Vadera Sonam, Osborne Timothy, Shah Vikas, Stephenson James A
Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
Insights Imaging. 2023 Apr 1;14(1):57. doi: 10.1186/s13244-023-01400-1.
It has previously been shown that CT scans performed for other indications can be used to identify patients with osteoporosis. This has not yet been tested in a British population. We sought to evaluate the use of vertebral CT attenuation measures for predicting osteoporosis in a British cohort, using dual-energy X-ray absorptiometry (DEXA) as a reference standard.
Patients who underwent abdominal CT in 2018 and concomitantly underwent DEXA within a six-month interval were retrospectively included. CT attenuation values in Hounsfield units (HU) were measured by placement of a region-of-interest at the central portion of the L1 vertebral body and then compared to their corresponding DEXA score. Receiver operating characteristic (ROC) curves were generated to evaluate the performance of a logistic regression model and to determine sensitivity and specificity thresholds.
536 patients (394 females, mean age 65.8) were included, of which 174 had DEXA-defined osteoporosis. L1 attenuation measures were significantly different (p < 0.01) between the three DEXA-defined groups of osteoporosis (118 HU), osteopenia (143 HU) and normal bone density (178 HU). The area under the ROC curve was 0.74 (95% CI 0.69-0.78). A threshold of 169 HU was 90% sensitive, and a threshold of 104 HU was 90% specific for diagnosing osteoporosis.
Routine abdominal CT can be used to opportunistically screen for osteoporosis without additional cost or radiation exposure. The thresholds identified in this study are comparable with previous studies in other populations. We recommend radiologists engage with primary care and rheumatology providers to determine appropriate cut-off values for further investigation.
先前的研究表明，因其他指征进行的CT扫描可用于识别骨质疏松症患者。但这尚未在英国人群中得到验证。我们试图以双能X线吸收法（DEXA）作为参考标准，评估在英国队列中使用椎体CT衰减测量来预测骨质疏松症的情况。
回顾性纳入2018年接受腹部CT检查且在6个月内同时接受DEXA检查的患者。通过在L1椎体中央部分放置感兴趣区域来测量亨氏单位（HU）的CT衰减值，然后将其与相应的DEXA评分进行比较。生成受试者工作特征（ROC）曲线以评估逻辑回归模型的性能，并确定敏感性和特异性阈值。
纳入536例患者（394例女性，平均年龄65.8岁），其中174例患有DEXA定义的骨质疏松症。在DEXA定义的骨质疏松症（118 HU）、骨质减少（143 HU）和正常骨密度（178 HU）这三组中，L1衰减测量值存在显著差异（p < 0.01）。ROC曲线下面积为0.74（95% CI 0.69 - 0.78）。169 HU的阈值诊断骨质疏松症的敏感性为90%，104 HU的阈值诊断骨质疏松症的特异性为90%。
常规腹部CT可用于机会性筛查骨质疏松症，无需额外费用或辐射暴露。本研究确定的阈值与其他人群先前的研究结果相当。我们建议放射科医生与初级保健和风湿病科医生合作，确定进一步检查的合适临界值。
