Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Department of Orthopedic Surgery, Osteoporosis and Metabolic Bone Disease Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Osteoporos Int. 2024 Apr;35(4):705-715. doi: 10.1007/s00198-023-06999-x. Epub 2023 Dec 27.
This study investigated bone mineral density assessment for patients with DISH. DXA-based T-scores overestimated bone quality, while MRI-based VBQ scores and CT-based HU values provided accurate assessments, particularly for advanced degenerative cases. This enhances accurate evaluation of BMD, crucial for clinical decision-making.
To investigate the diagnostic effectiveness of DXA, MRI, and CT in assessing bone mineral density (BMD) for diffuse idiopathic skeletal hyperostosis (DISH) patients.
Retrospective analysis of 105 DISH patients and 116 age-matched controls with lumbar spinal stenosis was conducted. BMD was evaluated using DXA-based T-scores, MRI-based vertebral bone quality (VBQ) scores, and CT-based Hounsfield unit (HU) values. Patients were categorized into three BMD subgroups. Lumbar osteophyte categories were determined by Mata score. Demographics, clinical data, T-scores, VBQ scores, and HU values were collected. Receiver operating characteristic (ROC) analysis identified VBQ and HU thresholds for diagnosing normal BMD using DXA in controls. Correlations between VBQ, HU, and lumbar T-score were analyzed.
Age, gender, and BMI showed no significant differences between DISH and control groups. DISH patients had higher T-score (L1-4), the lowest T-score, and Mata scores. VBQ and HU did not significantly differ between groups. In controls, VBQ and HU effectively diagnosed normal BMD (AUC = 0.857 and 0.910, respectively) with cutoffs of 3.0 for VBQ and 104.3 for HU. DISH had higher normal BMD prevalence using T-scores (69.5% vs. 58.6%, P < 0.05), but no significant differences using VBQ (57.1% vs. 56.2%, P > 0.05) and HU (58.1% vs. 57.8%, P > 0.05). Correlations revealed moderate correlations between HU and T-scores (L1-4) in DISH (r = 0.642, P < 0.001) and strong in controls (r = 0.846, P < 0.001). Moderate negative correlations were observed between VBQ and T-scores (L1-4) in DISH (r = - 0.450, P < 0.001) and strong in controls (r = - 0.813, P < 0.001).
DXA-based T-scores may overestimate BMD in DISH. VBQ scores and HU values could effectively complement BMD assessment, particularly in DISH patients or those with advanced lumbar degeneration.
探讨 DXA、MRI 和 CT 评估弥漫性特发性骨肥厚（DISH）患者骨密度（BMD）的诊断效能。
回顾性分析了 105 例 DISH 患者和 116 例年龄匹配的腰椎管狭窄症患者。使用 DXA 测定的 T 评分、MRI 测定的椎体骨质量（VBQ）评分和 CT 测定的 Hounsfield 单位（HU）值评估 BMD。将患者分为三组 BMD 亚组。根据 Mata 评分确定腰椎骨赘的类别。收集人口统计学、临床数据、T 评分、VBQ 评分和 HU 值。采用受试者工作特征（ROC）分析确定对照组中使用 DXA 诊断正常 BMD 的 VBQ 和 HU 阈值。分析了 VBQ、HU 和腰椎 T 评分之间的相关性。
DISH 组和对照组在年龄、性别和 BMI 方面无显著差异。DISH 患者的 T 评分（L1-4）较高，T 评分最低，Mata 评分较高。两组间 VBQ 和 HU 无显著差异。在对照组中，VBQ 和 HU 可有效诊断正常 BMD（AUC 分别为 0.857 和 0.910），VBQ 的截断值为 3.0，HU 的截断值为 104.3。使用 T 评分时，DISH 患者的正常 BMD 患病率较高（69.5%比 58.6%，P<0.05），但使用 VBQ（57.1%比 56.2%，P>0.05）和 HU（58.1%比 57.8%，P>0.05）时无显著差异。相关性分析显示，DISH 患者 HU 与 T 评分（L1-4）之间存在中度相关性（r=0.642，P<0.001），而对照组之间存在高度相关性（r=0.846，P<0.001）。DISH 患者 VBQ 与 T 评分（L1-4）之间存在中度负相关（r=-0.450，P<0.001），而对照组之间存在高度负相关（r=-0.813，P<0.001）。
DXA 测定的 T 评分可能会高估 DISH 患者的 BMD。VBQ 评分和 HU 值可有效补充 BMD 评估，特别是在 DISH 患者或腰椎退行性变严重的患者中。
