【摘要】 目的评价容积性定量CT(vQCT)技术测量的腰椎骨密度(BMD)参数区分骨质疏松性椎体骨折与无骨折老年妇女的能力,对骨质疏松老年妇女腰椎结构与正常老年妇女进行比较。方法将有骨质疏松脊椎骨折的26例老年妇女归为第1组,选择年龄与其相匹配的无脊椎骨折的30例骨质疏松妇女归为第2组。应用多层螺旋CT(MSCT)对56例病人腰椎L1、L2椎体行容积扫描,在横断面影像中经传统的QCT法测量L1、L2小梁骨BMD(2D-TRAB)、整体骨BMD(2D-INTGL);在经计算机工作站行容积再现(VR)三维处理的影像中应用直方图功能测量L1、L2椎体整体骨BMD(3D-INTGL)、皮质骨BMD(3D-CORT)、小梁骨BMD(3D-TRAB)。双能X线吸收仪(DXA)测量参数为腰椎正位BMD(AP-SPINE)、腰椎正位表观BMD(BMAD)。比较2组老年妇女间上述7组的BMD值。另对10例2D-TRAB正常的老年妇女在VR像中测量L1椎体中部边长为20mm的正方体内骨小梁容积比值,并与在56例妇女中随机选取的10例的数值比较。结果DXA测量中AP-SPINE、BMAD在第1组妇女为(0·796±0·170)g/cm2、(272·7±27·7)mg/cm3,与第2组妇女(0·817±0·140)g/cm2、(249·5±26·5)mg/cm3之间差异无统计学意义;vQCT中第1组的2D-TRAB为(70·4±22·2)mg/cm3、2D-INTGL为(138·3±35·1)mg/cm3、3D-INTGL为(139·4±34·9)mg/cm3、3D-CORT为(133·8±26·9)mg/cm3、3D-TRAB为(69·9±18·6)mg/cm3,比第2组数值(89·1±21·8)mg/cm3、(170·6±34·5)mg/cm3、(180·5±28·2)mg/cm3、(163·2±27·5)mg/cm3、(83·8±17·1)mg/cm3下降18%~23%。10例骨质疏松老年妇女L1椎体骨小梁容积比值为(8·12±1·96)%,明显低于正常老年妇女的(39·13±2·15)%,差异有统计学意义(P<0·01)。结论MSCT中vQCT参数区分骨质疏松性椎体骨折与无骨折老年妇女的能力优于DXA,三维重组影像显示的骨质疏松老年妇女椎体骨小梁容积明显低于正常老年妇女。更多还原

【Abstract】 Objective To evaluate the a bi lity of volumetric bone mineral density (BMD) parameters of lumbar vertebrae in differentiating osteoporotic fractured from nonfractured elderly women with vQCT technique, and to compare the bony structural conditions of osteoporotic elderl y women with healthy elderly women. Methods Multi-sli ce CT spinal scans of L1 and L2 were acquired in 26 osteoporotic vertebral fract ured elderly women (group one) and 30 nonfractured osteoporotic subjects (group two). All the retro-reconstructed images of L1 and L2 were sent to the worksta tion and processed by volume rendering (VR) technique to measure volumetric BMD (3D-INTGL, 3D-CORT, 3D-TRAB) and trabecular and integral BMD(2D-TRAB, 2D -INTGL)by conventional QCT technique. BMD indexes in DXA were AP-SPINE and b one mineral apparent density (BMAD) in anteroposterior position. The seven para meters between the two groups were compared. Ten healthy elderly women were sel ected as normal group to reformate 3D-VR images from MSCT images to analyze the bony structure and calculate the ratio of bone volume to total volume (BV/TV) in the center of L1 vertebrae, and to compare the index between the normal group and ten patients randomly selected from the 56 osteoporotic women. Results DXA measurements in group one: AP-SPINE and BMAD were (0 .796±0.170) g/cm~2 and (272.7±27.7) mg/cm~3, respectively, showing no st atistically significant differences comparing with (0.817±0.140) g/cm~2 and (249.5±26.5) mg/cm~3 in group two. Volumetric BMD in group one included 2D -TRAB (70.4±22.2) mg/cm~3, 2D-INTGL (138.3±35.1) mg/cm~3, 3D-INTGL (1 39.4±34.9) mg/cm~3, 3D-CORT (133.8±26.9) mg/cm~3, and 3D-TRAB (69.9± 18.6) mg/cm~3, respectively, showing statistically differences with (89.1±21 .8) mg/cm~3, (170.6±34.5) mg/cm~3, (180.5±28.2) mg/cm~3, (163.2±27. 5) mg/cm~3 , and (83.8±17.1) mg/cm~3 in group two (the decrements 18%-23%) . The mean value of BV/TV of L1 vertebrae was (8.12±1.96)% in osteoporotic w omen, which was significantly lower than (39.13±2.15)% of normal elderly wome n (P<0.01). Conclusion Volumetric QCT parameters o f lumbar vertebrae in MSCT were superior to DXA in identifying osteoporotic frac tured from nonfractured elderly women. Trabecular volume of vertebrae in 3D-VR images of osteoporotic women is lower than that of healthy elderly women.更多还原