| Part I The value of Dual-energy CT with multiparameter imaging in differentiation of bone island and calcificationPurpose: Dual-energy CT with multiparameter imaging of bone island and calcification were retrospectively analyzed,thereby evaluating the diagnostic value of dual-energy CT in the differentiation of them.Research objects and methods: Bone island and calcification,which were examined by dual-energy in affiliated hospital of Qingdao University between January 2014 and March 2014,were included in this study.40 patients were collected in this study,including20 bone island and 20 calcification.In 40 patients,22 were male and 18 were female with mean age 45.30±20.56.Dual-energy images were all transferred to the CT workstation by PACS.Using GSI post-processing software,ROIs(1-2mm2)were respectively placed on bone island,calcification,bone cortex,and bone spongiosa.Then spectral curves,the slope K value,and Effective-Z were described and measured.The shapes of spectral curves were concluded by two musculoskeletal radiologists with 10 years experience.The slope K value and Effective-Z of bone island and calcification were compared with independent-sample t-test using SPSS.Results: The spectral curves and Effective-Z of bone island and calcification have no significant abnormal values,and have the same variance.The slope K value of bone island(20.49±4.41)was lower than that of calcification(30.86±2.77).Statistical results showed that the slope K value of bone island and calcification was significantly different(t=8.906,p=0.000).The Effective-Z of bone island(11.09±1.21)was lower than that of calcification(12.73±0.80).The results of the independent sample t-test showed that the Effective-Z of bone island and calcification was significantly different(t=5.035,p=0.000).Conclusion: Dual-energy CT with multiparameter imaging can be used to differential diagnosis of bone island and calcification.Part II The value of Dual-energy CT with multiparameter imaging in differentiation of tumor bone and calcification of tumor cartilage in bone tumorsPurpose: Bone tumors include chondrogenic tumors,osteogenic tumors,fibrogenic tumors,fibrohistiocytic tumors,haematopoietic neoplasms,osteoclastic giant cell rich tumors,notochordal tumors,vascular tumors,myogenic tumors,lipogenic tumors,tumors of undefined neoplastic nature,miscellaneous tumors according to organization origin.With so many types of bone tumors,the overlapping of imaging features makes imaging diagnosis very difficult.However,early accurate imaging diagnosis plays an important role in the formulation of treatment plans and the monitoring of prognosis.Bone tumors can produce tumor bone and calcification of tumor cartilage.Through the differentiation of tumor bone and calcification of tumor cartilage,the origin of tumors can be determined in clinical.The former represents osteogenic tumors and the latter represents chondrogenic tumors.Therefore,the scope of differential diagnosis of tumors can be narrowed.Multi-parameter imaging can be used by Dual-energy CT,including single energy imaging,spectral curve,CT value under Optimal ke V and effective atomic number.There were good research results in the diagnosis of gout and the analysis of urinary stones.In this study,22 cases of osteogenic tumors and 20 cases of chondrogenic tumors were analyzed using Gemstone Spectral Imaging(GSI,GE Discovery HD 750,Milwaukee,Wisconsin,USA).Two groups of tumor bone and calcification of tumor cartilage spectral curve and slope value,CT value under Optimal ke V,the effective atomic number were compared.The purpose of this study is to evaluate the value of quantitative analysis of GSI in identifying tumor bone and calcification of tumor cartilage,then judges the histology of the tumor origin,and provides a more accurate imaging diagnostic methods for clinical.Research objects and methods: Bone tumors with tumor bone and calcification of tumor cartilage,were examined by GSI(Gemstone Spectral Imaging,GE Discovery HD750,Milwaukee,Wisconsin,USA)and proved by pathology in affiliated hospital of Qingdao University between March 2014 and March 2017.42 patients were collected in this study,including 22 osteogenic tumors and 20 chondrogenic tumors.In 22 osteogenic tumors,2 were osteoid osteomas,4 were osteoblastomas,and 16 were osteosarcomas.In20 chondrogenic tumors,3 were enchondromas,2 were chondroblastomas,and 15 were chondrosarcomas.In 42 patients,26 were male and 16 were female with mean age39.40±21.76(range,11-86 years).And osteogenic tumors included 8 women and 14 men,with a median age of 30.55±17.75 years(range,11-73 years).And chondrogenic tumors included 8 women and 12 men,with a median age of 49.15±21.97 years(range,13-86years).GSI images were all transferred to the CT workstation by PACS.Using GSI post-processing software,ROI(1-2mm2)was respectively placed on tumor bone and calcification of tumor cartilage,bone cortex and bone spongiosa.Then spectral curves,slope K value of the spectral curve,average CT values under 70 ke V,and Effective-Z were described and measured.The shapes of spectral curves were concluded by two musculoskeletal radiologists with 10 years experience.Slope K value of the spectral curve,average CT values under 70 ke V,and Effective-Z were compared with independent-sample t-test using SPSS.ROC curves were used to compare the diagnostic efficacy of slope K value of the spectral curve,average CT value under 70 ke V,and Effective-Z in the differentiation of tumor bone and calcification of tumor cartilage.Sensitivity and specificity were acquired from Area Under the Curve(AUC).Results: The spectral curves of tumor bone and calcification of tumor cartilage both showed decreasing attenuation with increasing ke V values(attenuating type).In 42 patients with bone tumors,slope K value of tumor bone group and calcification of tumor cartilage group was 12.94±7.43 and 22.52±7.23,respectively,and slope K value of tumor bone was lower than that of calcification of tumor cartilage(t=4.225,P < 0.01).The slope K value of bone cortex of tumor bone group and calcification of tumor cartilage group was22.48±6.94 and 22.31±8.00,respectively.There was no significant difference in the slope K value of bone cortex between the two groups(t=0.076,P > 0.05).The slope K value of bone spongiosa of tumor bone group and calcification of tumor cartilage group was4.66±2.23 and 3.57±1.77,respectively.There was no significant difference in the slope K value of the bone spongiosa between the two groups(t=1.736,P > 0.05).In the 22 patients in tumor bone group,the slope K value of tumor bone and bone cortex was 12.94±7.43 and22.48±6.94,respectively.The slope K value of tumor bone was lower than that of bone cortex,and the statistical difference was extremely significant(t=4.339,P < 0.01).The slope K value of tumor bone and bone spongiosa curve was 12.94±7.43 and 4.66±2.23,respectively.The slope K value of tumor bone was higher than that of bone spongiosa,and the statistical difference was extremely significant(t=5.009,P < 0.01).The slope K value of bone cortex and bone spongiosa was 22.48±6.94 and 4.66±2.23,respectively.The slope K value of bone cortex was higher than that of the bone spongiosa,and the statistical difference was extremely significant(t=11.466,P < 0.01).In 20 patients in calcification of tumor cartilage group,the slope K value of calcification of tumor cartilage and bone cortex curve was 22.52±7.23 and 22.31±8.00,respectively.There was no statistical difference in the slope K values of calcification of tumor cartilage and bone cortex(t=0.090,P > 0.05).The slope K value of calcification of tumor cartilage and bone spongiosa was 22.52±7.23 and 3.57±1.77,respectively,and the slope K value of calcification of tumor cartilage was higher than that of bone spongiosa,and the statistical difference was extremely significant(t=11.379,P < 0.01).The slope K value of bone cortex and bone spongiosa was22.31±8.00 and 3.57±1.77,respectively.The slope K value of bone cortex was higher than that of the bone spongiosa,and the statistical difference was extremely significant(t=10.217,P < 0.01).By using Optimal-CNR mode of GSI Viewer software,the CT value of optimal ke V were obtained.The average CT value of tumor bone under optimal ke V was 580.67±319.54 HU,the average CT value of calcification of tumor cartilage was1101.84±407.65 HU,and the average CT value of tumor bone was lower than that of calcification of tumor cartilage,and the statistical difference was extremely significant(t=4.663,P < 0.01).The average CT values of tumor bone group and calcification of tumor cartilage group of bone cortex were 1089.38±404.50 HU and 1156.59±373.54 HU,respectively,with no significant difference(t=0.558,P > 0.05).The average CT values of umor bone group and calcification of tumor cartilage group of bone spongiosa was214.76±127.06 HU and 186.18±83.09 HU,respectively,with no significant difference(t=1.645,P > 0.05).At 70 ke V,the CT difference between tumor bone and bone cortex was508.70±410.90 HU,and the CT difference between calcification of tumor cartilage and bone cortex was 54.75±45.41 HU,showing extremely significant difference(t=3.385,P <0.01).The CT difference between tumor bone and bone spongiosa was 365.91±324.27 HU,and 975.67±442.65 HU,which was highly significant(t=5.125,P < 0.01).In 42 patients,the average effective atomic number of tumor bone(n=22)was 10.21±1.43,the average effective atomic number of calcification of tumor cartilage(n=20)was 12.83±1.21,and the average effective atomic number of tumor bone was lower than that of calcification of tumor cartilage,showing a highly significant difference(t=6.359,P < 0.01).AUC of the slop K value was 0.809,and the sensitivity and specificity was 86.36% and 75%,respectively.AUC of the effective atomic number was 0.902,and the sensitivity and specificity was 72.73% and 100%,respectively.AUC of the CT value difference between mineralization(tumor bone and calcification of tumor cartilage)and bone cortex under70 ke V was 0.784,and the sensitivity and specificity was 72.73% and 80%,respectively.AUC of the CT value difference between mineralization(tumor bone and calcification of tumor cartilage)and bone spongiosa under 70 ke V was 0.873,and the sensitivity and specificity was 86.36% and 75%,respectively.AUC of Effective atomic number combined of slope K value was 0.973,and the sensitivity and specificity was 81.82% and 100%,respectively.AUC of the CT value difference between mineralization(tumor bone and calcification of tumor cartilage)and bone cortex under 70 ke V combined of the slope was0.841,and the sensitivity and specificity was 81.82% and 75%,respectively.AUC of the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone spongiosa under 70 ke V combined with the slope K value was 0.880,and the sensitivity and specificity was 81.82% and 80%,respectively.AUC of the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone cortex under 70 ke V combined of effective atomic number was 0.948,and the sensitivity and specificity was 81.82% and 95%,respectively.AUC of the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone spongiosa under 70 ke V combined of effective atomic number was0.970,and the sensitivity and specificity was 81.82% and 100%,respectively.AUC of CT value difference with bone cortex combined with CT value difference with bone spongiosa under 70 ke V was 0.873,and the sensitivity and specificity was 86.36% and 75%,respectively.Conclusion: The spectral curves of tumor bone and calcification of tumor cartilage both showed decreasing attenuation.The slope K value of tumor bone is lower than that of calcification of tumor cartilage and that of bone cortex,and higher than that of the tumor bone.The slope K value of calcification of tumor cartilage was higher than that of the bone spongiosa.However,there was no statistical difference in the slope K value of bone cortex.The slope K value of the bone cortex was higher than that of the bone spongiosa,but there was no statistically significant difference in the slope K value between the bone cortex of tumor bone group and calcification of tumor cartilage group,and between the bone spongiosa of two groups.The average CT value of tumor bone under 70 ke V was lower than that of calcification of tumor cartilage.There was no statistically significant difference in the average CT value between the bone cortex of tumor bone group and calcification of tumor cartilage group,and the bone spongiosa of two groups.Under 70 ke V,the difference between the CT value of tumor bone and bone cortex was greater than the difference between the average CT value of calcification of tumor cartilage and bone cortex,and the difference between the average CT value of tumor bone and bone spongiosa was smaller than the difference between the average CT value of calcification of tumor cartilage and bone spongiosa.Because spectral curve of tumor bone,calcification of tumor cartilage,bone cortex,bone spongiosa parallel to each other,the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone cortex under 70 ke V,and the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone spongiosa under 70 ke V can reflex spectral curve of the distance between each other.So it can be inferred that the spectral curve of tumor bone is closer to the spectrum curve of bone spongiosa and further to the spectral curve of bone cortex compared to spectral curve of the calcification of tumor cartilage.The average effective atomic number of tumor bone is lower than that of calcification of tumor cartilage.The values of AUC above 0.9 include slope K value combined with effective atomic number,effective atomic number combined with the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone spongiosa under70 ke V,effective atomic number combined with the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone cortex,and effective atomic number,indicating that these methods have a higher accuracy in identifying the tumor origin.The values of AUC between 0.7 to 0.9 include slope K value combined with the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone spongiosa under 70 ke V,the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone spongiosa under 70 ke V,the CT value difference under 70 ke V combined with the CT value difference of bone cortex and the CT value difference of bone spongiosa,slope K value combined with the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone cortex under 70 ke V,slope K value,the difference of CT value between mineralization(tumor bone and calcification of tumor cartilage)and bone cortex,showing that these methods to identify the tumor origin has certain accuracy.The diagnostic accuracy of slope K value combined with effective atomic number was the highest.In conclusion,dual-energy CT with multi-parameter imaging can be used to differentiate tumor bone and calcification of tumor cartilage of the bone tumors. |
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