebrae was statistically significant(P<0.05).The area under the receiver operating curve of VNCa for the diagnosis of osteoclastic vertebrae was 0.900;when the VNCa CT value>-44.55HU,the sensitivity is 95.0%,the specificity is 75.6%.The area under the receiver operating curve of VNCa for the diagnosis of osteoblastic vertebrae was 0.882;when the VNCa CT value is<-77.1HU,the sensitivity is 80.5% and the specificity is 85.7%.Conclusion:1 VNCa technology of DECT can be used to diagnose vertebral metastases,and the diagnostic performance for vertebral bone metastases was excellent.2 DECT VNCa technology can simultaneously diagnose vertebral metastases through subjective evaluation and objective analysis.3 Compared with standar CT,DECT VNCa technology is more effective in diagnosing vertebral metastases and has better clinical application value. |
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