Opportunistic Computed Tomography Screening Shows a High Incidence of Osteoporosis in Ankylosing Spondylitis Patients With Acute Vertebral Fractures
Opportunistic Computed Tomography Screening Shows a High Incidence of Osteoporosis in Ankylosing Spondylitis Patients With Acute Vertebral Fractures
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DOI：
10.1016/j.jocd.2014.07.006
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发表时间：
2015-01-01
影响因子：
2.5
通讯作者：
Gertner, Elie
中科院分区：
文献类型：
--
作者：
Emohare, Osa;Cagan, Amanda;Gertner, Elie
晚期强直性脊柱炎与骨矿物质密度（BMD）降低相关，导致疼痛和易患骨折。定量这种减少是复杂的，因为骨过度生长和骨小梁丢失同时发生。传统的方法，如双能X线吸收法，难以准确估计这些患者的B MD。本研究的目的是评估计算机断层扫描（CT）衰减在产生严重AS患者持续椎体骨折的BMD估计的效用。对严重AS和桥接韧带赘生物患者进行了回顾，以评估他们是否在损伤前或损伤后6个月内进行了CT扫描，包括L1椎骨的图像;如果是，则选择扫描进行分析。共对17例患者进行了评价。使用CT衰减阈值135 HU平衡敏感性和特异性，17例患者中有14例（82%）为乳腺癌。使用CT衰减阈值更高的灵敏度（160 HU），17例患者中有15例（88%）为乳腺癌。即使使用110 HU的L1 CT衰减阈值以获得更高的特异性，17例患者中仍有14例（82%）为椎间盘突出。CT衰减表明，高比例的AS患者谁持续骨折有骨质疏松症。这克服了在这组患者中使用双能X线吸收测定法所遇到的一些困难。这种简单易用的方法节省了时间，成本和辐射暴露，并有助于规划患者的管理。
Advanced ankylosing spondylitis is associated with reductions in bone mineral density (BMD), contributing to pain and predisposing to fractures. Quantifying this reduction is complicated because overgrowth of bone and loss of trabecular bone occur concurrently. Traditional methods such as dual-energy X-ray absorptiometry struggle to generate accurate estimates of B MD in these patients. The aim of this study was to evaluate the utility of computed tomography (CT) attenuation in generating estimates of BMD in patients with severe AS who had sustained vertebral fractures. Patients with severe AS and bridging syndesmophytes who presented, with acute fractures of the spine, were reviewed to assess whether they had a CT scan in the 6 mo before or after injury that included an image of the L1 vertebra; if it did, the scans were selected for analysis. A total of 17 patients were evaluated. Using a CT attenuation threshold of 135 HU balanced for sensitivity and specificity, 14 of 17 (82%) patients were osteoporotic. Using a CT attenuation threshold for higher sensitivity (160 HU), 15 of 17 (88%) patients were osteoporotic. Even using the L1 CT attenuation threshold of 110 HU for higher specificity, 14 of 17 (82%) patients were osteoporotic. CT attenuation demonstrates that a high proportion of AS patients who sustain fractures have osteoporosis. This overcomes some of the difficulties that have been encountered with the use of dual-energy X-ray absorptiometry in this group of patients. This simple and accessible method saves on time, cost, and exposure to radiation and can help in the planning of a patient's management.