Multidetector computed tomography-based microstructural analysis reveals reduced bone mineral content and trabecular bone changes in the lumbar spine after transarterial chemoembolization therapy for hepatocellular carcinoma.
Multidetector computed tomography-based microstructural analysis reveals reduced bone mineral content and trabecular bone changes in the lumbar spine after transarterial chemoembolization therapy for hepatocellular carcinoma.
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DOI：
10.1371/journal.pone.0110106
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Awai K
中科院分区：
文献类型：
--
作者：
Takasu M;Yamagami T;Nakamura Y;Komoto D;Kaichi Y;Tani C;Date S;Kiguchi M;Awai K
众所周知，治疗性辐射可导致骨损伤。然而，与介入血管造影期间进行的计算机断层扫描（CT）相关的长期骨毒性很少受到关注。本研究的目的是使用介入CT系统确定肝细胞癌经动脉化疗栓塞（TACE）治疗后患者骨质疏松症和骨小梁显微结构变化的患病率。通过64排CT检查了81例接受TACE的患者、35例慢性肝炎患者和79例对照者的脊柱微结构。对于每例患者，TACE期间的体积CT剂量指数（CTDIv）（CTDIv（TACE））、TACE期间的剂量长度乘积（DLP（TACE））以及常规动态CT扫描的CTDIv和DLP（分别为CTDIv（CT）和DLP（CT））计算为自2008年以来的总和。应用三维图像分析系统，计算第12胸椎骨密度（tBMD）和骨小梁参数。使用报告的临界值68 mg/cm 3的tBMD，评估骨质疏松症的患病率。TACE组的骨质疏松症患病率显著高于对照组（男性为39.6% vs. 18.2%，P<0.05;女性为60.6% vs. 34.8%，P<0.01）。多因素回归分析显示性别、年龄和CTDIv（CT）对骨质疏松的危险性有显著影响。在这些指标中，CTDIv（CT）的曲线下面积（AUC）最高（0.735）。tBMD与累积辐射剂量的相关分析显示，tBMD与CTDIv（CT）呈弱相关（r2 = 0.194，P<0.0 0 1）。 TACE术后患者的骨质疏松症患病率显著高于对照组。与常规动态CT研究相关的累积辐射剂量是骨质疏松症患病率的重要因素。
It is well recognized that therapeutic irradiation can result in bone damage. However, long-term bone toxicity associated with computed tomography (CT) performed during interventional angiography has received little attention. The purpose of this study was to determine the prevalence of osteoporosis and trabecular microstructural changes in patients after transarterial chemoembolization (TACE) for hepatocellular carcinoma therapy using an interventional-CT system. Spinal microarchitecture was examined by 64-detector CT in 81 patients who underwent TACE, 35 patients with chronic hepatitis, and 79 controls. For each patient, the volumetric CT dose index (CTDIv) during TACE (CTDIv (TACE)), the dose-length product (DLP) during TACE (DLP (TACE)), and CTDIv and DLP of routine dynamic CT scans (CTDIv (CT) and DLP (CT), respectively), were calculated as the sum since 2008. Using a three dimensional (3D) image analysis system, the tissue bone mineral density (tBMD) and trabecular parameters of the 12th thoracic vertebra were calculated. Using tBMD at a reported cutoff value of 68 mg/cm3, the prevalence of osteoporosis was assessed. The prevalence of osteoporosis was significantly greater in the TACE vs. the control group (39.6% vs. 18.2% for males, P<0.05 and 60.6% vs. 34.8% for females, P<0.01). Multivariate regression analysis demonstrated that sex, age, and CTDIv (CT) significantly affected the risk of osteoporosis. Of these indices, CTDIv (CT) had the highest area under the curve (AUC) (0.735). Correlation analyses of tBMD with cumulative radiation dose revealed weak correlations between tBMD and CTDIv (CT) (r 2 = 0.194, P<0.001). The prevalence of osteoporosis was significantly higher in post TACE patients than in control subjects. The cumulative radiation dose related to routine dynamic CT studies was a significant contributor to the prevalence of osteoporosis.
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