Kim Y W, Kim J H, Yoon S H, Lee J H, Lee C-H, Shin C S, Park Y S
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Osteoporos Int. 2017 Jan;28(1):329-338. doi: 10.1007/s00198-016-3724-2. Epub 2016 Aug 1.
This study evaluated the use of low-dose chest computed tomography (LDCT) for detecting bone fragility. LDCT-measured vertebral bone attenuation by volumetric methods showed good correlation with bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA, and good diagnostic performance for identifying osteoporosis and compression fractures. The results of this study suggest the feasibility of obtaining comprehensive information on bone health in subjects undergoing LDCT.
Osteoporosis is a prevalent but underdiagnosed disease that increases fracture risk. This study evaluated the utility of vertebral attenuation derived from low-dose chest computed tomography (LDCT) compared to dual-energy x-ray absorptiometry (DXA) for detecting bone fragility.
A total of 232 subjects (78 men and 154 women) aged above 50 years who underwent both LDCT and DXA within 30 days were evaluated. LDCT-measured bone attenuation in Hounsfield units (HU) of four vertebrae (T4, T7, T10, and L1) was evaluated using volumetric methods for correlation with DXA-measured bone mineral density (BMD) and for the diagnosis of compression fractures, osteoporosis, and low BMD (osteoporosis or osteopenia) in men and women, with DXA measurements as the reference standard.
The average attenuation of the four vertebrae showed strong correlation with DXA-measured BMD of the lumbar spine (r = 0.726, p < 0.05). In receiver-operating characteristic (ROC) analyses, the area under the curve (AUC) across LDCT-measured thresholds of the average attenuation to distinguish compression fractures was 0.827, and a threshold of 129.5 HU yielded 90.9 % sensitivity and 64.4 % specificity. Similarly, average attenuation showed high AUCs and good diagnostic performance for detecting osteoporosis and low BMD in both men and women. Among 44 subjects with compression fractures, the average bone attenuation showed strong negative correlation with both the worst fracture grade (r = -0.525, p < 0.05) and cumulative fracture grade score (r = -0.633, p < 0.05).
LDCT-measured bone attenuation by volumetric methods showed good correlation with BMD measured by DXA and good diagnostic performance for identifying bone fragility.
本研究评估了低剂量胸部计算机断层扫描（LDCT）用于检测骨质脆弱的情况。通过容积法测量的LDCT椎体骨衰减与双能X线吸收法（DXA）测量的骨矿物质密度（BMD）显示出良好的相关性，并且在识别骨质疏松症和压缩性骨折方面具有良好的诊断性能。本研究结果表明，在接受LDCT检查的受试者中获取骨骼健康综合信息是可行的。
骨质疏松症是一种普遍但诊断不足的疾病，会增加骨折风险。本研究评估了与双能X线吸收法（DXA）相比，低剂量胸部计算机断层扫描（LDCT）得出的椎体衰减在检测骨质脆弱方面的效用。
对总共232名年龄在50岁以上、在30天内同时接受了LDCT和DXA检查的受试者（78名男性和154名女性）进行了评估。使用容积法评估了四个椎体（T4、T7、T10和L1）以亨氏单位（HU）表示的LDCT测量的骨衰减，以与DXA测量的骨矿物质密度（BMD）进行相关性分析，并用于诊断男性和女性的压缩性骨折、骨质疏松症和低骨量（骨质疏松症或骨质减少），以DXA测量结果作为参考标准。
四个椎体的平均衰减与DXA测量的腰椎BMD显示出强烈相关性（r = 0.726，p < 0.05）。在受试者工作特征（ROC）分析中，通过LDCT测量的平均衰减阈值区分压缩性骨折的曲线下面积（AUC）为0.827，阈值为129.5 HU时，灵敏度为90.9%，特异性为64.4%。同样，平均衰减在检测男性和女性的骨质疏松症和低骨量方面显示出高AUC值和良好的诊断性能。在44名患有压缩性骨折的受试者中，平均骨衰减与最严重骨折分级（r = -0.525，p < 0.05）和累积骨折分级评分（r = -0.633，p < 0.05）均显示出强烈的负相关性。
通过容积法测量的LDCT骨衰减与DXA测量的BMD显示出良好的相关性，并且在识别骨质脆弱方面具有良好的诊断性能。
