Deriving Bone Density from Thoracic CT Scans, STTR Phase II

从胸部 CT 扫描得出骨密度，STTR 第二阶段

• 批准号: 9792243
• 负责人: MIKE ALLEN
• 金额: $ 49.81万
• 依托单位: BDI, INC.
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9792243
• 关键词: Address; Adult; Advocate; African American; Age; Algorithms; American; Asians; Award; Awareness; Bone Density; Calcitonin; Calcium; Calibration; Cardiac; Caucasians; Cessation of life; Chest; Clinical; Code; Communities; Comorbidity; Data; Diagnosis; Disease; Disease Progression; Dual-Energy X-Ray Absorptiometry; Endocrinologist; Epidemiology; Ethnic Origin; Evaluation; Fracture; Future; Gender; Goals; Gold; Guidelines; Healthcare; Heart; Hip Fractures; Hispanics; Hormones; Human; Image; Incidence; Individual; Journals; Legal patent; Letters; Life Expectancy; Lung; Malignant neoplasm of lung; Measurement; Measures; Medical; Medicare; Methods; Morbidity - disease rate; Multi-Ethnic Study of Atherosclerosis; Osteopenia; Osteoporosis; Outcome; Patients; Peer Review; Persons; Pharmaceutical Preparations; Phase; Population; Prevalence; Prevention strategy; Preventive measure; Primary Care Physician; Privatization; Publishing; Quality of life; Race; Recommendation; Risk; Risk Factors; Running; Scanning; Secondary to; Small Business Technology Transfer Research; Smoking History; Spinal Fractures; Subgroup; Techniques; Testing; Therapeutic; Time; United States National Institutes of Health; Variant; Vertebral Bone; Vertebral column; Vitamin D; Woman; X-Ray Computed Tomography; authority; base; bisphosphonate; bone; bone loss; bone mass; chest computed tomography; cohort; cost; cost effective; disability; epidemiology study; follow-up; fracture risk; high risk; improved outcome; lung cancer screening; men; off-patent; older patient; prevent; prospective; racial and ethnic; rapid technique; response; rheumatologist; screening

ABSTRACT Osteoporosis is a major cause of disability and morbidity in our population. As many as 10 million Americans have osteoporosis and 34 million more have osteopenia. However, bone mineral density (BMD) assessment does not occur in many Americans when indicated and measure currently requires a separate referral and separate imaging scan to obtain BMD. The result is that only 12% of Americans who are at risk of suffering a hip fracture get BMD assessment and this problem is most likely heightened in ethnic/racial subgroups. Preventive measures (e.g., drugs to inhibit bone loss) cannot be administered in the absence of measurement of BMD. We have created, patented and published a quantitative technique to measure BMD from the thoracic spine using chest CT scans without need of calcium phantom under the patient, effectively opening this up to every chest CT both prospectively and previously acquired. We have validated our method in multiple cohorts with cardiac CT scans, but have not achieved sufficient evaluation to sway guidelines and recommendations for preferred use of DXA scanning. This will require evaluation in epidemiologic studies and outcomes that show CT BMD can predict fractures. CT imaging is very common in persons who meet criteria for osteoporosis screening, and these patients have multiple co-morbidities that may be associated with increased bone risk. Effective strategies to prevent bone loss and/or to treat osteoporosis include calcium and vitamin D, hormone replacement when indicated, calcitonin, and bisphosphonate administration. However, many patients remain undiagnosed until their first fracture because of the lack of recognition of the disease. With an increased awareness by endocrinologists, rheumatologists and primary care physicians, the increased use of preventive strategies, the impact of osteoporosis and subsequent hip fractures on those patients should decrease. This use of CT is not fully validated as we have not established the prevalence of the disease with our methods using CT scans in epidemiologic populations; or that low CT BMD correlates with fractures in this population. We have a cohort of 6,814 adults who underwent serial CT imaging 3-5 times over 15 years in the Multi-Ethnic Study of Atherosclerosis (MESA). Our QCT method will be applied to all visible thoracic levels. We therefore plan to: 1) utilize the 19000+ chest CT scans already performed in MESA; 2) develop prevalence of osteopenia, osteoporosis and vertebral fractures; 3) determine the association between low CT-BMD and presence and incidence of fractures in the DM population, with follow-up approaching 15 years in this population. Measuring BMD on chest CT scans will identify whether they have an increased prevalence of osteoporosis and osteopenia, to justify assessing BMD testing when they undergo CT scans. This can simplify and streamline health care screening by assessing two diseases (BMD and CAD or lung cancer) in one test, already acquired clinically in millions of patients, allowing cost-effective osteoporosis diagnosis.

摘要 骨质疏松症是我国人口残疾和发病的主要原因。多达1000万美国人 患有骨质疏松症，3400万人患有骨质减少症。然而，骨矿物质密度（BMD）评估 在许多美国人中，当有指征和措施目前需要单独转诊时， 单独成像扫描以获得BMD。其结果是，只有12%的美国人谁是在遭受风险， 髋部骨折需要BMD评估，且这个问题在种族/人种亚组中很可能更严重。 预防措施（例如，抑制骨丢失的药物）不能在缺乏 BMD测量。我们已经创造了一种测量BMD的定量技术，并获得了专利， 从胸椎使用胸部CT扫描，而不需要钙体模下的病人，有效地 将其开放给前瞻性和之前获得的每次胸部CT。我们已经验证了我们的 方法在多个队列中进行心脏CT扫描，但尚未获得足够的评价， DXA扫描首选使用指南和建议。这将需要评估， 流行病学研究和结果表明CT BMD可以预测骨折。 CT成像在符合骨质疏松症筛查标准的人中非常常见，并且这些 患者患有多种可能与骨风险增加相关的合并症。的有效战略 预防骨质流失和/或治疗骨质疏松症包括钙和维生素D， 降钙素和双膦酸盐给药。然而，许多患者仍未确诊，直到 他们的第一次骨折是因为对这种疾病缺乏认识。随着意识的提高， 内分泌学家，风湿病学家和初级保健医生，预防策略的使用增加， 骨质疏松症和随后的髋部骨折对这些患者的影响应该减少。使用CT 因为我们还没有用我们的CT方法确定这种疾病的患病率， 在流行病学人群中进行CT扫描;或在该人群中低CT BMD与骨折相关。我们有 在多种族研究中，6，814名成年人在15年内接受了3 - 5次连续CT成像 阿塞罗（MESA）。我们的QCT方法将应用于所有可见的胸部水平。因此，我们计划 目的：1）利用MESA已进行的19000多例胸部CT扫描; 2）发展骨质减少的患病率， 骨质疏松症和椎骨骨折; 3）确定低CT-BMD和存在之间的关联， DM人群的骨折发生率，该人群的随访时间接近15年。 通过胸部CT扫描测量骨密度将确定他们是否有骨质疏松症的患病率增加 和骨质减少，以证明评估骨密度测试时，他们接受CT扫描。这可以简化和 通过在一次测试中评估两种疾病（BMD和CAD或肺癌）来简化医疗保健筛查， 已在临床上获得数百万患者，使成本效益的骨质疏松症诊断。