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Differentiation of usual vertebral compression fractures using CT histogram analysis as quantitative biomarkers: A proof-of-principle study.

Abstract：

PURPOSE:To investigate the utility of CT histogram analysis (CTHA) for discrimination of traumatic, osteoporotic and malignant fractures in patients with vertebral compression fractures (VCFs). To evaluate the feasibility and accuracy of CTHA in differentiating non-malignant (traumatic and osteoporotic) from malignant VCFs. MATERIALS AND METHODS:Totally, 235 patients with VCFs were enrolled in the current experimental study. There were 132 patients with traumatic VCFs, 51 with osteoporotic VCFs and 52 with malignant VCFs, with MRI and histology as the standard references. All the patients underwent unenhanced CT scans. Nineteen histogram-based parameters were derived using Omni-Kinetics software (Omni-Kinetics, GE Healthcare). The reproducibility of those parameters was evaluated using two independent delineations conducted by two observers. These histogram parameters were compared among the three different VCFs using Kruskal-Wallis H test. Traumatic VCFs and osteoporotic VCFs were combined as non-malignant VCFs and compared with malignant VCFs using Mann-Whitney U test Multivariable logistic regression analysis was performed on the significantly different features and built a diagnosis model. Receiver operating characteristic (ROC) curve was carried out to observe the difference of diagnostic performance between the single positive parameter and the combination of parameters. RESULTS:All the 19 parameters presented excellent reproducibility, with intraclass correlation coefficient values from 0.789 to 0.997. At quantitative evaluation, the best predictive histogram parameters in discrimination of the three different types of VCFs were relative min intensity (p = 0.022), relative entropy (p = 0.043), and relative frequency size (p < 0.001). Relative frequency size (p < 0.001) and relative quantile5 (p = 0.012) resulted in statistically significant difference between non-malignant and malignant VCFs. The area under ROC curve indicated that relative frequency size combined with relative quantile5 (0.754; 95 % confidence intervals: 0.661∼0.829; p < 0.001) was of best performance in differentiating malignant from non-malignant VCFs. CONCLUSIONS:Our results are encouraging and suggest that histogram parameters derived from unenhanced CT could be reliable quantitative biomarkers for diﬀ ;erential diagnosis of usual VCFs.

journal_name

Eur J Radiol

journal_title

European journal of radiology

authors

Lv M,Zhou Z,Tang Q,Xu J,Huang Q,Lu L,Duan S,Zhu J,Li H

doi

10.1016/j.ejrad.2020.109264

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

109264

eissn

0720-048X

issn

1872-7727

pii

S0720-048X(20)30453-8

journal_volume

131

pub_type

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Differentiation of usual vertebral compression fractures using CT histogram analysis as quantitative biomarkers: A proof-of-principle study.