1Hospital for Special Surgery, New York, NY 2Raleigh Orthopaedic Clinic, Raleigh, North Carolina 3New York Presbyterian Hospital, New York, NY.
J Bone Joint Surg Am. 2017 Sep 20;99(18):1580-1590. doi: 10.2106/JBJS.16.00749.
The purpose of this study was to determine the clinical opportunities for the use of computed tomography (CT) imaging for inferring bone quality and to critically analyze the correlation between dual x-ray absorptiometry (DXA) and diagnostic CT as reported in the literature.
A systematic review of the MEDLINE database was performed in February 2016 using the PubMed interface. The inclusion criteria were English language, studies performed using living human subjects, studies pertaining to orthopaedics, use of conventional diagnostic CT scans, studies that measured cancellous bone, and studies that reported Hounsfield unit (HU) measurements directly rather than a computed bone mineral density.
Thirty-seven studies that reported on a total of 9,109 patients were included. Of these, 10 studies correlated HU measurements of trabecular bone with DXA-based bone assessment. Reported correlation coefficients ranged between 0.399 and 0.891, and 5 of the studies reported appropriate threshold HU levels for diagnosing osteoporosis or osteopenia.
Direct HU measurement from diagnostic CT scans has the potential to be used opportunistically for osteoporosis screening, but in its current state it is not ready for clinical implementation. There is a lack of exchangeability among different machines that limits its broad applicability. Future research efforts should focus on identifying thresholds at specific anatomic regions in high-risk patients in order to have the greatest impact on patients. However, using diagnostic CT to infer region-specific osteoporosis could be extraordinarily valuable to orthopaedic surgeons and primary care physicians, and merits further research.
本研究旨在确定使用计算机断层扫描（CT）成像来推断骨质量的临床机会，并批判性地分析文献中报道的双能 X 线吸收法（DXA）和诊断 CT 之间的相关性。
2016 年 2 月，通过 PubMed 界面对 MEDLINE 数据库进行了系统评价。纳入标准为：英语、使用活体人体受试者进行的研究、与矫形外科相关的研究、使用常规诊断 CT 扫描、测量松质骨的研究、以及直接报告亨氏单位（HU）测量值而不是计算骨密度的研究。
共纳入 37 项研究，总计 9109 例患者。其中，10 项研究将小梁骨的 HU 测量值与基于 DXA 的骨评估进行了相关性分析。报告的相关系数范围在 0.399 至 0.891 之间，5 项研究报告了诊断骨质疏松症或骨量减少的适当 HU 阈值水平。
直接从诊断 CT 扫描获得 HU 测量值具有用于骨质疏松症筛查的机会，但目前尚未准备好用于临床实施。不同机器之间缺乏可互换性，限制了其广泛适用性。未来的研究应集中于确定特定解剖区域高危患者的阈值，以最大程度地影响患者。然而，使用诊断 CT 推断特定区域的骨质疏松症对于矫形外科医生和初级保健医生可能具有极高的价值，值得进一步研究。
