Image Fusion of Multislice Spiral CT with Magnetic Resonance Imaging (MRI) in the Diagnosis and Nursing of Malignant Bone Diseases Using ANOVA

Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi Province, China Department of Preventive Health Care, Yantai City Qishan Hospital, Shandong, Yantai 264001, China Department of Orthopaedic, Guangrao County People’s Hospital, Shandong 257300, China Department of Medical Imaging, 74 Group Military Hospital of People’s Liberation Army, Guangzhou 510318, China Operation Room, Linyi Cancer Hospital, Linyi, Shandong 276000, China


Introduction
Bone lesions mainly refer to bone structure or sclerotin lesions. With the rapid development of the national economy, there are more and more bone diseases caused by different factors, for example, years of strain, trauma, or bone degeneration and endocrine disorders with age, leading to bone lesions [1][2][3]. Moreover, clinically, due to the different lesions of the patient's bones, the clinical manifestations are also different. If a fracture occurs after being subjected to direct external force, needle-like pain at the injured site will not be felt. Moreover, there will be obvious local swelling, positive tenderness, positive percussion pain, and so on, and the joints adjacent to the fracture will also have dysfunction [4]. Bone lesions generally include cervical spondylosis, lumbar disc herniation, bone hyperplasia, osteoporosis, osteoarthritis, fractures, and bone tumor. Among which, bone tumor is a common tumor disease that occurs in the bone or its accessory tissues. e bone lesions can be divided into benign lesions and malignant lesions according to the degree of invasion. Different disease severity accompanied by different targeted treatment methods will also affect the quality of patient prognosis [5,6]. Malignant skeletal lesions may cause severe pain mechanisms due to the development of the disease and various adverse reactions after treatment, which can trigger negative emotions such as depression, pessimism, and despair. erefore, it is very important for patients to receive psychological and pain care. erefore, it is very important to diagnose benign and malignant bone diseases at an early stage.
In the diagnosis of clinical bone lesions, X-ray is a relatively traditional examination method, which has the advantages of low cost and easy operation. Unfortunately, because of the low display resolution, projection position, overlapping parts, and so on, sometimes there will be a higher missed diagnosis rate [7,8]. In recent years, with the rapid development of microelectronics and computer technology, multislice spiral computed tomography (MSCT) is gradually utilized in clinical examinations. It can obtain tomographic images by reconstructing the sagittal plane, coronal plane, and any cut plane, to clearly show the internal and marginal situation of the organization and provide corresponding reference information for subsequent clinical diagnosis. Moreover, due to the fast scanning speed, it can perform quantitative scanning diagnosis of heart beat, coronary artery, and its branch calcification, which is a noninvasive examination method [9,10]. Magnetic resonance imaging (MRI) is a technique that adopts magnetic fields and radio wave energy pulses to image and inspect human internal organs and structures. In many cases, MRI can provide more information than X-ray, ultrasound, or CT and has the advantages of multiple parameters, high resolution, and accurate display [11,12]. With the application of high-performance coils and the optimization of scanning sequences in recent years, MRI has been widely adopted in the diagnosis of bone lesions. At present, most of the research studies on MSCT and MRI are limited to a single index, and there are few studies on the combined application of the two [13]. erefore, this work intended to utilize MSCT combined with MRI to explore the diagnosis and treatment of malignant bone lesions in bone tumor.
In summary, the clinical adoption of MSCT and MRI is of great value. Based on which, 108 patients with bone tumor were taken as objects, who underwent MSCT and MRI scans. By comparing the accuracy, sensitivity, and specificity of MSCT, MRI, and MSCT + MRI in the identification of benign and malignant bone lesions and identifying the accuracy of different bone tumor pathological types, the application value of enhanced CT combined with MRI was comprehensively evaluated in the diagnosis and nursing of malignant bone diseases.

Selection of Research
Objects. 108 bone tumor patients who were admitted to the hospital from January 15, 2019, to January 10, 2020, were selected as the research objects, and their age range was 20-71 years. Both MSCT and MRI scans were performed. e study had been approved by the Medical Ethics Committee of Hospital, and the patients and their families understood the study and signed an informed consent form.
Inclusion criteria include the following: (1) patients who had not received relevant treatment before; (2) patients without pathological fractures; (3) patients who had not undergone needle biopsy in the past month; (4) patients with complete clinical data; and (6) patients without contraindications to CT examination.
Exclusion criteria include the following: (1) patients older than 71 years; (2) patients who had been treated with antitumor therapy; (3) patients with contraindications to MRI scanning; (4) patients with mental illness; (5) patients gave up halfway during examination; and (6) patients with poor compliance with examination.

Imaging Examination Methods.
In this study, a 64-slice spiral CT scanner manufactured by General Electric was adopted to perform enhanced CT scan on patients with the contrast enhancer of 300 mg/mL Omnipaque. Image collection was carried out at the central position of the tumor. Scan parameters are as follows: tube voltage was 120 kV, tube current was 240 mA, pitch was 0.85, thickness was 0.65 mm, matrix of 521 × 521, scanning speed was 1 s/week, and scan time of 100 s. 1.5 mL/kg of nonionic iodine contrast agent was injected into the forearm with an automatic highpressure CT syringe.
Open Mark 5000 permanent magnetic resonance imager produced by Shenzhen Anke High Technology Co., Ltd. was utilized to perform MRI scanning on the patients. e joint and the limb may adopt the body part array coil or the body part wrapping flexible coil and the body part winding coil. Patient was put in supine position with the foot advanced. e examination part was put in the center of the coil, and coronal plane and cross-sectional scan of the hip and shoulder joints were taken. e scanning parameters were as follows: the layer thickness of 5 mm, spacing of 0.5 mm, pulse train repetition time of 750 ms, and echo time of 10 ms.

Image Analysis.
Two senior radiologists independently reviewed MSCT images and MRI images to determine the disease degree of bone tumor lesions. MSCT image benign and malignant diagnostic criteria were as follows. e image showed signs of bone destruction such as osteolytic or osteogenic changes, and the image had sharp edges, and it showed whether there were characteristic manifestations such as calcification and ossification in the lesion. Diagnostic criteria for benign and malignant MRI images were as follows. e benign bone tumors showed expansive bone destruction, and T1WI (T1-weighted imaging) was mostly low signal. e T2WI (T2-weighted imaging) usually showed medium and high signal, and the boundary between the tumor bone and the normal bone was sharp, without periosteal reaction, and the surrounding masses were clear. Malignant bone tumors usually showed signals ranging from medium to high on T1WI and T2WI according to the different tissue components in the tumor. Malignant bone tumors usually showed invasive destruction of bone destruction and blur the boundary with normal bone tissue. e bone destruction area usually showed low signal on T1WI. Most of the cortical bone showed medium signal, and the T2WI showed high signal.

Observation Indexes.
e general information of the selected patients' (age, body mass index (BMI), course of disease, and male to female ratio), MSCT, and MRI imaging data were recorded. e accuracy, sensitivity, specificity, malignant misdiagnosis rate, and malignant missing report rate of MSCT, MRI, and MSCT + MRI for distinguishing benign and malignant bone tumors and nursing care were also recorded. e diagnostic accuracy of MSCT, MRI, and MSCT + MRI for different bone tumor pathological types was calculated.

Statistical Methods.
e data in this study were analyzed by SPSS19.0 version statistical software, the measurement data were expressed as mean ± standard deviation (x ± s), and the count data as percentage (%). e age, BMI, course of disease, and male-female ratio of the selected patients were compared by analysis of variance. Comparison of accuracy, sensitivity, specificity, malignant misdiagnosis rate, and malignant missing report rate of MSCT, MRI, and MSCT + MRI for distinguishing benign and malignant bone tumors and nursing care was conducted via pair t test, which was also adopted to compare the diagnosis accuracy of different bone tumor pathological types. e difference was statistically significant at P < 0.05. Table 1 shows the descriptive statistics of the basic data of selected patients. In terms of gender, the proportion of male patients (64.54%) was evidently greater than that of female patients (35.46%). In terms of age, patients younger than 30 years old accounted for the most (41.75%), followed by patients 30-50 years old (28.83%). In terms of BMI, patients between 18.5 and 22.9 m 2 /kg accounted for the most (46.72%), followed by patients less than 18.5 m 2 /kg (36.45%) and patients greater than 22.9 m 2 /kg (16.83%). In terms of disease course, the proportion of patients from 4 to 10 months was the largest (46.07%), followed by patients with course less than 4 months (35.26%) and more than 10 months (18.67%). Figures 1 and 2 show MSCT and MRI images of a male patient with bone tumor (aged 34 years old). On CT images, the tumor was manifested as peripheral sclerosis with a clear center, most of which were in the cortex. Tumor nests were with calcification, flocculent density increased, and no periosteal reaction was seen on the outer edge of the cortical bone. e MRI image showed that the tumor nest had a very rich blood supply. When the lesion was located in the bone marrow or adjacent to the joint, there was no sclerosis edge. Figure 3 shows the accuracy comparison of MSCT combined with MRI in identifying benign and malignant bone lesions. e accuracy of MSCT to distinguish benign and malignant skeletal lesions was 85.91%, that of MRI was 89.85%, and that of MSCT + MRI was 97.56%. Among which, the accuracy of MSCT + MRI in distinguishing benign and malignant bone lesions was   Scientific Programming 3 greatly higher in contrast to that of MSCT and MRI, and the difference was very notable (P < 0.05). Figure 4 presents the sensitivity and specificity comparison of MSCT combined with MRI in the identification of benign and malignant bone lesions. e sensitivity of MSCT and MRI to distinguish benign and malignant bone lesions was 83.66% and 86.02%, respectively, and the specificity was 79.05% and 81.17%, respectively. e sensitivity of MSCT + MRI to distinguish benign and malignant bone lesions was 94.85%, and the specificity was 90.52%. Among which, the sensitivity and specificity of MSCT + MRI in distinguishing benign and malignant bone lesions were notably better relative to MSCT and MRI, with considerable difference (P < 0.05).

Contrast of Malignant Misdiagnosis Rate and Malignant
Missing Report Rate of Different Detection Methods. Figure 5 shows the comparison of the malignant misdiagnosis rate and the malignant missing report rate of MSCT combined with MRI to identify benign and malignant bone lesions. e malignant misdiagnosis rate of MSCT for identifying benign and malignant bone lesions was 6.08%, and the malignant missing report rate was 8.44%. e malignant misdiagnosis rate and the malignant missing report rate of MRI were 5.22% and 6.96%, respectively, and those of MSCT + MRI were 3.87% and 4.31%, respectively. Among which, the malignant misdiagnosis rate and the malignant missing report rate of MSCT + MRI in distinguishing benign and malignant bone lesions were remarkably inferior to MSCT and MRI, and the difference was evident (P < 0.05).

Contrast of the Accuracy of Different Detection Methods to
Identify the Pathological Type of Bone Tumor. Figure 6 shows the accuracy comparison of MSCT combined with MRI in distinguishing osteosarcoma and GCT. e accuracy of MSCT identifying osteosarcoma was 83.86%, and the accuracy of identifying GCT was 84.2%. e accuracy of MRI identifying osteosarcoma was 85.47%, and the accuracy of identifying GCT was 85.11%. MSCT + MRI showed 93.28% accuracy in identifying the osteosarcoma and 94.06%  accuracy in identifying GCT. Among which, the accuracy of MSCT + MRI in distinguishing osteosarcoma and GCT was highly greater in contrast to that of MSCT and MRI, with obvious difference (P < 0.05). Figure 7 shows the accuracy comparison of MSCT combined with MRI in identifying bone cyst and OFD. e accuracy of MSCT identifying bone cyst was 82.17%, and the accuracy of identifying OFD was 82.08%. e accuracy of MRI identifying bone cyst was 80.95%, and the accuracy of identifying OFD was 84.14%. e accuracy of MSCT + MRI in identifying bone cyst was 89.33%, and the accuracy of identifying OFD was 88.55%. Among which, the accuracy of MSCT + MRI in distinguishing bone cyst and OFD was obviously higher versus that of MSCT and MRI (P < 0.05). Figure 8 compares the accuracy of MSCT combined with MRI in identifying the osteofibroma and ganglioneuroma. e accuracy of MSCT in identifying osteofibroma and ganglioneuroma was 58.55% and 61.51%, respectively. e accuracy of MRI in identifying osteofibroma and ganglioneuroma was 54.91% and 59.74%, respectively. MSCT + MRI showed 68.64% accuracy in identifying the osteofibroma and 71.63% accuracy in identifying ganglioneuroma. Among which, the accuracy of MSCT + MRI in identifying osteofibroma and ganglioneuroma was evidently better relative to MSCT and MRI, and the difference was considerable (P < 0.05).

Discussion
Bone tumor generally includes basic bone tissue tumors and bone accessory tissue tumors, which are relatively common tumor diseases. In malignant bone tumors, osteosarcoma generally has the highest incidence, accounting for about 42%, followed by GCT, which is about 13% [14,15]. How to diagnose malignant bone tumor with appropriate examination methods in clinic is also a hot topic at present. erefore, 108 patients with bone tumor were selected as the research objects, and they all underwent MSCT and MRI scans. Moreover, the accuracy, sensitivity, and specificity of MSCT, MRI, and MSCT + MRI were compared regarding identifying benign and malignant bone lesions and nursing care. e results showed that the accuracy of MSCT + MRI in distinguishing benign and malignant bone lesions was obviously higher versus that of MSCT and MRI, and the difference was evident (P < 0.05). It was similar to the results of Caers et al. [16], showing that compared with the single MSCR and MRI, MSCT combined with MRI detection can more effectively improve the accuracy of the diagnosis of malignant bone tumor. e sensitivity and specificity of MSCT + MRI in distinguishing benign and malignant bone lesions were also better than those of MSCT and MRI (P < 0.05), revealing that MSCT combined with MRI detection had high sensitivity and specificity for the diagnosis of malignant bone tumor and was of adoption value. e malignant misdiagnosis rate and malignant missing report rate of MSCT + MRI in distinguishing benign and malignant bone lesions were notably inferior to those of MSCT and MRI, with remarkable difference (P < 0.05). It was consistent with the results of Carlbom et al. [17], indicating that MSCT combined with MRI detection can better improve the misdiagnosis and missed diagnosis of single MSCT and MRI examination of malignant bone tumor.
After the accuracy of MSCT combined with MRI for different pathological types of bone tumor was analyzed, it was found that the accuracy of MSCT + MRI in distinguishing osteosarcoma and GCT was greatly higher in contrast to that of MSCT and MRI (P < 0.05), which was similar to the results of Leynes et al. [18], indicating that MSCT combined with MRI had a better diagnostic effect for osteosarcoma and GCT, and the accuracy had been greatly improved [19]. e accuracy of MSCT + MRI in distinguishing bone cyst and OFD was also the optimal one among all methods (P < 0.05), which also suggested that MSCT combined with MRI was better than single MSCT and MRI detection for the diagnosis of bone cyst and OFD. In addition, the accuracy of MSCT + MRI in distinguishing osteofibroma and ganglioneuroma was also higher versus that of MSCT and MRI (P < 0.05). However, the accuracy of MSCT + MRI in distinguishing osteofibroma and ganglioneuroma was 68.64% and 71.63%, respectively. e results   were different from those of Ellmann et al. [20], and the reason may be that the sample size of patients was quite different, and the adopted contrast agent for CT scan was also different. erefore, although MSCT + MRI can improve the accuracy of single MSCT and MRI detection for osteofibroma and ganglioneuroma, the diagnostic performance of these two malignant tumors was poor and the accuracy was relatively low.

Conclusion
108 cases of bone tumor patients were selected as the research objects, and all of them underwent MSCT and MRI scans.
en, the accuracy, sensitivity, and specificity of MSCT, MRI, and MSCT + MRI were compared in terms of identifying benign and malignant bone lesions and nursing care, and the diagnosis accuracy of different bone tumor pathological types was compared, too. It was disclosed that compared with single MSCT and MRI detection, MSCT combined with MRI can effectively improve the accuracy of identifying benign and malignant bone tumor lesions and had higher sensitivity and specificity. MSCT combined with MRI had better performance in identifying osteosarcoma, GCT, bone cyst, and OFD but poor performance in osteofibroma and ganglioneuroma. However, the sample size of the patients selected is small, resulting in fewer bone tumor cases such as soft osteosarcoma, bone schwannoma, and ganglioneuroma. Later, the patient sample size will be considered to expand to further explore the clinical effects of MSCT combined with MRI. In conclusion, the results of this article provide good experimental support for the combined diagnosis of clinical imaging of bone tumors and malignant bone lesions.

Data Availability
No data were used to support this study.

Conflicts of Interest
e authors declare that there are no conflicts of interest.