定量 CT 筛查较双能 X 射线吸收法改善了老年患者的腰椎 BMD 评估。
Quantitative CT screening improved lumbar BMD evaluation in older patients compared to dual-energy X-ray absorptiometry.
机构信息
Department of Spine Surgery, Shunde Hospital, Southern Medical University, The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China.
The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China.
出版信息
BMC Geriatr. 2023 Apr 17;23(1):231. doi: 10.1186/s12877-023-03963-6.
BACKGROUND
Robust evidence on whether diagnostic discordance exists between lumbar osteoporosis detected by quantitative computed tomography (QCT) vs. dual-energy X-ray absorptiometry (DXA) is still lacking. In this study involving a relatively large prospective cohort of older men (aged > 60 years) and postmenopausal women, we assessed lumbar QCT-derived volumetric bone mineral density (vBMD) and DXA-derived area BMD and evaluated their predictive performance for prevalent vertebral fracture (VF).
METHODS
A total of 501 patients who underwent spinal surgery from September 2020 to September 2022 were enrolled. The criteria recommended by the American College of Radiology and the World Health Organization were used for lumbar osteoporosis diagnosis. The osteoporosis detection rates between QCT and DXA were compared. QCT-vBMD was plotted against the DXA T score, and the line of best fit was calculated based on linear regression. Multivariate logistic regression was used to analyze the associations between risk factors and VF. Receiver operating characteristic curve analysis was performed, and the corresponding area under the curve (AUC) was calculated.
RESULTS
QCT screening showed that 60.7% of patients had osteoporosis, whereas DXA screening showed that 50.7% of patients had osteoporosis. Diagnoses were concordant for 325 (64.9%) patients. In all, 205 patients suffered a VF of at least one anatomic level. Of these, 84.4% (173/205) were diagnosed with osteoporosis by QCT, while only 73.2% (150/205) were diagnosed by DXA. Multivariate logistic regression showed that osteoporosis detected by QCT exhibited a stronger relationship with VF than that detected by DXA (unadjusted OR, 6.81 vs. 5.04; adjusted OR, 3.44 vs. 2.66). For discrimination between patients with and without VF, QCT-vBMD (AUC = 0.802) showed better performance than DXA T score (AUC = 0.76).
CONCLUSION
In older patients undergoing spinal surgery, QCT-vBMD is more helpful than DXA in terms of osteoporosis detection rate and prediction of patients with prevalent VFs.
背景
目前仍缺乏关于定量计算机断层扫描（QCT）与双能 X 射线吸收法（DXA）检测腰椎骨质疏松症之间是否存在诊断差异的有力证据。在这项涉及年龄较大的男性（年龄>60 岁）和绝经后女性的大型前瞻性队列研究中，我们评估了腰椎 QCT 衍生的体积骨密度（vBMD）和 DXA 衍生的面积骨密度，并评估了它们对现有椎体骨折（VF）的预测性能。
方法
共纳入 2020 年 9 月至 2022 年 9 月期间接受脊柱手术的 501 例患者。采用美国放射学会和世界卫生组织推荐的标准诊断腰椎骨质疏松症。比较 QCT 和 DXA 检测骨质疏松症的检出率。绘制 QCT-vBMD 与 DXA T 评分的关系图，并根据线性回归计算最佳拟合线。采用多变量 logistic 回归分析 VF 与危险因素的关系。进行受试者工作特征曲线分析，并计算相应的曲线下面积（AUC）。
结果
QCT 筛查显示 60.7%的患者患有骨质疏松症，而 DXA 筛查显示 50.7%的患者患有骨质疏松症。325 例（64.9%）患者的诊断结果相符。共有 205 例患者至少发生一个解剖水平的 VF。其中，84.4%（173/205）通过 QCT 诊断为骨质疏松症，而仅 73.2%（150/205）通过 DXA 诊断为骨质疏松症。多变量 logistic 回归显示，与 DXA 相比，QCT 检测的骨质疏松症与 VF 的关系更强（未经调整的 OR，6.81 比 5.04；调整后的 OR，3.44 比 2.66）。对于区分有和无 VF 的患者，QCT-vBMD（AUC=0.802）的表现优于 DXA T 评分（AUC=0.76）。
结论
在接受脊柱手术的老年患者中，与 DXA 相比，QCT-vBMD 更有助于提高骨质疏松症的检出率和预测现有 VF 患者的发病风险。
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