Takasu Miyuki, Yamagami Takuji, Nakamura Yuko, Komoto Daisuke, Kaichi Yoko, Tani Chihiro, Date Shuji, Kiguchi Masao, Awai Kazuo
Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
PLoS One. 2014 Oct 16;9(10):e110106. doi: 10.1371/journal.pone.0110106. eCollection 2014.
It is well recognized that therapeutic irradiation can result in bone damage. However, long-term bone toxicity associated with computed tomography (CT) performed during interventional angiography has received little attention. The purpose of this study was to determine the prevalence of osteoporosis and trabecular microstructural changes in patients after transarterial chemoembolization (TACE) for hepatocellular carcinoma therapy using an interventional-CT system.
Spinal microarchitecture was examined by 64-detector CT in 81 patients who underwent TACE, 35 patients with chronic hepatitis, and 79 controls. For each patient, the volumetric CT dose index (CTDIv) during TACE (CTDIv (TACE)), the dose-length product (DLP) during TACE (DLP (TACE)), and CTDIv and DLP of routine dynamic CT scans (CTDIv (CT) and DLP (CT), respectively), were calculated as the sum since 2008. Using a three dimensional (3D) image analysis system, the tissue bone mineral density (tBMD) and trabecular parameters of the 12th thoracic vertebra were calculated. Using tBMD at a reported cutoff value of 68 mg/cm3, the prevalence of osteoporosis was assessed.
The prevalence of osteoporosis was significantly greater in the TACE vs. the control group (39.6% vs. 18.2% for males, P<0.05 and 60.6% vs. 34.8% for females, P<0.01). Multivariate regression analysis demonstrated that sex, age, and CTDIv (CT) significantly affected the risk of osteoporosis. Of these indices, CTDIv (CT) had the highest area under the curve (AUC) (0.735). Correlation analyses of tBMD with cumulative radiation dose revealed weak correlations between tBMD and CTDIv (CT) (r2 = 0.194, P<0.001).
The prevalence of osteoporosis was significantly higher in post TACE patients than in control subjects. The cumulative radiation dose related to routine dynamic CT studies was a significant contributor to the prevalence of osteoporosis.
众所周知，治疗性放疗可导致骨损伤。然而，介入血管造影期间进行的计算机断层扫描（CT）相关的长期骨毒性很少受到关注。本研究的目的是使用介入CT系统确定肝细胞癌经动脉化疗栓塞术（TACE）后患者骨质疏松症的患病率和小梁微结构变化。
对81例行TACE的患者、35例慢性肝炎患者和79例对照者进行64层螺旋CT检查脊柱微结构。对于每位患者，计算自2008年以来TACE期间的容积CT剂量指数（CTDIv）（CTDIv（TACE））、TACE期间的剂量长度乘积（DLP）（DLP（TACE））以及常规动态CT扫描的CTDIv和DLP（分别为CTDIv（CT）和DLP（CT））。使用三维（3D）图像分析系统，计算第12胸椎的组织骨密度（tBMD）和小梁参数。使用报道的68mg/cm³临界值的tBMD评估骨质疏松症的患病率。
TACE组骨质疏松症的患病率显著高于对照组（男性为39.6%对18.2%，P<0.05；女性为60.6%对34.8%，P<0.01）。多因素回归分析表明，性别、年龄和CTDIv（CT）显著影响骨质疏松症的风险。在这些指标中，CTDIv（CT）的曲线下面积（AUC）最高（0.735）。tBMD与累积辐射剂量的相关性分析显示tBMD与CTDIv（CT）之间存在弱相关性（r² = 0.194，P<0.001）。
TACE术后患者骨质疏松症的患病率显著高于对照组。与常规动态CT研究相关的累积辐射剂量是骨质疏松症患病率的一个重要因素。
