中国中西医结合影像学杂志

目的:对比北京光大宏达骨密度分析QCT系统(HD)与Mindways QCT系统(MW)测量腰椎体积骨密度(vBMD)的一致性、相关性,评价其临床应用价值。方法:纳入行胸部CT检查的患者353例,分别采用MW与HD测量L₁、L₂椎体vBMD,并计算平均值。采用ICC评价2位医师使用HD测量vBMD的一致性;采用Wilcoxon符号秩和检验比较2种QCT测量结果的差异;通过Spearman相关分析、Bland-Altman分析评价2种QCT测量结果的相关性与一致性;采用Kappa检验及McNemar检验分析2种QCT对≥50岁人群骨质疏松诊断的一致性与检出率。结果:2位医师使用HD测量的L₁、L₂及L_1～2椎体平均vBMD一致性良好(均ICC>0.75)。HD与MW测量L_1～2椎体平均vBMD差异无统计学意义(P>0.05)。2种QCT测得的L₁、L₂及L_1～2椎体平均vBMD均呈正相关(r=0.941,0.941,0.945;均P<0.001)。Bland-Altman分析显示,2种方法测量结果一致性良好。2种方法对≥50岁人群骨质疏松的检出率差异无统计学意义(P>0.05),诊断一致性较好(K=0.67,P<0.001)。结论:HD与MW测量的vBMD相关性高、一致性好,诊断效能相当,可作为胸部体检患者行机会性vBMD评估的可靠工具,适合基层医院及大规模筛查。

Objective:To compare the agreement and correlation of lumbar volumetric bone mineral density(v BMD) measurements between Beijing Guangda Hongda bone density analysis QCT software(HD) and Mindways QCT software(MW),and to evaluate the clinical application value of HD. Methods:A total of 353 patients who underwent chest CT examinations were enrolled. The vBMD of the L₁ and L₂ vertebrae was measured separately using MW and HD,and the mean values were calculated. Inter-observer agreement between two physicians using HD was assessed using ICC. Differences between the two QCT measurements were compared using the Wilcoxon signed-rank test. Correlation and agreement were evaluated using Spearman correlation analysis and Bland-Altman analysis. Diagnostic consistency and detection rates of osteoporosis by two QCT measurements in subjects aged ≥ 50 years were analyzed using the Kappa test and McNemar test. Results:The vBMD of L₁,L₂,and mean L_1—2 by two physicians using HD showed good consistency(all ICC >0.75). No statistically significant difference was found in the mean vBMD of L_1—2 between HD and MW(P>0.05). The vBMD values of L₁,L₂,and mean L_1—2 measured by the two QCT measurements were positively correlated(r=0.941,0.941,and 0.945,respectively; all P<0.001). Bland-Altman analysis showed good agreement between the two QCT measurements. No statistically significant difference was found in the detection rate of osteoporosis between the two QCT measurements in subjects aged ≥ 50 years(P>0.05),with good diagnostic consistency(K=0.67,P<0.001). Conclusions:HD and MW show high correlation and good consistency in vBMD measurements,with equivalent diagnostic efficacy. They can serve as reliable tools for opportunistic vBMD assessment in patients undergoing chest CT examinations and are suitable for primary hospitals and large-scale screening.