Zeng Fei, Wang Yandie, Gu Peipei, Wang Xinhong, Lan Meijuan
Department of Nursing, the Second Affiliated Hospital of Zhejiang, University School of Medicine, Hangzhou, 310000, China.
Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310000, China.
J Orthop Surg Res. 2025 Sep 26;20(1):843. doi: 10.1186/s13018-025-06271-4.
To evaluate the diagnostic performance of pre-transplant chest computed tomography (CT) as an opportunistic screening tool for predicting osteoporosis 1 year after lung transplantation.
We retrospectively enrolled lung transplant patients from a tertiary center in Zhejiang, China, between September 2022 and December 2023. Standardized regions of interest were placed on the first thoracic vertebra (T1) through the first lumbar vertebra (L1) to measure CT-derived Hounsfield unit (HU) values. Patients were categorized into normal BMD, osteopenia, and osteoporosis groups on the basis of their baseline dual-energy X-ray absorptiometry (DEXA) T-scores. Clinical baseline characteristics and HU values were compared among the three groups. The correlation between pre-transplant HU values and DEXA T-scores was analyzed, and receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of pre-transplant HU values in predicting post-transplant osteopenia and osteoporosis.
A total of 139 lung transplant patients were included in the study, among whom 60 had normal bone mass, 51 had osteopenia, and 28 had osteoporosis at baseline. Notably, HU values significantly differed among the three groups (P < 0.05). The HU values of T1-L1 were weakly to moderately positively correlated with the T-scores of the lumbar spine (LS), femoral neck (FN), and total hip (TH; r = 0.28-0.51, P < 0.01). After lung transplantation, the proportion of patients with low bone mineral density (BMD) increased, and T-scores of the FN and TH decreased (P < 0.01). Baseline HU values showed good diagnostic performance for detecting bone abnormalities 1 year after transplantation, with T2 showing particular potential for distinguishing osteoporosis from non-osteoporosis and T9 for distinguishing low BMD from normal BMD.
Pretransplant thoracic CT provides a clinically feasible and opportunistic screening approach to stratify osteoporosis risk in lung transplant candidates without additional radiation exposure. By quantifying T2 and T9 vertebral HU values, clinicians can identify high-risk patients for timely intervention, potentially reducing fracture-related morbidity.
评估移植前胸部计算机断层扫描（CT）作为一种机会性筛查工具，用于预测肺移植术后1年骨质疏松症的诊断性能。
我们回顾性纳入了2022年9月至2023年12月期间来自中国浙江一家三级中心的肺移植患者。在第一胸椎（T1）至第一腰椎（L1）设置标准化感兴趣区域，以测量CT衍生的亨氏单位（HU）值。根据患者基线双能X线吸收法（DEXA）T值，将患者分为骨密度正常、骨质减少和骨质疏松组。比较三组的临床基线特征和HU值。分析移植前HU值与DEXA T值之间的相关性，并使用受试者操作特征（ROC）曲线评估移植前HU值在预测移植后骨质减少和骨质疏松方面的诊断性能。
本研究共纳入139例肺移植患者，其中60例基线骨量正常，51例骨质减少，28例骨质疏松。值得注意的是，三组间HU值存在显著差异（P < 0.05）。T1-L1的HU值与腰椎（LS）、股骨颈（FN）和全髋（TH）的T值呈弱至中度正相关（r = 0.28 - 0.51，P < 0.01）。肺移植后，低骨密度（BMD）患者比例增加，FN和TH的T值降低（P < 0.01）。基线HU值对检测移植后1年的骨异常具有良好的诊断性能，T2在区分骨质疏松与非骨质疏松方面具有特别潜力，T9在区分低BMD与正常BMD方面具有潜力。
移植前胸部CT提供了一种临床可行的机会性筛查方法，可在不增加辐射暴露的情况下对肺移植候选者的骨质疏松风险进行分层。通过量化T2和T9椎体HU值，临床医生可以识别高危患者以便及时干预， potentially reducing fracture-related morbidity.（此处原文有误，正确翻译为“潜在地降低与骨折相关的发病率”）从而可能降低与骨折相关的发病率。
