Zochling J, Nguyen T V, March L M, Sambrook P N
Institute of Bone & Joint Research, University of Sydney, Australia.
Osteoporos Int. 2004 Aug;15(8):619-24. doi: 10.1007/s00198-004-1594-5. Epub 2004 Feb 13.
The performance of quantitative ultrasound (QUS) for the assessment of osteoporotic fracture must be fully defined if it is to be used in the clinical setting. We have examined the precision and reproducibility of two ultrasound instruments in 1,267 institutionalized elderly men and women (mean age 82.1 and 85.9 years, respectively). Measurement of BUA and VOS was reliable, least significant change for BUA being 2.4% and for VOS 0.3% using the CUBA McCue instrument and 2.7% for BUA using the Metra QUS-2. Importantly, age was not found to influence the precision of either parameter. Comparison of the instruments showed the QUS-2 measures BUA higher than the CUBA by 1.9 dB/MHz (+/-9.55 dB/MHz). Moreover classification of individuals as osteoporotic by machine-derived T-score was different between instruments (kappa = 0.44 in men and kappa = 0.62 in women). Fifty-six residents were remeasured by CUBA after 2.2 years; BUA was observed to decrease by 5.2% (+/-16.5%, p = 0.02) without significant change in VOS, suggesting BUA is more useful in longitudinal studies. In conclusion, ultrasound measurements were highly reliable and sensitive to longitudinal change even in the very elderly. However, diagnosis by T-score criteria was instrument specific, and such criteria should be interpreted with caution in the assessment of fracture risk.
如果要将定量超声（QUS）用于临床评估骨质疏松性骨折，就必须全面明确其性能。我们在1267名入住机构的老年男性和女性（平均年龄分别为82.1岁和85.9岁）中检测了两种超声仪器的精密度和可重复性。使用CUBA McCue仪器测量骨超声振幅（BUA）和骨超声速度（VOS）是可靠的，BUA的最小显著变化为2.4%，VOS为0.3%；使用Metra QUS - 2测量时，BUA的最小显著变化为2.7%。重要的是，未发现年龄会影响任何一个参数的精密度。仪器比较显示，QUS - 2测量的BUA比CUBA高1.9 dB/MHz（±9.55 dB/MHz）。此外，通过机器得出的T值将个体分类为骨质疏松症患者时，不同仪器之间存在差异（男性kappa值 = 0.44，女性kappa值 = 0.62）。56名居民在2.2年后用CUBA进行了重新测量；观察到BUA下降了5.2%（±16.5%，p = 0.02），而VOS没有显著变化，这表明BUA在纵向研究中更有用。总之，即使在非常年长的人群中，超声测量也具有高度可靠性，并且对纵向变化敏感。然而，通过T值标准进行的诊断因仪器而异，在评估骨折风险时，对这些标准的解释应谨慎。
