Trinity College Dublin, School of Medicine, Department of Obstetrics and Gynaecology, D02 PN40 Dublin, Ireland.
Department of Gynaecological Oncology, St James's Hospital, D08 NHY1 Dublin, Ireland.
Medicina (Kaunas). 2021 Dec 20;57(12):1386. doi: 10.3390/medicina57121386.
: Women with gynecological cancers constitute a high-risk cohort for loss of bone density. International guidance stipulates women undergoing cancer treatments associated with bone loss should have a quantitative assessment of bone density. Access to Dual-energy X-ray Absorptiometry (DXA) is limited. This study aimed to assess the accuracy of opportunistic bone density measurement on staging computed tomography (CT) scans for gynaecological malignancies, in comparison to the gold standard DXA. : Women with a staging CT scan of the abdomen and pelvis for a new diagnosis of gynecological cancer were recruited. DXA was performed within 6 weeks of treatment for gynaecological cancer. Lumbar bone density was measured by CT attenuation values, in Hounsfield units (HU), of the anterior trabecular region. Correlations between CT and DXA parameters were analysed. Receiver Operating Characteristic(ROC) curves for diagnosis of low bone density and osteoporosis were analysed. Final cohort included 48 of 50 women recruited. There was good diagnostic accuracy for abnormal bone density and osteoporosis, with areas under the ROC curve at L1 of 0.77 ( = 0.002) and 0.80 ( = 0.020) respectively. CT-HU of 170-190 yielded sensitivities of 87-90%, positive predictive values of 75-84% and negative predictive values of 71-75% for the diagnosis of low bone mineral density. CT-HU of 90-110 yielded specificities of 85-93% for the diagnosis of osteoporosis. Moderate correlations were found between CT-HU and both DXA T-scores and diagnostic categories. This is the first study to assess the opportunistic application of CT in the assessment of bone health in women with gynaecological cancer, a cohort at high-risk of osteoporosis. The correlation between bone density assessment in CT-HU and DXA, and strong AUC values for the diagnosis of low bone density (0.77) and osteoporosis (0.80) support this pragmatic solution in resolving the care-gap in cancer treatment-induced bone loss, often associated with poor access to DXA.
: 患有妇科癌症的女性骨质密度降低的风险较高。国际指南规定，接受可能导致骨质流失的癌症治疗的女性应进行骨质密度的定量评估。双能 X 射线吸收法（DXA）的应用受限。本研究旨在评估妇科恶性肿瘤分期 CT 扫描中机会性骨密度测量与金标准 DXA 的准确性。: 本研究招募了因新发妇科癌症行腹部和骨盆分期 CT 扫描的女性。妇科癌症治疗后 6 周内进行 DXA 检查。通过 CT 衰减值（HU）测量前小梁区域的腰椎骨密度。分析 CT 和 DXA 参数之间的相关性。分析诊断低骨密度和骨质疏松症的受试者工作特征（ROC）曲线。最终纳入 50 名女性中的 48 名。L1 处的 ROC 曲线下面积（AUC）为 0.77（ = 0.002）和 0.80（ = 0.020），对于异常骨密度和骨质疏松症具有良好的诊断准确性。CT-HU 为 170-190 时，对低骨密度的诊断灵敏度为 87-90%，阳性预测值为 75-84%，阴性预测值为 71-75%。CT-HU 为 90-110 时，特异性为 85-93%，可诊断骨质疏松症。发现 CT-HU 与 DXA T 评分和诊断类别之间存在中度相关性。: 这是第一项评估妇科癌症女性 CT 检查在评估骨健康中的机会性应用的研究，该研究对象骨质疏松风险较高。CT-HU 与 DXA 之间的相关性以及低骨密度（0.77）和骨质疏松症（0.80）的诊断 AUC 值较高，支持在癌症治疗相关骨质流失的治疗间隙中使用这种实用方法，这种方法通常与 DXA 应用受限有关。
