Deriving Bone Density from Thoracic CT Scans, STTR Phase II

摘要 骨质疏松症是我们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，还有3400万人患有骨质疏松症。然而，骨密度(BMD)评估 在许多美国人中不会出现，当标明和测量目前需要单独的转诊和 单独进行影像扫描以获得骨密度。其结果是，只有12%的美国人面临患上癌症的风险 髋部骨折接受骨密度评估，这一问题很可能在种族/种族亚群中加剧。 预防措施(例如，抑制骨丢失的药物)不能在缺乏的情况下实施 骨密度测量。我们已经创造了一种测量BMD的定量技术，并获得了专利并出版了该技术 从胸椎采用胸部CT扫描，不需要下钙模的患者，有效 这对每个预期和先前获得的胸部CT来说都是开放的。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，但尚未取得足够的评估结果 首选使用DXA扫描的指南和建议。这将需要在以下方面进行评估 流行病学研究和结果表明，CT骨密度可以预测骨折。 CT成像在符合骨质疏松症筛查标准的人中非常常见，这些 患者有多种合并症，可能与骨骼风险增加有关。有效的战略，以 预防骨质流失和/或治疗骨质疏松症包括钙和维生素D，当 适应症，降钙素和双膦酸类药物。然而，许多患者一直没有得到诊断，直到 他们的第一次骨折是因为对这种疾病缺乏认识。随着意识的增强， 内分泌学家、风湿病学家和初级保健医生，更多地使用预防策略， 骨质疏松和随后的髋部骨折对这些患者的影响应该减少。CT的这种使用 没有得到充分的验证，因为我们还没有用我们的CT方法来确定疾病的流行率 在流行病学人群中进行扫描；或者低CT骨密度与该人群中的骨折相关。我们有 在这项多种族研究中，6814名成年人在15年内接受了3-5次连续CT成像 动脉粥样硬化(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 为了：1)利用已经在梅萨进行的19000多次胸部CT扫描；2)发展骨量减少的流行， 骨质疏松症和椎体骨折；3)确定低CT-BMD与存在和 糖尿病人群中骨折的发生率，并在该人群中进行了近15年的随访。 在胸部CT扫描上测量骨密度将确定他们是否有增加的骨质疏松症患病率 和骨量减少，以证明在接受CT扫描时评估骨密度测试是合理的。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)来简化医疗筛查， 已在数百万患者的临床上获得，从而实现了经济高效的骨质疏松症诊断。

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.