Potential for Early Fracture Risk Assessment in Patients with Metastatic Bone Disease using Parametric Response Mapping of CT Images.
Potential for Early Fracture Risk Assessment in Patients with Metastatic Bone Disease using Parametric Response Mapping of CT Images.
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DOI：
10.18383/j.tom.2015.00154
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Galbán CJ
中科院分区：
文献类型：
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作者：
Hoff BA;Toole M;Yablon C;Ross BD;Luker GD;VanPoznak C;Galbán CJ
病理性椎体压缩性骨折（PVCF）导致转移性骨疾病患者的发病率显着。现有临床生物标志物的局限性使临床医生没有可靠的指标来预测PVCF，从而阻碍了预防这种严重并发症的努力。为了建立一种新的方法来确定PVCF的风险的可行性，我们回顾性分析了5例乳腺癌患者的连续计算机断层扫描（CT）扫描，使用参数反应映射（PRM）来量化动态骨矿物质密度（BMD）的变化之前的事件。将每次扫描分割的椎骨配准到相同的空间框架，并使用亨氏单位（HU）的预定变化阈值完成体素分类，导致相对体积增加（PRMHU+）、减少（PRMHU-）或不变（PRMHU 0）衰减。将每例患者的共7个PVCF与作为对照的未患病椎骨进行比较。受试者工作曲线（ROC）分析确定了组分层的最佳成像时间。早在骨折前1年，通过升高PRMHU+，BMD变化明显。ROC分析显示PRMHU-在PVCF分层方面与对照组相比表现较差。早在PVCF前6个月，PRMHU+（12.9 ± 11.6%）显著大于对照椎骨（2.3 ± 2.5%），ROC分析的曲线下面积为0.918。同期PVCF（26.8 ± 26.9%）和对照组（−2.2 ± 22.0%）的平均HU变化也显著。使用标准CT成像的BMD变化的PRM分析对于这些患者中结构失效之前的空间分辨变化是敏感的。
Pathologic vertebral compression fractures (PVCFs) cause significant morbidity in patients with metastatic bone disease. Limitations in existing clinical biomarkers leave clinicians without reliable metrics for predicting PVCF, thus impeding efforts to prevent this severe complication. To establish the feasibility of a new method for defining the risk of a PVCF, we retrospectively analyzed serial computed tomography (CT) scans from 5 breast cancer patients using parametric response mapping (PRM) to quantify dynamic bone miniral density (BMD) changes that preceded an event. Vertebrae segmented from each scan were registered to the same spatial frame and voxel classification was accomplished using a predetermined threshold of change in Hounsfield units (HU), resulting in relative volumes of increased (PRMHU+), decreased (PRMHU−), or unchanged (PRMHU0) attenuation. A total of 7 PVCFs were compared to undiseased vertebrae in each patient serving as controls. A receiver operator curve (ROC) analysis identified optimal imaging times for group stratification. BMD changes were apparent by an elevated PRMHU+ as early as 1 year before fracture. ROC analysis showed poor performance of PRMHU− in stratifying PVCFs versus controls. As early as 6 months before PVCF, PRMHU+ was significantly larger (12.9 ± 11.6%) than control vertebrae (2.3 ± 2.5%), with an area under the curve of 0.918 from an ROC analysis. Mean HU changes were also significant between PVCF (26.8 ± 26.9%) and control (−2.2 ± 22.0%) over the same period. A PRM analysis of BMD changes using standard CT imaging was sensitive for spatially resolving changes that preceded structural failure in these patients.