Treatment Planning and Fracture Prediction in Patients with Skeletal Metastasis with CT-Based Rigidity Analysis.
Treatment Planning and Fracture Prediction in Patients with Skeletal Metastasis with CT-Based Rigidity Analysis.
复制标题
DOI：
10.1158/1078-0432.ccr-14-2668
复制
发表时间：
2015-06-01
期刊：
影响因子：
--
通讯作者：
Snyder BD
中科院分区：
文献类型：
--
作者：
Nazarian A;Entezari V;Zurakowski D;Calderon N;Hipp JA;Villa-Camacho JC;Lin PP;Cheung FH;Aboulafia AJ;Turcotte R;Anderson ME;Gebhardt MC;Cheng EY;Terek RM;Yaszemski M;Damron TA;Snyder BD
如果有可靠的骨折风险评估方法，可以预防病理性骨折。进行了一项多中心前瞻性研究，以确定基于临床骨折风险评估和拟议的基于CT的刚度分析（CTRA）的医生治疗计划的骨转移的重要预测因素。根据Mirels方法为124例患者的149个转移灶选择了治疗方案。然后，进行CTRA，并将结果提供给医生，要求他们重新评估他们的治疗计划。比较CTRA前后的治疗计划，以确定根据CTRA报告改变治疗计划的病例。对患者随访4个月，以确定病理性骨折的发生率。疼痛、病变类型和病变大小是CTRA前计划的重要预测因素。在提供CTRA结果后，医生改变了36名患者的计划。CTRA结果、疼痛和原发转移源是CTRA后计划的重要预测因素。对未进行固定的患者进行随访，发现7例骨折; CTRA预测这些骨折的敏感性为100%，特异性为90%，而Mirels方法的敏感性为71%，特异性为50%。病灶的类型、大小和疼痛程度影响了医生对转移性病灶的治疗计划。医生的治疗计划和骨折风险的预测显着影响CTRA结果的可用性。由于其高灵敏度和特异性。CTRA可作为病理性骨折的筛查方法。
Pathological fractures could be prevented if reliable methods of fracture risk assessment were available. A multi-center, prospective study was conducted to identify significant predictors of physicians' treatment plan for skeletal metastasis based on clinical fracture risk assessments and the proposed CT-based Rigidity Analysis (CTRA). Orthopaedic oncologists selected a treatment plan for 124 patients with 149 metastatic lesions based on Mirels method. Then, CTRA was performed and the results were provided to the physicians, who were asked to reassess their treatment plan. The pre- and post-CTRA treatment plans were compared to identify cases where the treatment plan was changed based on the CTRA report. Patients were followed for a 4 month period to establish the incidence of pathological fractures. Pain, lesion type and lesion size were significant predictors of the pre-CTRA plan. After providing the CTRA results, physicians changed their plan for 36 patients. CTRA results, pain and primary source of metastasis were significant predictors of the post-CTRA plan. Follow up of patients who did not undergo fixation resulted in 7 fractures; CTRA predicted these fractures with 100% sensitivity and 90% specificity, whereas the Mirels method was 71% sensitive and 50% specific. Lesion type and size and pain level influenced the physicians’ plans for management of metastatic lesions. Physicians’ treatment plans and fracture risk predictions were significantly influenced by the availability of CTRA results. Due to its high sensitivity and specificity. CTRA could potentially be used as a screening method for pathological fractures.