早期非创伤性股骨头坏死的CT表现及与预后的关系

CT findings of early non-traumatic osteonecrosis of femoral head and its relationship with prognosis

摘要:

目的 分析早期非创伤性股骨头坏死的CT表现及与预后的关系。方法 选取2019年3月—2020年3月于诸暨市中医医院就诊的疑似早期非创伤性股骨头坏死患者168例。所有患者均接受CT及MRI检查，以手术病理检查结果为金标准，分析CT、MRI及两者联合诊断对早期非创伤性股骨头坏死的诊断效能。根据随访结果分为预后良好组和预后不良组，比较两组的CT参数［血容积（BV）、血流量（BF）及平均通过时间（MMT）］，绘制受试者工作特征（ROC）曲线，分析CT各参数及联合预测早期非创伤性股骨头坏死患者预后的价值。结果 168例患者经CT检查结果显示，74例以骨小梁增粗或骨质硬化、股骨头呈拥挤融合及扇状硬化改变为主；94例以骨小梁微骨折及股骨头关节面轻微塌陷、部分出现新月征为主；CT、MRI及两者联合诊断早期非创伤性股骨头坏死与金标准一致性分别为0.535、0.676和0.870；联合诊断的敏感性及准确性均高于CT及MRI单一诊断（P <0.05），但CT与MRI的敏感性及准确性比较，差异无统计学意义（P >0.05）。预后良好组BF、BV均大于预后不良组，MMT长于预后不良组（P <0.05）；ROC曲线显示，BF预测早期非创伤性股骨头坏死患者预后不良的AUC为0.810（95% CI：0.729，0.892）、敏感性为78.6%（95% CI：0.584，0.831）、特异性为65.5%（95% CI：0.517，0.792），BV预测早期非创伤性股骨头坏死患者预后不良的AUC为0.790（95% CI：0.671，0.910）、敏感性为74.8%（95% CI：0.556，0.824）、特异性为79.3%（95% CI：0.621，0.875），MMT预测早期非创伤性股骨头坏死患者预后不良的AUC为0.808（95% CI：0.699，0.917）、敏感性为80.6%（95% CI：0.704，0.923）、特异性为82.8%（95% CI：0.650，0.946），联合检测预测早期非创伤性股骨头坏死患者预后不良的AUC为0.881（95% CI：0.816，0.946）、敏感性为86.5%（95% CI：0.765，0.951）、特异性为85.1%（95% CI：0.724，1.185）。结论 早期非创伤性股骨头坏死的CT表现以骨小梁增粗或骨质硬化、变形、模糊及新月征等为主，CT可有效诊断早期非创伤性股骨头坏死，且CT灌注参数可有效预测患者预后。

Abstract:

Objective To analyze the CT findings of early non traumatic necrosis of the femoral head and its relationship with prognosis.Methods A total of 168 suspected early nontraumatic femoral head necrosis patients treated at Zhuji Chinese Medicine Hospital from March 2019 to March 2020 were selected, All patients underwent CT and MRI examination. The results of the surgical pathology examination were used as the gold standard. The diagnostic efficacy of CT, MRI, and combined diagnosis on early non-traumatic femoral head necrosis was analyzed. All patients were divided into good prognosis and poor prognosis according to the follow-up results. The two groups of CT parameters [blood volume (BV), blood flow (BF), and average passage time (MMT) ] were compared to draw the ROC curve. The relationship of CT parameters with the prognosis of patients with early non-traumatic femoral head necrosis was analyzed.Results CT examination of 168 cases showed that 74 cases were mainly characterized by thickening of bone trabeculae or osteosclerosis, crowded fusion of femoral head, and fan-shaped sclerosis; 94 cases were mainly trabecular microfracture, slight collapse of articular surface of femoral head, and crescent sign in some cases; the consistency between CT, MRI, and the gold standard in the diagnosis of early non traumatic femoral head necrosis was 0.535, 0.676, and 0.870, respectively; The sensitivity and accuracy of combined diagnosis were higher than that of CT and MRI (P < 0.05), but there was no significant difference between CT and MRI (P > 0.05). The levels of BF, BV, and MMT in the group with good prognosis were higher than those in the group with poor prognosis (P < 0.05); the ROC curve showed that the AUC of BF for predicting poor prognosis in patients with early non-traumatic femoral head necrosis was 0.810 (95% CI: 0.729, 0.892), the sensitivity was 78.6% (95% CI: 0.584, 0.831), and the specificity was 65.5% (95% CI: 0.517, 0.792); and the AUC of BV for predicting poor prognosis in patients with early non-traumatic femoral head necrosis was 0.790 (95% CI: 0.671, 0.910), the sensitivity was 74.8% (95% CI:0.556, 0.824), and the specificity was 79.3% (95% CI:0.621, 0.875). The AUC of MMT for predicting poor prognosis in patients with early non-traumatic femoral head necrosis was 0.808 (95% CI: 0.699, 0.917), the sensitivity was 80.6% (95% CI: 0.704, 0.923), and the specificity was 82.8% (95% CI: 0.650, 0.946). The AUC of combined detection for predicting poor prognosis in patients with early non traumatic femoral head necrosis was 0.881 (95% CI: 0.816, 0.946), the sensitivity was 86.5% (95% CI: 0.765, 0.951), and the specificity was 85.1% (95% CI: 0.724, 1.185).Conclusion CT findings of early non-traumatic avascular necrosis of the femoral head are mainly trabecular thickening, osteosclerosis, deformation, blurring, and crescent sign. CT can effectively diagnose early non-traumatic avascular necrosis of the femoral head, and CT perfusion parameters can effectively predict the prognosis of patients.