Level-Specific Volumetric BMD Threshold Values for the Prediction of Incident Vertebral Fractures Using Opportunistic QCT: A Case-Control Study

Frontiers in Endocrinology

卷:13

Malek El Husseini¹  Claus Zimmer¹  Michael Dieckmeyer¹  Thomas Baum¹  Anjany Sekuboyina¹  Nico Sollmann²  Maria Wostrack³  Bjoern Menze⁴  Maximilian Thomas Löffler⁵  Jan Stefan Kirschke⁷ 

[1] Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany;

[2] Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany;

[3] Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany;

[4] Department of Quantitative Biomedicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland;

[5] Department of Radiology, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany;

[6] Image-Based Biomedical Modeling, Department of Computer Science, Technical University of Munich, Munich, Germany;

[7] TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany;

关键词: bone mineral density (BMD);    osteoporosis;    spinal fracture;    multidetector computed tomography (MDCT);    threshold value;   

DOI  :  10.3389/fendo.2022.882163

来源: DOAJ

【 摘 要 】

PurposeTo establish and evaluate the diagnostic accuracy of volumetric bone mineral density (vBMD) threshold values at different spinal levels, derived from opportunistic quantitative computed tomography (QCT), for the prediction of incident vertebral fractures (VF).Materials and MethodsIn this case-control study, 35 incident VF cases (23 women, 12 men; mean age: 67 years) and 70 sex- and age-matched controls were included, based on routine multi detector CT (MDCT) scans of the thoracolumbar spine. Trabecular vBMD was measured from routine baseline CT scans of the thoracolumbar spine using an automated pipeline including vertebral segmentation, asynchronous calibration for HU-to-vBMD conversion, and correction of intravenous contrast medium (https://anduin.bonescreen.de). Threshold values at T1-L5 were calculated for the optimal operating point according to the Youden index and for fixed sensitivities (60 – 85%) in receiver operating characteristic (ROC) curves.ResultsvBMD at each single level of the thoracolumbar spine was significantly associated with incident VFs (odds ratio per SD decrease [OR], 95% confidence interval [CI] at T1-T4: 3.28, 1.66–6.49; at T5-T8: 3.28, 1.72–6.26; at T9-T12: 3.37, 1.78–6.36; and at L1-L4: 3.98, 1.97–8.06), independent of adjustment for age, sex, and prevalent VF. AUC showed no significant difference between vertebral levels and was highest at the thoracolumbar junction (AUC = 0.75, 95%-CI = 0.63 - 0.85 for T11-L2). Optimal threshold values increased from lumbar (L1-L4: 52.0 mg/cm³) to upper thoracic spine (T1-T4: 69.3 mg/cm³). At T11-L2, T12-L3 and L1-L4, a threshold of 80.0 mg/cm³ showed sensitivities of 85 - 88%, and specificities of 41 - 49%. To achieve comparable sensitivity (85%) at more superior spinal levels, resulting thresholds were higher: 114.1 mg/cm³ (T1-T4), 92.0 mg/cm³ (T5-T8), 88.2 mg/cm³ (T9-T12).ConclusionsAt all levels of the thoracolumbar spine, lower vBMD was associated with incident VFs in an elderly, predominantly oncologic patient population. Automated opportunistic osteoporosis screening of vBMD along the entire thoracolumbar spine allows for risk assessment of imminent VFs. We propose level-specific vBMD threshold at the thoracolumbar spine to identify individuals at high fracture risk.

【 授权许可】

Unknown