Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France.
Eur Radiol. 2023 Jan;33(1):106-115. doi: 10.1007/s00330-022-08946-6. Epub 2022 Jul 1.
To study the relationship between opportunistic CT bone density measurements and the occurrence of new vertebral fractures after percutaneous vertebral cementoplasty (PVC) of osteoporotic vertebral compression fractures (OVCF).
A prospective analysis of retrospective data of 275 patients with OVCF treated by PVC between 2014 and 2019 with a clinico-radiological follow-up one year after treatment was conducted. Opportunistic bone density measurements were obtained at the trabecular bone of the L1 or an adjacent vertebra in Hounsfield units performed on the preoperative CT study. These density measurements values were then compared between patients with and without new OCVF and in various population subgroups.
There were 275 patients included, with 53 (19%) presenting a new OCVF and 24 (9%) developing a fracture cascade. The median opportunistic density measurements in patients with recurrent OCVF were lower than those without (median 52[40.5]) HU and 77[49] HU)(p < 0.00001). Among the patients with new OVCF the median opportunistic density measurements in patients with fracture cascades were also lower than those without (44 HU and 62 HU, respectively) (p < 0.0096). Patients with density measurements under 61 HU were 3.6 times more likely to present recurrent fractures and those with density under 54 HU were 9.8 times more likely to develop a fracture cascade. The 36 HU threshold yielded a high specificity (90-91%) for the prediction of recurrent fractures and fracture cascade but with low sensitivity (respectively 26% and 37%).
Low opportunistic vertebral density measurements are associated with a higher risk of OVCF and fracture cascades after PVC.
• Low opportunistic density measurements are associated with a higher risk of OVCF and fracture cascades after PVC. • Measuring bone density before performing a PVC could help predict the risk of new vertebral fracture after treatment • Patient management could be adapted according to bone density.
研究骨质疏松性椎体压缩性骨折经皮椎体后凸成形术（PVC）后机会性 CT 骨密度测量与新发椎体骨折发生的关系。
对 2014 年至 2019 年期间接受 PVC 治疗的 275 例骨质疏松性椎体压缩性骨折患者的回顾性数据进行前瞻性分析，临床和放射学随访治疗后 1 年。在术前 CT 研究中，用亨氏单位（Hounsfield units）对 L1 或相邻椎体的小梁骨进行机会性骨密度测量。然后比较有和无新发 OVCF 患者以及不同人群亚组之间的这些密度测量值。
共纳入 275 例患者，其中 53 例（19%）出现新发 OVCF，24 例（9%）发生骨折级联。有复发性 OVCF 的患者的机会性密度测量中位数低于无复发性 OVCF 的患者（中位数 52[40.5] HU 和 77[49] HU）（p<0.00001）。在新发 OVCF 的患者中，有骨折级联的患者的机会性密度测量中位数也低于无骨折级联的患者（分别为 44 HU 和 62 HU）（p<0.0096）。密度测量值低于 61 HU 的患者发生复发性骨折的可能性增加 3.6 倍，密度测量值低于 54 HU 的患者发生骨折级联的可能性增加 9.8 倍。36 HU 的阈值对预测复发性骨折和骨折级联具有较高的特异性（90-91%），但敏感性较低（分别为 26%和 37%）。
机会性椎体密度测量值低与 PVC 后 OVCF 和骨折级联的风险增加相关。
• 机会性椎体密度测量值低与 PVC 后 OVCF 和骨折级联的风险增加相关。
• 在进行 PVC 之前测量骨密度有助于预测治疗后新椎体骨折的风险。
• 根据骨密度调整患者管理。
