Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA
Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA
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DOI：
10.1007/s00330-019-06018-w
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发表时间：
2019-09-01
影响因子：
5.9
通讯作者：
Kirschke, Jan S.
中科院分区：
文献类型：
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作者：
Loeffler, Maximilian T.;Jacob, Alina;Kirschke, Jan S.
目的比较机会性定量CT（QCT）和双能X线骨密度仪（DXA）预测椎体骨折的能力。方法我们纳入了84例年龄在50岁及以上的患者，他们在12个月内（基线）进行了常规CT检查，包括腰椎和DXA检查，并在至少12个月后进行了随访成像，或者他们在早期记录了发生椎体骨折。排除了除骨质疏松症外的骨疾病患者。在基线CT中回顾性评估骨折状态和骨小梁矿物质密度（BMD），并在随访时重新评估骨折状态。通过机会性QCT评估BMDQCT，同时对多台MDCT扫描仪进行异步校准。结果16例患者发生椎体骨折，平均BMDQCT低于无骨折患者（p = 0.001）。对于发生椎体骨折的风险，在BMDQCT（4.07; 95% CI，1.98-8.38）中，以及在调整年龄、性别和普遍骨折后（2.54; 95% CI，1.09-5.90），风险比按SD增加。对于DXA，仅在调整年龄和性别后观察到T评分每SD降低的相对风险统计学显著增加（1.57; 95% CI，1.04-2.38）。通过BMDQCT（AUC = 0.76; 95%CI，0.64-0.89），对发生椎体骨折的预测性良好，通过T评分，预测性不显著。异步校准的CT扫描仪表现出良好的长期稳定性（线性漂移范围从-0.55到-2.29 HU每年）。结论：在CT中对主要神经外科和肿瘤患者进行骨密度测定以外的适应症筛查，可以比专用DXA更好地评估即将发生的椎体骨折的风险。
Objectives To compare opportunistic quantitative CT (QCT) with dual energy X-ray absorptiometry (DXA) in their ability to predict incident vertebral fractures. Methods We included 84 patients aged 50 years and older, who had routine CT including the lumbar spine and DXA within a 12-month period (baseline) as well as follow-up imaging after at least 12 months or who sustained an incident vertebral fracture documented earlier. Patients with bone disorders aside from osteoporosis were excluded. Fracture status and trabecular bone mineral density (BMD) were retrospectively evaluated in baseline CT and fracture status was reassessed at follow-up. BMDQCT was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners. Results Sixteen patients had incident vertebral fractures showing lower mean BMDQCT than patients without fracture (p = 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMDQCT (4.07; 95% CI, 1.98-8.38), as well as after adjusting for age, sex, and prevalent fractures (2.54; 95% CI, 1.09-5.90). For DXA, a statistically significant increase in relative hazard per SD decrease in T-score was only observed after age and sex adjustment (1.57; 95% CI, 1.04-2.38). The predictability of incident vertebral fractures was good by BMDQCT (AUC = 0.76; 95% CI, 0.64-0.89) and non-significant by T-scores. Asynchronously calibrated CT scanners showed good long-term stability (linear drift ranging from - 0.55 to - 2.29 HU per year). Conclusions Opportunistic screening of mainly neurosurgical and oncologic patients in CT performed for indications other than densitometry allows for better risk assessment of imminent vertebral fractures than dedicated DXA.