Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA
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 (bas...
Gespeichert in:
| Veröffentlicht in: | European radiology 2019-09, Vol.29 (9), p.4980-4989 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 4989 |
|---|---|
| container_issue | 9 |
| container_start_page | 4980 |
| container_title | European radiology |
| container_volume | 29 |
| creator | Löffler, Maximilian T. Jacob, Alina Valentinitsch, Alexander Rienmüller, Anna Zimmer, Claus Ryang, Yu-Mi Baum, Thomas Kirschke, Jan S. |
| description | 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. BMD
QCT
was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners.
Results
Sixteen patients had incident vertebral fractures showing lower mean BMD
QCT
than patients without fracture (
p
= 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMD
QCT
(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 BMD
QCT
(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.
Key Points
• Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients.
• More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA.
• Standard ACR QCT-cutoff values for osteoporosis ( |
| doi_str_mv | 10.1007/s00330-019-06018-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6682570</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2184325800</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-bad013eee0094798172eb71af926ffb6bf4ce2d37c4b59b26ec78e43893bf4d83</originalsourceid><addsrcrecordid>eNp9kUtv1DAUhS1ERYfCH2CBLLFhE3r9SGxvkKopj0qVEFKRkFhYjnMzuJrEwU6m4t_jYUpbWLDy4pz73XN9CHnB4A0DUKcZQAiogJkKGmC6unlEVkwKXjHQ8jFZgRG6UsbIY_I052sAMEyqJ-RYgDIAvF6RbxfDlOIOOzol7IKfQxxp7GkYfehwnOkO04xtclvaJ-fnJWGmSw7jhsZpimlexpDn4Onn9RX1cZhcwdA50vOvZ8_IUe-2GZ_fvifky_t3V-uP1eWnDxfrs8vKSyXnqnUdMIGIJZ5URjPFsVXM9YY3fd82bS898k4oL9vatLxBrzRKoY0oUqfFCXl74E5LO2DnS-yS104pDC79tNEF-7cyhu92E3e2aTSvFRTA61tAij8WzLMdQva43boR45ItZ7qu64bz_a5X_1iv45LGct7eVf6-1rAH8oPLp5hzwv4uDAO7784eurOlO_u7O3tThl4-PONu5E9ZxSAOhlykcYPpfvd_sL8AewqnHg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2184325800</pqid></control><display><type>article</type><title>Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Löffler, Maximilian T. ; Jacob, Alina ; Valentinitsch, Alexander ; Rienmüller, Anna ; Zimmer, Claus ; Ryang, Yu-Mi ; Baum, Thomas ; Kirschke, Jan S.</creator><creatorcontrib>Löffler, Maximilian T. ; Jacob, Alina ; Valentinitsch, Alexander ; Rienmüller, Anna ; Zimmer, Claus ; Ryang, Yu-Mi ; Baum, Thomas ; Kirschke, Jan S.</creatorcontrib><description>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. BMD
QCT
was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners.
Results
Sixteen patients had incident vertebral fractures showing lower mean BMD
QCT
than patients without fracture (
p
= 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMD
QCT
(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 BMD
QCT
(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.
Key Points
• Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients.
• More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA.
• Standard ACR QCT-cutoff values for osteoporosis (< 80 mg/cm
3
) and osteopenia (≤ 120 mg/cm
3
) can also be applied scanner independently in calibrated opportunistic QCT.</description><identifier>ISSN: 0938-7994</identifier><identifier>ISSN: 1432-1084</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-019-06018-w</identifier><identifier>PMID: 30790025</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Absorptiometry, Photon ; Aged ; Biocompatibility ; Biomedical materials ; Bone Density ; Bone diseases ; Bone Diseases, Metabolic - complications ; Bone Diseases, Metabolic - diagnostic imaging ; Bone mineral density ; Calibration ; Cancellous bone ; Computed tomography ; Densitometers ; Densitometry ; Diagnostic Radiology ; Dual energy X-ray absorptiometry ; Female ; Fractures ; Humans ; Imaging ; Internal Medicine ; Interventional Radiology ; Lumbar Vertebrae - diagnostic imaging ; Lumbar Vertebrae - injuries ; Male ; Mass Screening - methods ; Medicine ; Medicine & Public Health ; Middle Aged ; Musculoskeletal ; Neuroradiology ; Neurosurgery ; Osteopenia ; Osteoporosis ; Osteoporotic Fractures - diagnostic imaging ; Patients ; Radiology ; Retrospective Studies ; Risk assessment ; Scanners ; Sex ; Spinal Fractures - diagnostic imaging ; Spine ; Spine (lumbar) ; Statistical analysis ; Tomography, X-Ray Computed ; Ultrasound ; Vertebrae</subject><ispartof>European radiology, 2019-09, Vol.29 (9), p.4980-4989</ispartof><rights>The Author(s) 2019</rights><rights>European Radiology is a copyright of Springer, (2019). All Rights Reserved. © 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-bad013eee0094798172eb71af926ffb6bf4ce2d37c4b59b26ec78e43893bf4d83</citedby><cites>FETCH-LOGICAL-c474t-bad013eee0094798172eb71af926ffb6bf4ce2d37c4b59b26ec78e43893bf4d83</cites><orcidid>0000-0002-6022-3682</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-019-06018-w$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-019-06018-w$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,777,781,882,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30790025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Löffler, Maximilian T.</creatorcontrib><creatorcontrib>Jacob, Alina</creatorcontrib><creatorcontrib>Valentinitsch, Alexander</creatorcontrib><creatorcontrib>Rienmüller, Anna</creatorcontrib><creatorcontrib>Zimmer, Claus</creatorcontrib><creatorcontrib>Ryang, Yu-Mi</creatorcontrib><creatorcontrib>Baum, Thomas</creatorcontrib><creatorcontrib>Kirschke, Jan S.</creatorcontrib><title>Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>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. BMD
QCT
was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners.
Results
Sixteen patients had incident vertebral fractures showing lower mean BMD
QCT
than patients without fracture (
p
= 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMD
QCT
(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 BMD
QCT
(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.
Key Points
• Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients.
• More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA.
• Standard ACR QCT-cutoff values for osteoporosis (< 80 mg/cm
3
) and osteopenia (≤ 120 mg/cm
3
) can also be applied scanner independently in calibrated opportunistic QCT.</description><subject>Absorptiometry, Photon</subject><subject>Aged</subject><subject>Biocompatibility</subject><subject>Biomedical materials</subject><subject>Bone Density</subject><subject>Bone diseases</subject><subject>Bone Diseases, Metabolic - complications</subject><subject>Bone Diseases, Metabolic - diagnostic imaging</subject><subject>Bone mineral density</subject><subject>Calibration</subject><subject>Cancellous bone</subject><subject>Computed tomography</subject><subject>Densitometers</subject><subject>Densitometry</subject><subject>Diagnostic Radiology</subject><subject>Dual energy X-ray absorptiometry</subject><subject>Female</subject><subject>Fractures</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Lumbar Vertebrae - injuries</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Musculoskeletal</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Osteopenia</subject><subject>Osteoporosis</subject><subject>Osteoporotic Fractures - diagnostic imaging</subject><subject>Patients</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Risk assessment</subject><subject>Scanners</subject><subject>Sex</subject><subject>Spinal Fractures - diagnostic imaging</subject><subject>Spine</subject><subject>Spine (lumbar)</subject><subject>Statistical analysis</subject><subject>Tomography, X-Ray Computed</subject><subject>Ultrasound</subject><subject>Vertebrae</subject><issn>0938-7994</issn><issn>1432-1084</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kUtv1DAUhS1ERYfCH2CBLLFhE3r9SGxvkKopj0qVEFKRkFhYjnMzuJrEwU6m4t_jYUpbWLDy4pz73XN9CHnB4A0DUKcZQAiogJkKGmC6unlEVkwKXjHQ8jFZgRG6UsbIY_I052sAMEyqJ-RYgDIAvF6RbxfDlOIOOzol7IKfQxxp7GkYfehwnOkO04xtclvaJ-fnJWGmSw7jhsZpimlexpDn4Onn9RX1cZhcwdA50vOvZ8_IUe-2GZ_fvifky_t3V-uP1eWnDxfrs8vKSyXnqnUdMIGIJZ5URjPFsVXM9YY3fd82bS898k4oL9vatLxBrzRKoY0oUqfFCXl74E5LO2DnS-yS104pDC79tNEF-7cyhu92E3e2aTSvFRTA61tAij8WzLMdQva43boR45ItZ7qu64bz_a5X_1iv45LGct7eVf6-1rAH8oPLp5hzwv4uDAO7784eurOlO_u7O3tThl4-PONu5E9ZxSAOhlykcYPpfvd_sL8AewqnHg</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Löffler, Maximilian T.</creator><creator>Jacob, Alina</creator><creator>Valentinitsch, Alexander</creator><creator>Rienmüller, Anna</creator><creator>Zimmer, Claus</creator><creator>Ryang, Yu-Mi</creator><creator>Baum, Thomas</creator><creator>Kirschke, Jan S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6022-3682</orcidid></search><sort><creationdate>20190901</creationdate><title>Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA</title><author>Löffler, Maximilian T. ; Jacob, Alina ; Valentinitsch, Alexander ; Rienmüller, Anna ; Zimmer, Claus ; Ryang, Yu-Mi ; Baum, Thomas ; Kirschke, Jan S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-bad013eee0094798172eb71af926ffb6bf4ce2d37c4b59b26ec78e43893bf4d83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Absorptiometry, Photon</topic><topic>Aged</topic><topic>Biocompatibility</topic><topic>Biomedical materials</topic><topic>Bone Density</topic><topic>Bone diseases</topic><topic>Bone Diseases, Metabolic - complications</topic><topic>Bone Diseases, Metabolic - diagnostic imaging</topic><topic>Bone mineral density</topic><topic>Calibration</topic><topic>Cancellous bone</topic><topic>Computed tomography</topic><topic>Densitometers</topic><topic>Densitometry</topic><topic>Diagnostic Radiology</topic><topic>Dual energy X-ray absorptiometry</topic><topic>Female</topic><topic>Fractures</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Lumbar Vertebrae - diagnostic imaging</topic><topic>Lumbar Vertebrae - injuries</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Musculoskeletal</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Osteopenia</topic><topic>Osteoporosis</topic><topic>Osteoporotic Fractures - diagnostic imaging</topic><topic>Patients</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Risk assessment</topic><topic>Scanners</topic><topic>Sex</topic><topic>Spinal Fractures - diagnostic imaging</topic><topic>Spine</topic><topic>Spine (lumbar)</topic><topic>Statistical analysis</topic><topic>Tomography, X-Ray Computed</topic><topic>Ultrasound</topic><topic>Vertebrae</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Löffler, Maximilian T.</creatorcontrib><creatorcontrib>Jacob, Alina</creatorcontrib><creatorcontrib>Valentinitsch, Alexander</creatorcontrib><creatorcontrib>Rienmüller, Anna</creatorcontrib><creatorcontrib>Zimmer, Claus</creatorcontrib><creatorcontrib>Ryang, Yu-Mi</creatorcontrib><creatorcontrib>Baum, Thomas</creatorcontrib><creatorcontrib>Kirschke, Jan S.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Löffler, Maximilian T.</au><au>Jacob, Alina</au><au>Valentinitsch, Alexander</au><au>Rienmüller, Anna</au><au>Zimmer, Claus</au><au>Ryang, Yu-Mi</au><au>Baum, Thomas</au><au>Kirschke, Jan S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>29</volume><issue>9</issue><spage>4980</spage><epage>4989</epage><pages>4980-4989</pages><issn>0938-7994</issn><issn>1432-1084</issn><eissn>1432-1084</eissn><abstract>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. BMD
QCT
was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners.
Results
Sixteen patients had incident vertebral fractures showing lower mean BMD
QCT
than patients without fracture (
p
= 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMD
QCT
(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 BMD
QCT
(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.
Key Points
• Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients.
• More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA.
• Standard ACR QCT-cutoff values for osteoporosis (< 80 mg/cm
3
) and osteopenia (≤ 120 mg/cm
3
) can also be applied scanner independently in calibrated opportunistic QCT.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30790025</pmid><doi>10.1007/s00330-019-06018-w</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6022-3682</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2019-09, Vol.29 (9), p.4980-4989 |
| issn | 0938-7994 1432-1084 1432-1084 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6682570 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Absorptiometry, Photon Aged Biocompatibility Biomedical materials Bone Density Bone diseases Bone Diseases, Metabolic - complications Bone Diseases, Metabolic - diagnostic imaging Bone mineral density Calibration Cancellous bone Computed tomography Densitometers Densitometry Diagnostic Radiology Dual energy X-ray absorptiometry Female Fractures Humans Imaging Internal Medicine Interventional Radiology Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - injuries Male Mass Screening - methods Medicine Medicine & Public Health Middle Aged Musculoskeletal Neuroradiology Neurosurgery Osteopenia Osteoporosis Osteoporotic Fractures - diagnostic imaging Patients Radiology Retrospective Studies Risk assessment Scanners Sex Spinal Fractures - diagnostic imaging Spine Spine (lumbar) Statistical analysis Tomography, X-Ray Computed Ultrasound Vertebrae |
| title | Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T20%3A19%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Improved%20prediction%20of%20incident%20vertebral%20fractures%20using%20opportunistic%20QCT%20compared%20to%20DXA&rft.jtitle=European%20radiology&rft.au=L%C3%B6ffler,%20Maximilian%20T.&rft.date=2019-09-01&rft.volume=29&rft.issue=9&rft.spage=4980&rft.epage=4989&rft.pages=4980-4989&rft.issn=0938-7994&rft.eissn=1432-1084&rft_id=info:doi/10.1007/s00330-019-06018-w&rft_dat=%3Cproquest_pubme%3E2184325800%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2184325800&rft_id=info:pmid/30790025&rfr_iscdi=true |