Zhou Shuwei, Zhu Lu, You Tian, Li Ping, Shen Hongrong, He Yewen, Gao Hui, Yan Luyou, He Zhuo, Guo Ying, Zhang Yaxi, Zhang Kun
Department of Radiology, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China.
The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China.
Quant Imaging Med Surg. 2021 Jan;11(1):341-350. doi: 10.21037/qims-20-367.
Osteoporosis is a common, progressive disease related to low bone mineral density (BMD). If it can be diagnosed at an early stage, osteoporosis is treatable. Quantitative computed tomography (QCT) is one of the current reference standards of BMD measurement, but dual-energy computed tomography (DECT) is considered to be a potential alternative. This study aimed to evaluate the feasibility and accuracy of phantomless DECT-based BMD quantification in comparison with QCT.
A total of 128 consecutive participants who underwent DECT lumbar examinations between July 2018 and February 2019 were retrospectively analyzed. The density of calcium (water), hydroxyapatite (water), calcium (fat), and hydroxyapatite (fat) [D, D, D and D, respectively] were measured along with BMD in the trabecular bone of lumbar level 1-2 by DECT and QCT. Linear regression analysis was performed to assess the relationship between DECT- and QCT-derived BMD at both the participant level and the vertebral level. Linear regression models were quantitatively evaluated with adjusted -square, normalized mean squared error (NMSE) and relative error (RE). Bland-Altman analysis was conducted to assess agreement between measurements. P<0.05 was considered statistically significant.
Strong correlations were observed between DECT- and QCT-derived BMD at both the participant level and the vertebral level (adjusted R =0.983-0.987; NMSE = 1.6-2.1%; RE =0.6-0.9%). Bland-Altman plots indicated high agreement between both measurements. D and D showed relatively similar and optimal predictive capability for QCT-derived BMD (both: adjusted R =0.987, NMSE =1.6%, RE =0.6%).
Fast kVp switching DECT enabled accurate phantomless BMD quantification of the lumbar spine. D and D had relatively similar and optimal predictive capability.
骨质疏松症是一种常见的、与低骨矿物质密度（BMD）相关的进行性疾病。如果能在早期诊断出骨质疏松症，是可以治疗的。定量计算机断层扫描（QCT）是目前骨密度测量的参考标准之一，但双能计算机断层扫描（DECT）被认为是一种潜在的替代方法。本研究旨在评估与QCT相比，基于无体模DECT的骨密度定量的可行性和准确性。
回顾性分析了2018年7月至2019年2月期间连续接受DECT腰椎检查的128名参与者。通过DECT和QCT测量了腰椎1-2节段小梁骨中钙（水）、羟基磷灰石（水）、钙（脂肪）和羟基磷灰石（脂肪）的密度[分别为D、D、D和D]以及骨密度。进行线性回归分析以评估参与者水平和椎体水平上DECT和QCT衍生的骨密度之间的关系。使用调整后的R平方、归一化均方误差（NMSE）和相对误差（RE）对线性回归模型进行定量评估。进行Bland-Altman分析以评估测量之间的一致性。P<0.05被认为具有统计学意义。
在参与者水平和椎体水平上，DECT和QCT衍生的骨密度之间均观察到强相关性（调整后的R=0.983-0.987；NMSE=1.6-2.1%；RE=0.6-0.9%）。Bland-Altman图表明两种测量之间具有高度一致性。D和D对QCT衍生的骨密度显示出相对相似且最佳的预测能力（两者：调整后的R=0.987，NMSE=1.6%，RE=0.6%）。
快速千伏切换DECT能够对腰椎进行准确的无体模骨密度定量。D和D具有相对相似且最佳的预测能力。
