Mousavi Seyedeh Zahra, Moshfeghinia Reza, Molavi Vardanjani Hossein, Sasani Mohammad Reza
MPH Department, Student Research Committee, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Medical Imaging Research Center, Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Clin Imaging. 2025 Feb;118:110372. doi: 10.1016/j.clinimag.2024.110372. Epub 2024 Nov 26.
The efficacy of opportunistic osteoporosis screening with computed tomography (CT) scans obtained for other indications has not yet been implemented by the current guidelines. We aimed to compile available evidence on the efficacy of osteoporosis screening with CT scans obtained for other indications compared with dual X-ray absorptiometry (DXA). Studies comparing the diagnostic performance of the CT scan with the DXA published before 2023 were retrieved. We conducted a bias assessment using the Newcastle-Ottawa Scale for cross-sectional studies. Correlation coefficients (CC), area under the curve (AUC), sensitivity, and specificity of the CT scans compared with the DXA were meta-analyzed with random effects modeling. 41 studies fulfilled the inclusion/exclusion criteria. The included studies reported weak to very strong CC (0.35 to 0.95) and low to high accuracy for opportunistic osteoporosis screening with CT scans. The meta-analysis showed a moderate pooled CC of 0.59 (95 % CI: 0.53-0.64, P-value<0.001), and a relatively high AUC of 0.81 (95 % CI: 0.78-0.84, P-value<0.001). Subgroup analysis based on age and menopausal status did not show significant between-group differences. Significantly higher accuracy measures were estimated for CT scans of the proximal femur compared to other anatomic regions (CC: 0.70, 95 % CI: 0.57-0.82; AUC: 0.79, 95 % CI: 0.72-0.87), North American cases (CC: 0.66, 95 % CI: 0.52-0.80; AUC: 0.82, 95 % CI: 0.82-0.83), and populations with a higher percentage of women (CC: 0.60, 95 % CI: 0.52-0.69; AUC: 0.86, 95 % CI: 0.83-0.89). We observed a moderate performance of opportunistic osteoporosis screening with CT scans obtained for other indications.
目前的指南尚未采用因其他指征进行计算机断层扫描（CT）来进行机会性骨质疏松筛查的方法。我们旨在汇总现有证据，以比较因其他指征进行CT扫描与双能X线吸收法（DXA）在骨质疏松筛查方面的效果。检索了2023年之前发表的比较CT扫描与DXA诊断性能的研究。我们使用纽卡斯尔-渥太华量表对横断面研究进行偏倚评估。采用随机效应模型对CT扫描与DXA相比的相关系数（CC）、曲线下面积（AUC）、敏感性和特异性进行荟萃分析。41项研究符合纳入/排除标准。纳入的研究报告了因CT扫描进行机会性骨质疏松筛查的CC值从弱到非常强（0.35至0.95）以及低到高的准确性。荟萃分析显示合并的CC值为0.59（95%CI：0.53 - 0.64，P值<0.001），相对较高的AUC为0.81（95%CI：0.78 - 0.84，P值<0.001）。基于年龄和绝经状态的亚组分析未显示组间有显著差异。与其他解剖区域相比，股骨近端CT扫描的准确性指标显著更高（CC：0.70，95%CI：0.57 - 0.82；AUC：0.79，95%CI：0.72 - 0.87），北美病例（CC：0.66，95%CI：0.52 - 0.80；AUC：0.82，95%CI：0.82 - 0.83），以及女性比例较高的人群（CC：0.60，95%CI：0.52 - 0.69；AUC：0.86，95%CI：0.83 - 0.89）。我们观察到因其他指征进行CT扫描在机会性骨质疏松筛查方面表现中等。
