Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation.
Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation.
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DOI：
10.1177/1759720x211024029
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发表时间：
2021
影响因子：
4.2
通讯作者：
Poole KES
中科院分区：
文献类型：
--
作者：
Aggarwal V;Maslen C;Abel RL;Bhattacharya P;Bromiley PA;Clark EM;Compston JE;Crabtree N;Gregory JS;Kariki EP;Harvey NC;Ward KA;Poole KES
骨质疏松症导致骨骼变得脆弱，多孔和更容易骨折。虽然椎骨骨折是骨质疏松症的典型骨折，但它也是临床上最难诊断的。患者在诊断前经常遭受进一步的脊柱或其他骨折、畸形、身高损失和疼痛。2017年，英国估计有520，000例脆性骨折（耗资45亿英镑），到2030年，这一数字将增加30%。提高脊椎骨折识别和骨质疏松症诊断的一种方法是在常规计算机断层扫描（CT）期间评估患者的脊柱或髋部。患者参加常规CT诊断和监测各种医疗条件，但骨骼可以被忽视，因为放射科医生专注于扫描的主要原因。每年在国家卫生服务（NHS）中进行的50多万次CT扫描可能会筛查骨质疏松症（每年增加5%）。如果基于CT的筛查在实践中得到应用，那么该技术可能在识别脆性骨折和/或低骨密度方面产生积极的临床影响。几家公司已经开发了软件方法来诊断骨质疏松症/脆弱的骨强度和/或识别CT数据集中的椎骨骨折，使用各种方法，包括图像处理，计算建模，人工智能和生物力学工程概念。评估Hounsfield单位的技术用于计算骨密度，但不一定是骨强度。在这篇快速证据综述中，我们总结了目前支持常规CT图像机会性筛查技术的文献，以识别骨折、骨密度或强度信息。我们强调了其他新的软件技术如何嵌入NHS临床实践（克服了实施障碍），并强调了新的骨质疏松症技术如何能够效仿。我们定义了关键的未回答的问题，需要进一步的研究，使这些技术的采用，以最大限度地提高患者的利益。
Osteoporosis causes bones to become weak, porous and fracture more easily. While a vertebral fracture is the archetypal fracture of osteoporosis, it is also the most difficult to diagnose clinically. Patients often suffer further spine or other fractures, deformity, height loss and pain before diagnosis. There were an estimated 520,000 fragility fractures in the United Kingdom (UK) in 2017 (costing £4.5 billion), a figure set to increase 30% by 2030. One way to improve both vertebral fracture identification and the diagnosis of osteoporosis is to assess a patient’s spine or hips during routine computed tomography (CT) scans. Patients attend routine CT for diagnosis and monitoring of various medical conditions, but the skeleton can be overlooked as radiologists concentrate on the primary reason for scanning. More than half a million CT scans done each year in the National Health Service (NHS) could potentially be screened for osteoporosis (increasing 5% annually). If CT-based screening became embedded in practice, then the technique could have a positive clinical impact in the identification of fragility fracture and/or low bone density. Several companies have developed software methods to diagnose osteoporosis/fragile bone strength and/or identify vertebral fractures in CT datasets, using various methods that include image processing, computational modelling, artificial intelligence and biomechanical engineering concepts. Technology to evaluate Hounsfield units is used to calculate bone density, but not necessarily bone strength. In this rapid evidence review, we summarise the current literature underpinning approved technologies for opportunistic screening of routine CT images to identify fractures, bone density or strength information. We highlight how other new software technologies have become embedded in NHS clinical practice (having overcome barriers to implementation) and highlight how the novel osteoporosis technologies could follow suit. We define the key unanswered questions where further research is needed to enable the adoption of these technologies for maximal patient benefit.