调查普通和增强谱CT推导的测量结果在骨岛骨转移（OBM）与骨岛（BI）之间的差异。自2020年1月至11月，回顾性纳入73名新诊断的癌症患者（共201个骨病灶，OBM=92个，BI=109个），这些患者接受过谱CT检查。在普通和增强谱CT上手工分割病灶，推导出包括40-140 keV的CT数值、谱曲线斜率、有效原子数（Zeff）、水（钙）密度、钙（水）密度和碘（钙）密度等测量结果，然后使用学生t检验和皮尔逊相关性进行分析。进行多变量分析建立模型（普通谱CT模型、增强谱CT模型和组合模型）以区分OBM和BI，性能评估采用接受者操作特征曲线和DeLong检验。所有特征在BI组和OBM组之间均存在显著差异（所有p<0.05），在OBM（r: 0.392-0.763）和BI（r: 0.430-0.544）之间与普通和增强谱CT的相应特征高度相关。就模型性能而言，组合模型表现最佳（AUC=0.925，95% CI: 0.879 to 0.957），在区分OBM和BI方面明显优于普通谱CT模型（AUC=0.815，95% CI: 0.754 to 0.866，p<0.001）和增强谱CT模型（AUC=0.901，95% CI: 0.852 to 0.939，p=0.024）。除普通谱CT测量结果外，增强谱CT测量结果可以进一步显著改善骨转移和骨岛之间的鉴别诊断。普通或增强谱CT推导的测量结果可以为新诊断的癌症患者提供额外有价值的信息，改善OBM和BI之间的鉴别诊断。我们打算调查普通和增强谱CT推导的测量结果在鉴别OBM和BI方面的应用。普通和增强谱CT均有助于区分新诊断的癌症患者中的OBM和BI。增强谱CT测量结果进一步改善了基于普通谱CT测量结果的鉴别诊断。© 2023. 作者（们），在欧洲放射学学会的独家许可下。

To investigate measurements derived from plain and enhanced spectral CT in differentiating osteoblastic bone metastasis (OBM) from bone island (BI).From January to November 2020, 73 newly diagnosed cancer patients with 201 bone lesions (OBM = 92, BI = 109) having received spectral CT were retrospectively enrolled. Measurements including CT values of 40-140 keV, slope of the spectral curve, effective atomic number (Zeff), water (calcium) density, calcium (water) density, and Iodine (calcium) density were derived from manually segmented lesions on plain and enhanced spectral CT, and then analyzed using Student t-test and Pearson's correlation. Multivariate analysis was performed to build models (plain spectral model, enhanced spectral CT model, and combined model) for the discrimination of OBM and BI with performance evaluated using receiver operator characteristics curve and DeLong test.All features were significantly different between the BI group and OBM group (all p < 0.05), highly correlated with the corresponding features between plain and enhanced spectral CT both in OBM (r: 0.392-0.763) and BI (r: 0.430-0.544). As for the model performance, the combined model achieved the best performance (AUC = 0.925, 95% CI: 0.879 to 0.957), which significantly outperformed the plain spectral CT model (AUC = 0.815, 95% CI: 0.754 to 0.866, p < 0.001) and enhanced spectral CT model (AUC = 0.901, 95% CI: 0.852 to 0.939, p = 0.024) in differentiating OBM and BI.In addition to plain spectral CT measurements, enhanced spectral CT measurements would further significantly benefit the differential diagnosis.Measurements derived either from plain or enhanced spectral CT could provide additional valuable information to improve the differential diagnosis between OBM and BI in newly diagnosed cancer patients.• We intend to investigate plain and enhanced spectral CT measurements in differentiating OBM from BI. • Both plain and enhanced spectral CT help in discriminating OBM and BI in newly diagnosed cancer patients. • Enhanced spectral CT measurements further improve plain spectral CT measurements-based differential diagnosis.© 2023. The Author(s), under exclusive licence to European Society of Radiology.