DR、传统平片诊断脊柱结核ROC曲线评价
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摘要
目的:比较直接数字X线摄影(DR)与传统平片对于脊柱结核及其各种病变的诊断性能。
方法:对83例传统平片怀疑脊柱结核的患者进行脊柱正侧位DR检查(颈椎患者检查正斜位),相同的光学条件下,三位经验丰富的影像学医师在不知道最终结果的情况下按照不同的随机次序分别评价DR与传统平片对脊柱结核及其各种病变(骨质破坏,椎间隙变窄或消失,椎旁寒性脓肿,死骨,椎体变形)的检出差异,并按照五级法进行打分,评价结果与病理诊断结果进行对照,采用受试者操作特征(receiver operating characteristic,ROC)曲线进行统计分析。每种诊断技术的准确性用曲线下面积A_Z表示,其差异性评价采用两样本配对u检验,P＜0.05为差异具有统计学意义。
结果:(1)83例疑似脊柱结核病例最终经病理确诊53例,其余病例则为脊柱肿瘤等而除外诊断。ROC分析结果显示,在诊断脊柱结核方面,DR组的灵敏度(94.3%)和特异度(66.7%)均高于传统平片组(90.6%,56.7%),正确诊断指数(61%)高于传统平片组(47.3%),其ROC曲线下面积(A_Z=0.939)大于传统平片组(A_Z=0.857),统计学差异具有显著性(P=0.03);(2)在发现椎体骨质破坏、椎旁寒性脓肿方面,DR组灵敏度和特异度高于传统平片组,ROC曲线下面积(分别为A_Z=0.936,0.881)大于传统平片组(A_Z=0.891,0.740),差异具有统计学意义(P＜0.05);(3)在发现椎间隙变窄或消失、死骨形成和椎体变形方面,DR组灵敏度和特异度高于传统平片组,ROC曲线下面积(分别为A_Z=0.937,0.911,0.900)大于传统平片组(A_Z=0.922,0.893,0.875),统计学差异意义(P＞0.05)。
结论:对于脊柱结核及其各种病变,DR较传统平片诊断灵敏度和特异度更高,ROC曲线下面积更大,可以对脊柱结核做到提早发现,减少致残。
Objective To compare the value of direct digital radiography(DR)and conventional plain film in the diagnosis of spinal tuberculosis and its' pathological changes by using receiver operating characteristic(ROC)curve analysis.Methods PA and lateral view of DR were performed in 83 patients whose conventional plain films have been suspected of spinal tuberculosis(If it's cervical vertebra,then the anteteroposterior and oblique radiographs were performed).Under the same exposure parameters,according to a five-point scale,each paired image(the imaging materials of DR group and conventional radiography group)were analyzed independently by three experienced radiologists for the diagnosis of spinal tuberculosis,the destruction of spongyboue of vertebral body,the intervertebral space narrowing or destruction,the paraver-tebral soft abcess,high density intraosseous sequestrum and vertebral collapse.All radiologists were blind to the results of another imaging modality and the results of pathology or clinical records.The ROC analysis was used to compare the difference between the two techniques.Results(1)In 83 suspected cases,53 were pathologically diagnosed as spinal tuberculosis.For the detection of spinal tuberculosis,the sensitivity and specificity in DR group(94.3%,66.7%)was higher than that in conventional group(90.6%,56.7%),both the Youden's index in DR group(r=61%)and the area under ROC curve in DR group(A_Z=0.939) were larger than that in conventional group(r=47.3%,A_Z=0.857).The A_Z difference beteen DR and conventional group was statisticly significant(P=0.03);(2)For the detection of vertebral destruction and paravertebral cold abscesses,the sensitivity and specificity in DR was higher than that in conventional group and the area under ROC curve in DR group(A_Z=0.936, 0.881)was larger than that in conventional group(A_Z=0.891,0.740)with significant difference (P＜0.05);(3)For the detection of intervertebral space narrowing or destruction,intraosseous sequestrum and vertebral collapse,the sensitivity and specificity in DR was higher than that in conventional group and the area under ROC curve in DR group(A_Z=0.937,0.911,0.900)were larger than that in conventional group(A_Z=0.922,0.893,0.875),but the difference did not reach statistical significance(P＞0.05).The veracity of each technich was estimated with the erea under the ROC curve(A_Z)and the othemess of each was estimated with the paired u-test. Diffrence in diagnostic performance was statisticly significant if probability(P)was litter than 0.05.Conclusion The digital images were rated significantly better than conventional plain film for the diagnosis of spinal tuberculosis and its' pathological changes,which could diagnose earlier and reduce the results of deformity。
方法:对83例传统平片怀疑脊柱结核的患者进行脊柱正侧位DR检查(颈椎患者检查正斜位),相同的光学条件下,三位经验丰富的影像学医师在不知道最终结果的情况下按照不同的随机次序分别评价DR与传统平片对脊柱结核及其各种病变(骨质破坏,椎间隙变窄或消失,椎旁寒性脓肿,死骨,椎体变形)的检出差异,并按照五级法进行打分,评价结果与病理诊断结果进行对照,采用受试者操作特征(receiver operating characteristic,ROC)曲线进行统计分析。每种诊断技术的准确性用曲线下面积A_Z表示,其差异性评价采用两样本配对u检验,P＜0.05为差异具有统计学意义。
结果:(1)83例疑似脊柱结核病例最终经病理确诊53例,其余病例则为脊柱肿瘤等而除外诊断。ROC分析结果显示,在诊断脊柱结核方面,DR组的灵敏度(94.3%)和特异度(66.7%)均高于传统平片组(90.6%,56.7%),正确诊断指数(61%)高于传统平片组(47.3%),其ROC曲线下面积(A_Z=0.939)大于传统平片组(A_Z=0.857),统计学差异具有显著性(P=0.03);(2)在发现椎体骨质破坏、椎旁寒性脓肿方面,DR组灵敏度和特异度高于传统平片组,ROC曲线下面积(分别为A_Z=0.936,0.881)大于传统平片组(A_Z=0.891,0.740),差异具有统计学意义(P＜0.05);(3)在发现椎间隙变窄或消失、死骨形成和椎体变形方面,DR组灵敏度和特异度高于传统平片组,ROC曲线下面积(分别为A_Z=0.937,0.911,0.900)大于传统平片组(A_Z=0.922,0.893,0.875),统计学差异意义(P＞0.05)。
结论:对于脊柱结核及其各种病变,DR较传统平片诊断灵敏度和特异度更高,ROC曲线下面积更大,可以对脊柱结核做到提早发现,减少致残。
Objective To compare the value of direct digital radiography(DR)and conventional plain film in the diagnosis of spinal tuberculosis and its' pathological changes by using receiver operating characteristic(ROC)curve analysis.Methods PA and lateral view of DR were performed in 83 patients whose conventional plain films have been suspected of spinal tuberculosis(If it's cervical vertebra,then the anteteroposterior and oblique radiographs were performed).Under the same exposure parameters,according to a five-point scale,each paired image(the imaging materials of DR group and conventional radiography group)were analyzed independently by three experienced radiologists for the diagnosis of spinal tuberculosis,the destruction of spongyboue of vertebral body,the intervertebral space narrowing or destruction,the paraver-tebral soft abcess,high density intraosseous sequestrum and vertebral collapse.All radiologists were blind to the results of another imaging modality and the results of pathology or clinical records.The ROC analysis was used to compare the difference between the two techniques.Results(1)In 83 suspected cases,53 were pathologically diagnosed as spinal tuberculosis.For the detection of spinal tuberculosis,the sensitivity and specificity in DR group(94.3%,66.7%)was higher than that in conventional group(90.6%,56.7%),both the Youden's index in DR group(r=61%)and the area under ROC curve in DR group(A_Z=0.939) were larger than that in conventional group(r=47.3%,A_Z=0.857).The A_Z difference beteen DR and conventional group was statisticly significant(P=0.03);(2)For the detection of vertebral destruction and paravertebral cold abscesses,the sensitivity and specificity in DR was higher than that in conventional group and the area under ROC curve in DR group(A_Z=0.936, 0.881)was larger than that in conventional group(A_Z=0.891,0.740)with significant difference (P＜0.05);(3)For the detection of intervertebral space narrowing or destruction,intraosseous sequestrum and vertebral collapse,the sensitivity and specificity in DR was higher than that in conventional group and the area under ROC curve in DR group(A_Z=0.937,0.911,0.900)were larger than that in conventional group(A_Z=0.922,0.893,0.875),but the difference did not reach statistical significance(P＞0.05).The veracity of each technich was estimated with the erea under the ROC curve(A_Z)and the othemess of each was estimated with the paired u-test. Diffrence in diagnostic performance was statisticly significant if probability(P)was litter than 0.05.Conclusion The digital images were rated significantly better than conventional plain film for the diagnosis of spinal tuberculosis and its' pathological changes,which could diagnose earlier and reduce the results of deformity。
引文
[1]李威,黎竹勇。老年人脊柱结核的影像表现特点[J]。中华老年医学杂志,2004,23(9):619-622
[2]Lusted LB.Logical analysis in roentgen diagnosis[J].Radiology,1960,74(1):178-193.
[3]张雪哲,田宗皎,王德生.脊柱结核的CT表现[J].中华放射杂志,1994,28(2):123-124.
[4]Shul man GL.,Schwarz J.,Miezin FM.,Petersen SE.Effect of motion contrast on human cortical responses to moving stimuli.[J].Neurophysicol.1998.79:2794
[5]Frank F,Jens R.Flat panel digital radiography compared to storage phosphor computed radiography:assessment of dose versus image quality in phantom studies[J].Invest Radiol,2002,37:609-614
[6]尹树平,张燕群,叶宏军,等.DR成像技术在严重急性呼吸综合征病人临床诊治过程中的应用[J].中国医学影像技术杂志,2003,19(10):814-816
[7]Ludwig K,Lenzen H,Kamm K,et al.Performance of a Flat-Panel Detector in Detecting Artificial Bone Lesions:Comparison with Conventional Screen-Film and Storage-Phosphor Radiography[J].Radiology,2002,222(2):453-459
[8]Ludwig K,Henschel A,.Bernhardt TM et al.Performance of a fiat-panel detector in the detection of artificial erosive changes:comparison with conventional screen-film and storage-phosphor radiography[J].Eur Radiol,2003,13(11):1316 - 1323
[9]Strotzer M,Vo"lk M,Wild T,et al.Simulated Bone Erosions in a Hand Phantom:Detection with Conventional Screen-Film Technology versus Cesium Iodide-Amorphous Silicon Flat-Panel Detector[J].Radiology,2000,215(6):512-515
[10]Okamura T,Tanaka S,Koyama K,Norihumi N,et al.Clinical evaluation of digital radiography based on a large-area cesium iodide-amorphous silicon fiat-panel detector compared with screen-film radiography for skeletal system and abdomen[J].Eur Radiol,2002,12(5):1741-1747
[11]Winterer JT,Kotter E,Einert A et al.Pelvic Imaging With a Selenium-Based Detector (Thoravision):Comparison With Screen-Film Radiography in 75 Patients[J].Lippincott Williams & Wilkins,1999,34(12):761
[12]Hamers S,Freyschmidt J,Neitzel U et al.Digital radiography with a large-scale electronic fiat-panel detector vs screen-film radiography:observer preference in clinical skeletal diagnostics[J].Eur Radiol,2001,11(3):1753-1759
[13]林建华,陈德基,陈焱淼,等.数字X线摄影和计算机X线摄影的应用比较与评价[J].中国医学计算机成像杂志.2004,10(2):136-138
[14]Cormican L,Hammal R,Messenger J,et al.Current difficulties in the diagnosis and management of spinal tuberculosis[J].Postgrad Med J,2006,82:46-51
[1] Chotas HG, Dobbin JT ,Ravin CE ,et al. Principles of digital radiography with large-area .electronically readable detectors :a review of the basics [J]. Radiology, 1999,210(3):5954-599.
[2] Ludwig K,; Ahlers K, BS ;Wormanns D,.et al. Lumbar Spine Radiography:Digital Flat-Panel Detector versus Screen-Film and Storage-Phosphor Systems in Monkeys as a Pediatric Model [J]. Radiology ,2003,229:140-144
[3] Ludwig K, Schu "Ike C, BS; Diederich S , et al. Detection of Subtle Undisplaced Rib Fractures in a Porcine ModehRadiation DoseRequirement—Digital Flat-Panel versus Screen-Filmand Storage-Phosphor Systems [J]. Radiology, 2003,227:163-168
[4] Ludwig K, Lenzen H, Kamm K, et al. Performance of a Flat-Panel Detector in Detecting Artificial Bone Lesions: Comparison with Conventional Screen-Film and Storage-Phosphor Radiography [J]. Radiology ,2002,222:453-459
[5] Ludwig K, Henschel A,. Bernhardt TM et al. Performance of a flat-panel detector in the detection of artificial erosive changes: comparison with conventional screen-film and storage-phosphor radiography [J]. Eur Radiol ,2003,13:1316 - 1323
[6] Strotzer M , Vo¨lk M , Wild T, et al. Simulated Bone Erosions in a Hand Phantom:Detection with Conventional Screen-Film Technology versus Cesium Iodide-Amorphous Silicon Flat-Panel Detector [J]. Radiology ,2000,215:512-515
[7] Peer S,Neitzer U,Salvatore M,et al. Direct digital radiography versus storage phosphor radiography in the detection of wrist fractures[J].Clinical Radiology, 2002,57:258-262.
[8] Strotzer M, Gmeinwieser J, Spahn M, et al. Amorphous silicon, flat-panel, x-ray detector versus screen-film radiography: effect of dose reduction on the detectability of cortical bone defects and fractures[J]. Invest Radiol, 1998, 33(1):33-38
[9] Kolbeck S, Bail H, Weiler A et al. Digital Radiography :A Predictor of Regenerate Bone Stiffness in Distraction Osteogenesis[J]. Clin Orthop, 1999, 366(9):221-228
[10] Frank F, Jens R et al. Flat panel digital radiography compared to storage phosphor computed radiography :assessment of dose versus image quality in phantom studies[J].InvestRadiol,2002,37:609-614.
[11] Winterer JT, Kotter E, Einert A et al. Pelvic Imaging With a Selenium-Based Detector (Thoravision):Comparison With Screen-Film Radiography in 75 Patients[J]. Lippincott Williams & Wilkins, 1999, 34(12): 761
[12] Okamura T, Tanaka S, Koyama K, Norihumi N, et al . Clinical evaluation of digital radiography based on a large-area cesium iodide-amorphous silicon flat-panel detector compared with screen-film radiography for skeletal system and abdomen[J]. Eur Radiol.2002,12:1741-1747
[13] Hamers S, Freyschmidt J, Neitzel U et al. Digital radiography with a large-scale electronic flat-panel detector vs screen-film radiography: observer preference in clinical skeletal diagnostics[J]. Eur Radiol ,2001,11:1753-1759.
[14] Ludwig K, Diederich S, Wormanns D, et al. Selenium-based digital radiography of the cervical spine: comparison with screen-film radiography for the depiction of anatomic details[J]. Rofo.2002,174(8): 1028-32.
[15] Piraino DW, Davros WJ, Lieber M,et al. Selenium-based digital radiography versus conventional film-screen radiography of the hands and feet: a subjective comparison[J].AJR Am J Roentgenol. 1999,172(1):177-84.
[16] E. J. van der Jagt, S. Hofman, B. M. Kraft, et al. Can we see enough? A comparative study of film-screen vs digital radiographs in small lesions in rheumatoid arthritis[J].European Radiology. 2000(l):304 - 307
[17] Strotzer M, Gmeinwieser J, Volk M,et al . Clinical application of a flat-panel X-ray detector based on amorphous silicon technology: image quality and potential for radiation dose reduction in skeletal radiography[J]. American Journal of Roentgenology,1998 , 171:23-27.
[2]Lusted LB.Logical analysis in roentgen diagnosis[J].Radiology,1960,74(1):178-193.
[3]张雪哲,田宗皎,王德生.脊柱结核的CT表现[J].中华放射杂志,1994,28(2):123-124.
[4]Shul man GL.,Schwarz J.,Miezin FM.,Petersen SE.Effect of motion contrast on human cortical responses to moving stimuli.[J].Neurophysicol.1998.79:2794
[5]Frank F,Jens R.Flat panel digital radiography compared to storage phosphor computed radiography:assessment of dose versus image quality in phantom studies[J].Invest Radiol,2002,37:609-614
[6]尹树平,张燕群,叶宏军,等.DR成像技术在严重急性呼吸综合征病人临床诊治过程中的应用[J].中国医学影像技术杂志,2003,19(10):814-816
[7]Ludwig K,Lenzen H,Kamm K,et al.Performance of a Flat-Panel Detector in Detecting Artificial Bone Lesions:Comparison with Conventional Screen-Film and Storage-Phosphor Radiography[J].Radiology,2002,222(2):453-459
[8]Ludwig K,Henschel A,.Bernhardt TM et al.Performance of a fiat-panel detector in the detection of artificial erosive changes:comparison with conventional screen-film and storage-phosphor radiography[J].Eur Radiol,2003,13(11):1316 - 1323
[9]Strotzer M,Vo"lk M,Wild T,et al.Simulated Bone Erosions in a Hand Phantom:Detection with Conventional Screen-Film Technology versus Cesium Iodide-Amorphous Silicon Flat-Panel Detector[J].Radiology,2000,215(6):512-515
[10]Okamura T,Tanaka S,Koyama K,Norihumi N,et al.Clinical evaluation of digital radiography based on a large-area cesium iodide-amorphous silicon fiat-panel detector compared with screen-film radiography for skeletal system and abdomen[J].Eur Radiol,2002,12(5):1741-1747
[11]Winterer JT,Kotter E,Einert A et al.Pelvic Imaging With a Selenium-Based Detector (Thoravision):Comparison With Screen-Film Radiography in 75 Patients[J].Lippincott Williams & Wilkins,1999,34(12):761
[12]Hamers S,Freyschmidt J,Neitzel U et al.Digital radiography with a large-scale electronic fiat-panel detector vs screen-film radiography:observer preference in clinical skeletal diagnostics[J].Eur Radiol,2001,11(3):1753-1759
[13]林建华,陈德基,陈焱淼,等.数字X线摄影和计算机X线摄影的应用比较与评价[J].中国医学计算机成像杂志.2004,10(2):136-138
[14]Cormican L,Hammal R,Messenger J,et al.Current difficulties in the diagnosis and management of spinal tuberculosis[J].Postgrad Med J,2006,82:46-51
[1] Chotas HG, Dobbin JT ,Ravin CE ,et al. Principles of digital radiography with large-area .electronically readable detectors :a review of the basics [J]. Radiology, 1999,210(3):5954-599.
[2] Ludwig K,; Ahlers K, BS ;Wormanns D,.et al. Lumbar Spine Radiography:Digital Flat-Panel Detector versus Screen-Film and Storage-Phosphor Systems in Monkeys as a Pediatric Model [J]. Radiology ,2003,229:140-144
[3] Ludwig K, Schu "Ike C, BS; Diederich S , et al. Detection of Subtle Undisplaced Rib Fractures in a Porcine ModehRadiation DoseRequirement—Digital Flat-Panel versus Screen-Filmand Storage-Phosphor Systems [J]. Radiology, 2003,227:163-168
[4] Ludwig K, Lenzen H, Kamm K, et al. Performance of a Flat-Panel Detector in Detecting Artificial Bone Lesions: Comparison with Conventional Screen-Film and Storage-Phosphor Radiography [J]. Radiology ,2002,222:453-459
[5] Ludwig K, Henschel A,. Bernhardt TM et al. Performance of a flat-panel detector in the detection of artificial erosive changes: comparison with conventional screen-film and storage-phosphor radiography [J]. Eur Radiol ,2003,13:1316 - 1323
[6] Strotzer M , Vo¨lk M , Wild T, et al. Simulated Bone Erosions in a Hand Phantom:Detection with Conventional Screen-Film Technology versus Cesium Iodide-Amorphous Silicon Flat-Panel Detector [J]. Radiology ,2000,215:512-515
[7] Peer S,Neitzer U,Salvatore M,et al. Direct digital radiography versus storage phosphor radiography in the detection of wrist fractures[J].Clinical Radiology, 2002,57:258-262.
[8] Strotzer M, Gmeinwieser J, Spahn M, et al. Amorphous silicon, flat-panel, x-ray detector versus screen-film radiography: effect of dose reduction on the detectability of cortical bone defects and fractures[J]. Invest Radiol, 1998, 33(1):33-38
[9] Kolbeck S, Bail H, Weiler A et al. Digital Radiography :A Predictor of Regenerate Bone Stiffness in Distraction Osteogenesis[J]. Clin Orthop, 1999, 366(9):221-228
[10] Frank F, Jens R et al. Flat panel digital radiography compared to storage phosphor computed radiography :assessment of dose versus image quality in phantom studies[J].InvestRadiol,2002,37:609-614.
[11] Winterer JT, Kotter E, Einert A et al. Pelvic Imaging With a Selenium-Based Detector (Thoravision):Comparison With Screen-Film Radiography in 75 Patients[J]. Lippincott Williams & Wilkins, 1999, 34(12): 761
[12] Okamura T, Tanaka S, Koyama K, Norihumi N, et al . Clinical evaluation of digital radiography based on a large-area cesium iodide-amorphous silicon flat-panel detector compared with screen-film radiography for skeletal system and abdomen[J]. Eur Radiol.2002,12:1741-1747
[13] Hamers S, Freyschmidt J, Neitzel U et al. Digital radiography with a large-scale electronic flat-panel detector vs screen-film radiography: observer preference in clinical skeletal diagnostics[J]. Eur Radiol ,2001,11:1753-1759.
[14] Ludwig K, Diederich S, Wormanns D, et al. Selenium-based digital radiography of the cervical spine: comparison with screen-film radiography for the depiction of anatomic details[J]. Rofo.2002,174(8): 1028-32.
[15] Piraino DW, Davros WJ, Lieber M,et al. Selenium-based digital radiography versus conventional film-screen radiography of the hands and feet: a subjective comparison[J].AJR Am J Roentgenol. 1999,172(1):177-84.
[16] E. J. van der Jagt, S. Hofman, B. M. Kraft, et al. Can we see enough? A comparative study of film-screen vs digital radiographs in small lesions in rheumatoid arthritis[J].European Radiology. 2000(l):304 - 307
[17] Strotzer M, Gmeinwieser J, Volk M,et al . Clinical application of a flat-panel X-ray detector based on amorphous silicon technology: image quality and potential for radiation dose reduction in skeletal radiography[J]. American Journal of Roentgenology,1998 , 171:23-27.