Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, United Kingdom; Faculty of Medicine, Omar Al-Mukhtar University, Bayda, Libya.
Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, United Kingdom; Department of Pediatric Endocrinology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom.
Bone. 2021 Sep;150:116013. doi: 10.1016/j.bone.2021.116013. Epub 2021 May 23.
Skeletal imaging techniques have become clinically valuable methods for measuring and assessing bone mineral density in children and young people. Dual-energy X-ray absorptiometry (DXA) is the current reference standard for evaluating bone density, as recommended by the International Society for Clinical Densitometry (ISCD). Various bone imaging modalities, such as quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), high-resolution peripheral quantitative computed tomography (HR-pQCT), magnetic resonance imaging (MRI), and digital X-ray radiogrammetry (DXR) have been developed to further quantify bone health in children and adults. The purpose of this review, with meta-analysis, was to systematically research the literature to compare the various imaging methods and identify the best modality for assessing bone status in healthy papulations and children and young people with chronic disease (up to 18 years).
A systematic computerized search of Medline, PubMed, and Web of Science databases was conducted to identify English-only studies published between 1st January 1990 and 1st December 2019. In this review, clinical studies comparing imaging modalities with DXA were chosen according to the inclusion criteria. The risk of bias and quality of articles was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The meta-analysis to estimate the overall correlation was performed using a Fisher Z transformation of the correlation coefficient. Additionally, the diagnostic accuracy measures of different imaging methods compared with DXA were calculated.
The initial search strategy identified 13,412 papers, 29 of which matched the inclusion and exclusion criteria. Of these, twenty-two papers were included in the meta-analysis. DXA was compared to QUS in 17 papers, to DXR in 7 and to pQCT in 4 papers. A single paper compared DXA, DXR, and pQCT. The meta-analysis demonstrated that the strongest correlation was between DXR and DXA, with a coefficient of 0.71 [95%CI: 0.43; 1.00, p-value < 0.001], while the correlation coefficients between QUS and DXA, and pQCT and DXA were 0.57 [95%CI: 0.25; 0.90, p-value < 0.001] and 0.57 [95%CI: 0.46; 0.67, p-value < 0.001], respectively. The overall sensitivity and specificity were statistically significant 0.71 and 0.80, respectively.
No current imaging modality provides a full evaluation of bone health in children and young adults, with each method having some limitations. Compared to QUS and pQCT, DXR achieved the strongest positive relationship with DXA. DXR should be further evaluated as a reliable method for assessing bone health and as a predictor of fractures in children and young people.
骨骼成像技术已成为测量和评估儿童和青少年骨矿物质密度的临床有价值的方法。双能 X 射线吸收法（DXA）是目前评估骨密度的参考标准，国际临床密度学学会（ISCD）推荐使用该方法。为了进一步量化儿童和成人的骨骼健康，已经开发出各种骨骼成像方式，例如定量超声（QUS）、外周定量计算机断层扫描（pQCT）、高分辨率外周定量计算机断层扫描（HR-pQCT）、磁共振成像（MRI）和数字 X 射线辐射计（DXR）。本综述通过荟萃分析对文献进行了系统性研究，旨在比较各种成像方法，并确定评估健康人群和患有慢性疾病（18 岁以下）的儿童和年轻人的骨骼状况的最佳方法。
通过计算机检索 Medline、PubMed 和 Web of Science 数据库，检索 1990 年 1 月 1 日至 2019 年 12 月 1 日期间发表的英文文献。本综述根据纳入标准选择了与 DXA 进行成像方式比较的临床研究。使用诊断准确性研究质量评估工具（QUADAS-2）评估偏倚风险和文章质量。使用 Fisher Z 变换对相关系数进行荟萃分析，以估计整体相关性。此外，还计算了不同成像方法与 DXA 比较的诊断准确性指标。
最初的搜索策略确定了 13412 篇论文，其中 29 篇符合纳入和排除标准。其中，22 篇论文被纳入荟萃分析。DXA 与 QUS 比较的论文有 17 篇，与 DXR 比较的论文有 7 篇，与 pQCT 比较的论文有 4 篇。有一篇论文比较了 DXA、DXR 和 pQCT。荟萃分析表明，DXR 与 DXA 的相关性最强，相关系数为 0.71 [95%CI：0.43；1.00，p 值<0.001]，而 QUS 与 DXA 和 pQCT 与 DXA 的相关系数分别为 0.57 [95%CI：0.25；0.90，p 值<0.001]和 0.57 [95%CI：0.46；0.67，p 值<0.001]。总体敏感性和特异性均具有统计学意义，分别为 0.71 和 0.80。
目前尚无任何成像方式能够全面评估儿童和青少年的骨骼健康，每种方法都存在一定的局限性。与 QUS 和 pQCT 相比，DXR 与 DXA 具有最强的正相关性。DXR 应进一步评估为评估儿童和青少年骨骼健康和预测骨折的可靠方法。
