摘要
目的基于踝关节骨性结构(包括胫骨远端、腓骨远端及距骨)骨肿瘤的临床及X线特征建立评分模型,并评价其诊断效能。方法回顾性分析接受X线检查并经病理证实的114例踝关节骨性结构骨肿瘤患者的临床与X线征象,纳入25个特征,临床9个[性别、年龄、触及肿块(有或无)、压痛(有或无)、休息缓解(是或否)、运动加剧(有或无)、皮温升高(有或无)、夜间疼痛(有或无)及活动障碍(有或无)]、X线16个[部位(胫骨远端、腓骨远端、距骨)、数量(单或多)、长横径之比(>1cm或≤1cm)、生长方式(膨胀性生长或浸润性生长)、钙化(有或无)、残留骨嵴(有或无)、毛玻璃样改变(有或无)、硬化边(有或无)、边缘清晰(是否)、病理性骨折(有或无)、累及关节面(有或无)、突出骨皮质(有或无)、病灶主体(骨皮质或骨髓腔内)、骨膜反应(有或无)、软组织肿块形成(有或无)、假关节形成(有或无)],通过二分类Logistic回归分析,获取相关性高的征象,构建简易评分模型评价肿瘤良恶性,并利用ROC曲线分析该模型的诊断效能。结果经二分类Logistic回归分析,年龄(OR=4.545)、病理性骨折(OR=2.567)、骨膜反应(OR=4.675)及软组织肿块(OR=8.148)为危险因素,长横径之比(OR=0.126)、硬化边(OR<0.001)、边缘(OR=0.074)及病灶主体(OR=0.070)为保护因素。建立简易评分模型:评分=(长横比+硬化边+边缘+病灶主体)-(年龄+病理骨折+骨膜反应+软组织肿块),以上各因素每存在一个累加1分,若无则为0分。此简易评分模型AUC为0.897(P<0.001),良恶性临界值为1.5分,敏感度为86.9%,特异度为74.7%。结论踝关节简易评分系统有助于影像医师对踝关节骨性结构骨肿瘤定性诊断,可提高诊断效率并提供肿瘤良恶性鉴别的客观依据。
Objective To establish simple scoring model to identify benign and malignant bone structure tumor of the ankle and diagnosis effectiveness based on the clinical and X-ray features.Methods The clinical feature and X-ray signs data of 114 cases of ankle bone structure tumor confirmed by pathology were retrospectively analyzed.Clinial feature included sex,age,accessible mass,tenderness,pain improves,get worse with exercise,increase skin temperature,night pain,movement disorder;X-ray included location（shins,fibulas and talus）,quantity,long cross ratio（〉1cm or ≤1cm）,grown（expansive or infiltrative）,calcifications,bony ridge,ground-glass opacity,sclerotic margins,edge,pathological fracture,articular surface,outside of bony cortex,the body of lesions,periosteal reaction,soft tissue mass,pseudarthrosis.High correlation signs were obtained by univariate and binary Logistic regression analysis,and a simple evaluation model was established,the diagnostic efficacy was evaluated with ROC curve.Results Through univariate and binary Logistic regression analysis,age（OR=4.545）,pathological fracture（OR=2.567）,periosteal reaction（OR=4.675）and soft tissue mass（OR=8.148）were risk factors;long cross ratio（OR=0.126）,sclerotic margins（OR〈0.001）,the body of lesions（OR=0.070）and edge（OR=0.074）were protection factors.Score=（long cross ratio＋sclerotic margins＋close to the bone cortex＋edge）-（age＋pathological fracture＋periosteal reaction＋soft tissue mass）,there was a cumulative one point when existed each of the above factors,whereas was 0points when the absence.Taking 1.5points as threshold,there was benign which was larger than 1.5points,malignant which was less than 1.5points,the sensitivity was86.9%,specificity of 74.7%.Conclusion Ankle simple scoring model can help to qualitative ankle bone tumors,and improve the diagnostic efficiency and provide objective basis for benign and malignant identification.
出处
《中国医学影像技术》
CSCD
北大核心
2016年第11期1735-1739,共5页
Chinese Journal of Medical Imaging Technology
基金
广东省省级科技计划项目(2015B020233002
2015B020233008)
广东省科技计划项目(2016ZC0058)
广州市科技计划项目(201604020058)
南方医科大学大学生创新创业训练计划项目(201512121126)
