Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, PR China; Department of Orthopaedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China.
Department of Orthopaedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China.
Bone. 2023 Jul;172:116749. doi: 10.1016/j.bone.2023.116749. Epub 2023 Mar 25.
Bone void is a novel intuitive morphological indicator to assess bone quality but its use in vertebrae has not been described. This cross-sectional and multi-center study aimed to investigate the distribution of bone voids in the thoracolumbar spine in Chinese adults based on quantitative computed tomography (QCT). A bone void was defined as a trabecular net region with extremely low bone mineral density (BMD) (<40 mg/cm), detected by an algorithm based on phantom-less technology. A total of 464 vertebrae from 152 patients (51.8 ± 13.4 years old) were included. The vertebral trabecular bone was divided into eight sections based on the middle sagittal, coronal, and horizontal planes. Bone void of the whole vertebra and each section were compared between healthy, osteopenia, and osteoporosis groups and between spine levels. Receiver operator characteristic (ROC) curves were plotted and optimum cutoff points of void volume between the groups were obtained. The total void volumes of the whole vertebra were 124.3 ± 221.5 mm, 1256.7 ± 928.7 mm and 5624.6 ± 3217.7 mm in healthy, osteopenia, and osteoporosis groups, respectively. The detection rate of vertebrae with bone voids was higher and the normalized void volume was larger in the lumbar than in thoracic vertebrae. L3 presented the largest void (2165.0 ± 3396.0 mm), while T12 had the smallest void (448.9 ± 699.4 mm). The bone void was mainly located in the superior-posterior-right section (40.8 %). Additionally, bone void correlated positively with age and increased rapidly after 55 years. The most significant void volume increase was found in the inferior-anterior-right section whereas the least increase was found in the inferior-posterior-left section with aging. The cutoff points were 345.1 mm between healthy and osteopenia groups (sensitivity = 0.923, specificity = 0.932) and 1693.4 mm between osteopenia and osteoporosis groups (sensitivity = 1.000, specificity = 0.897). In conclusion, this study demonstrated the bone void distribution in vertebrae using clinical QCT data. The findings provide a new perspective for the description of bone quality and showed that bone void could guide clinical practice such as osteoporosis screening.
骨空洞是一种新颖的直观形态学指标，可用于评估骨质量，但尚未在椎体中描述。这项横断面和多中心研究旨在基于定量计算机断层扫描（QCT）调查中国成年人胸腰椎骨空洞的分布。骨空洞定义为通过基于无模型技术的算法检测到的具有极低骨矿物质密度（BMD）（<40mg/cm）的小梁网络区域。共纳入 152 例患者的 464 个椎体（51.8±13.4 岁）。根据中间矢状面、冠状面和水平面将椎体的小梁骨分为八个节段。比较健康组、骨量减少组和骨质疏松组以及脊柱水平之间的整个椎体和每个节段的骨空洞。绘制接收器工作特征（ROC）曲线，并获得组间空洞体积的最佳截断点。整个椎体的总空洞体积分别为健康组、骨量减少组和骨质疏松组的 124.3±221.5mm、1256.7±928.7mm 和 5624.6±3217.7mm。腰椎的骨空洞检出率高于胸椎，且骨空洞的归一化体积较大。L3 具有最大的空洞（2165.0±3396.0mm），而 T12 具有最小的空洞（448.9±699.4mm）。骨空洞主要位于上后右区（40.8%）。此外，骨空洞与年龄呈正相关，55 岁后迅速增加。随着年龄的增长，下前右区的空洞体积增加最为显著，下后左区的增加最少。健康组和骨量减少组之间的截断点为 345.1mm（敏感性=0.923，特异性=0.932），骨量减少组和骨质疏松组之间的截断点为 1693.4mm（敏感性=1.000，特异性=0.897）。总之，本研究使用临床 QCT 数据显示了椎体中的骨空洞分布。研究结果为描述骨质量提供了新视角，并表明骨空洞可以指导骨质疏松筛查等临床实践。
