Opportunistic screening for vertebral compression fracture using routine thoracic and abdominal CT scans according to T12 and L1 trabecular attenuation

doi:10.3877/cma.j.issn.2096-0263.2022.04.005

Abstract

Abstract:

Objective

To investigate the feasibility of opportunistic screening for osteoporotic vertebral compression fracture (OVCF) according to the trabecular attenuation (Hounsfield units, HU) of T₁₂ and L₁ from routine thoracic or abdominal CT examination.

Methods

1, 229 patients whose age ≥60 years with thoracic or abdominal CT examination in our hospital from December 2019 to June 2020 were enrolled in the present study. Among these patients, aged from 60 to 99 years [M(QR) 72(12)], and 728 males and 501 females. Clinical data and the HU value of T₁₂ and L₁ trabecular attenuation were obtained, and compared between the OVCF group and the control group.

Results

The HU value of T₁₂ and L₁ trabecular attenuation were negatively correlated with age (T₁₂: r=-0.458, P<0.01, L₁: r=-0.445, P<0.01). The HU value of T₁₂ and L₁ trabecular attenuation in the OVCF group were significantly lower than the control group [T₁₂: (55.1±30.3) Hu vs (100.8±36.9) Hu, L₁: (50.5±31.4) Hu vs (94.4±36.9) Hu](P<0.01). In patients with fractured vertebral body <3 segments, the HU value of T₁₂ and L₁ trabecular attenuation were higher than those with fractured vertebral body ≥3 segments [T₁₂, (60.8±28.1)Hu vs (37.3±30.4) Hu, L₁, (56.8±28.6) Hu vs (30.8±32.1) Hu] (P<0.01). In patients with moderate vertebral compression fractures, the HU value of T₁₂ and L₁ trabecular attenuation were higher than those of severe vertebral compression fractures [T₁₂, (60.1±30.4) Hu vs (45.9±31.8) Hu, L₁, (56.5±29.5) Hu vs (38.9±35.4) Hu] (P<0.05). The ROC curve analysis shows that the HU value of T₁₂ and L₁ trabecular attenuation had good diagnostic efficacy for OVCF (T₁₂: AUC=0.831, L₁: AUC=0.818). The ROC curve of the HU value of T₁₂ and L₁ trabecular attenuation had the highest diagnostic performance for OVCF in patients of age range from 60-69 years (T₁₂: AUC=0.866, L₁: AUC=0.843) and the lowest diagnostic performance in patients of age ≥80 years (T₁₂: AUC=0.760, L₁: AUC=0.759). The results of binary logistics regression analysis showed that the HU value of T₁₂ [OR=1.039, 95% CI: 1.032, 1.046] and L₁[OR=1.036, 95% CI: 1.030, 1.043] trabecular attenuation were independent risk factors for vertebral compression fractures.

Conclusion

The HU value of T₁₂ and L₁ trabecular attenuation in routine thoracic or abdominal CT examination are associated with OVCF, and may be an useful tool for osteoporosis and OVCF opportunistic screening.

Key words: Osteoporosis, Vertebral compression fracture, Computed Tomography

Jinhui Cai, Haoyi Ye, Chen Shen, Liangye Lin, Fandeng Diao, Donghua Guo, Zhifeng Liu, Qingyu Liu. Opportunistic screening for vertebral compression fracture using routine thoracic and abdominal CT scans according to T₁₂ and L₁ trabecular attenuation[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(04): 217-223.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlngkykfdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-0263.2022.04.005

https://zhlngkykfdzzz.cma-cmc.com.cn/EN/Y2022/V08/I04/217

Figures/Tables 9

References 18

1	中华医学会放射学分会骨关节学组,中国医师协会放射医师分会肌骨学组,中华医学会骨科学分会骨质疏松学组,等.骨质疏松的影像学与骨密度诊断专家共识[J].中国骨质疏松杂志, 2020, 26(9): 1249-1256.
2	Zeng Q, Li N, Wang Q, et al. The prevalence of Osteoporosis in China, a Nationwide, Multicenter DXA Survey [J]. J Bone Miner Res, 2019, 34(10): 1789-1797.
3	Lems WF, Paccou J, Zhang J, et al. Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services [J]. Osteoporos Int, 2021, 32(3): 399-411.
4	Löffler MT, Kallweit M, Niederreiter E, et al. Epidemiology and reporting of osteoporotic vertebral fractures in patients with long-term hospital records based on routine clinical CT imaging [J]. Osteoporos Int, 2022, 33(3):685-694.
5	Jain RK, Lee E, Mathai C, et al. Using opportunistic screening with abdominal CT to identify osteoporosis and osteopenia in patients with diabetes [J]. Osteoporos Int, 2020, 31(11): 2189-2196.
6	Li YL, Wong KH, Law MW, et al. Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population [J]. Arch Osteoporos, 2018, 13(1): 76.
7	Barton DW, Behrend CJ, Carmouche JJ. Rates of osteoporosis screening and treatment following vertebral fracture [J]. Spine J, 2019, 19(3): 411-417.
8	Söreskog E, Ström O, Spångéus A, et al. Risk of major osteoporotic fracture after first, second and third fracture in Swedish women aged 50 years and older [J]. Bone, 2020, 134(5): 115286.
9	Ensrud K, Crandall CJ. Osteoporosis [J]. Ann Intern Med, 2017, 167(3): ITC17-ITC32.
10	中华医学会骨质疏松和骨矿盐疾病分会.中国骨质疏松症流行病学调查及"健康骨骼"专项行动结果发布[J].中华骨质疏松和骨矿盐疾病杂志, 2019, 12(4): 317-318.
11	Li Y, Yan L, Cai S, et al. The prevalence and under-diagnosis of vertebral fractures on chest radiograph [J]. BMC Musculoskelet Disord, 2018, 19(1): 235.
12	Varney E, Abou Elkassem A, Khan M, et al. Prospective validation of a rapid CT-based bone mineral density screening method using colored spinal images [J]. Abdom Radiol (NY), 2021, 46(4):1752-1760.
13	Pickhardt PJ, Pooler BD, Lauder T, et al. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications [J]. Ann Intern Med, 2013, 158(8): 588-595.
14	Da Z, Li WS, Chao D, et al. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases [J]. European Spine Journal, 2019, 28(8): 1758-1766.
15	Graffy PM, Lee SJ, Ziemlewicz TJ, et al. Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening [J]. AJR Am J Roentgenol, 2017, 209(3): 491-496.
16	Kim YW, Kim JH, Yoon SH, et al. Vertebral bone attenuation on low-dose chest CT: quantitative volumetric analysis for bone fragility assessment [J]. Osteoporosis International, 2017, 28(1): 329-338.
17	Albano D, Messina C, Vitale J, et al. Imaging of sarcopenia: old evidence and new insights [J]. Eur Radiol, 2020, 30(4): 2199-2208.
18	Lin YH, Shih YT, Teng M. The impact of the "osteo" component of osteosarcopenia on fragility fractures in Post-Menopausal women [J]. Int J Mol Sci, 2021, 22(10): 5256.

一般资料	组别		χ ²/Z值	P值
一般资料	骨折组（n=207）	对照组（n=1 022）	χ ²/Z值	P值
年龄（岁）	78（13）	71（12）	-7.284	<0.01
性别（例）
男	81	647	41.668	<0.01
女	126	375	41.668	<0.01
年龄分层（例）
60~69岁	45	445
70~79岁	76	373	54.514	<0.01
≥80岁	86	204
CT检查部位（例）
胸部	162	854
腹部	18	82	4.692	0.096
胸部+腹部	27	86

一般资料	组别		χ ²/Z值	P值
一般资料	骨折组（n=207）	对照组（n=1 022）	χ ²/Z值	P值
年龄（岁）	78（13）	71（12）	-7.284	<0.01
性别（例）
男	81	647	41.668	<0.01
女	126	375	41.668	<0.01
年龄分层（例）
60~69岁	45	445
70~79岁	76	373	54.514	<0.01
≥80岁	86	204
CT检查部位（例）
胸部	162	854
腹部	18	82	4.692	0.096
胸部+腹部	27	86

年龄	T₁₂椎体CT值（Hu）				L₁椎体CT值（Hu）
年龄	骨折组（n=207）	对照组（n=1 022）	t值	P值	骨折组（n=207）	对照组（n=1 022）	t值	P值
60~69岁	71.8±22.3	115.2±33.5	-8.475	<0.01	67.4±22.7	107.9±33.1	-8.015	<0.01
70~79岁	59.3±30.3	97.2±34.0	-9.032	<0.01	55.4±30.8	91.0±34.9	-8.253	<0.01
≥80岁	42.7±29.0	76.2±35.0	-7.818	<0.01	37.4±30.7	71.2±35.6	-7.676	<0.01
总体	55.1±30.3	100.8±36.9	-16.682	<0.01	50.5±31.4	94.4±36.9	-15.956	<0.01

年龄	T₁₂椎体CT值（Hu）				L₁椎体CT值（Hu）
年龄	骨折组（n=207）	对照组（n=1 022）	t值	P值	骨折组（n=207）	对照组（n=1 022）	t值	P值
60~69岁	71.8±22.3	115.2±33.5	-8.475	<0.01	67.4±22.7	107.9±33.1	-8.015	<0.01
70~79岁	59.3±30.3	97.2±34.0	-9.032	<0.01	55.4±30.8	91.0±34.9	-8.253	<0.01
≥80岁	42.7±29.0	76.2±35.0	-7.818	<0.01	37.4±30.7	71.2±35.6	-7.676	<0.01
总体	55.1±30.3	100.8±36.9	-16.682	<0.01	50.5±31.4	94.4±36.9	-15.956	<0.01

椎体CT值（Hu）	骨折椎体数量		骨折椎体压缩程度
椎体CT值（Hu）	<3节（n=157）	≥3节（n=50）	中度压缩（n=138）	重度压缩（n=69）
T₁₂椎体	60.8±28.1	37.3±30.4	60.1±30.4	45.9±31.8
L₁椎体	56.8±28.6	30.8±32.1	56.5±29.5	38.9±35.4
t值	5.039	5.423	2.969	3.586
P值	<0.01	<0.01	0.003	<0.01

Please choose a citation manager

Content to export

Opportunistic screening for vertebral compression fracture using routine thoracic and abdominal CT scans according to T₁₂ and L₁ trabecular attenuation

RichHTML

PDF (PC)

Knowledge

Cited

Abstract

Cite this article

share this article

Figures/Tables 9

References 18

Related Articles 15

Recommended Articles

Metrics

Comments

椎体	年龄	例数	AUC（95% CI）	阈值（Hu）	敏感度	特异度	阳性预测值	阴性预测值
T₁₂	60~69岁	490	0.866（0.823~0.909）	90.0	80.0%	78.2%	27.1%	97.5%
	70~79岁	449	0.805（0.750~0.860）	70.0	73.7%	79.1%	41.8%	93.7%
	≥80岁	290	0.760（0.703~0.817）	61.0	73.3%	62.0%	46.7%	91.0%
	总体	1 229	0.831（0.804~0.859）	71.5	74.0%	78.5%	41.2%	93.8%
L₁	60~69岁	490	0.843（0.796~0.890）	87.5	80.0%	71.7%	22.2%	97.3%
	70~79岁	449	0.788（0.731~0.845）	67.5	73.7%	74.0%	36.6%	93.2%
	≥80岁	290	0.759（0.700~0.817）	57.5	73.3%	63.2%	45.7%	84.7%
	总体	1 229	0.818（0.789~0.847）	68.5	74.9%	75.0%	37.8%	93.7%

因素	B	B.E.	Wald	OR（95% CI）	P值
年龄	0.005	0.012	0.143	1.005（0.981，1.029）	0.705
性别	0.352	0.178	3.909	1.423（1.003，2.017）	0.048
T₁₂椎体CT值	0.039	0.003	126.816	1.039（1.032，1.046）	<0.01
L₁椎体CT值	0.036	0.003	116.300	1.036（1.030，1.043）	<0.01

[1]	Dan Han, Ting Wang, Huan Xiao, Lirong Zhu, Jingyu Chen, Yi Tang. Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 939-944.
[2]	Heng Lyu, Licong Dong, Haiqin Xie, Zhuofei Zhao, Li Liu, Desheng Sun. CT-ultrasound comparison for evaluating missed diagnosis of focal liver lesions by ultrasound: a single-center cross-sectional quality control survey [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 712-716.
[3]	Yanjuan Bao, Xiaohong Yang, Xinghai Yang, Sheng Zhao, Fan Yang, Shengbao Pan, Xiaoyan Zhang. Ultrasound combined with magnetic resonance imaging and computed tomography for diagnosis of retroperitoneal fetus-in-fetu [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(03): 265-271.
[4]	The Joint Surgery Branch of the Chinese Orthopedic Association, Guangdong’s Medical Association of Osteoporosis And Bone Mineral Research, Foshan Shunde 3rd Peoele’s Hospital. Clinical intervention guideline for using of anti-osteoporosis drugs in postoperative fragile hip fractures in China (2023 Edition) [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 751-764.
[5]	Yan Wang, Jianxiong Ma, Shuang Lang, Benchao Dong, Aixian Tian, Yan Li, Lei Sun, Hongzhen Jin, Bin Lu, Ying Wang, Haohao Bai, Xinlong Ma. Research progress in application of exosomes in diagnosis and treatment of osteoporosis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 673-678.
[6]	Luqiao Pu, Yongqing Xu, Baochuang Qi, Hongxin Shi, Wei Lin, Pengfei Bu, Yan Bai, Zhifang Tang, Chuan Li. Prospectus on clinical intervention guideline for anti-osteoporosis drugs in postoperative fragile hip fractures in China (2023 edition) [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 747-750.
[7]	Xiaoyan Dong, Qi Zhao, Jun Tang, Li Zhang, Xiaoyan Yang, Jiao Li. Clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 595-603.
[8]	Yixian Lu, Zhentao Zhang, Demeng Xia, Jialin Wang. Research progress of the regulating role and mechanism of macrophage polarization in osteoporosis [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(06): 538-541.
[9]	Kexin Wang, Shengyou Ge, Lin Wang, Jieying Li, Kai Song, Wei Shang. Ten cases of Stafne bone cavity: From image analysis to diagnosis and treatment [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2023, 17(05): 353-358.
[10]	Yueqi Chen, Rui Luo, Han Xiang, Yongyan Yu, Ting Yu. The causal association between osteoporosis and periodontitis: A two-sample Mendelian randomization study [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2023, 17(04): 292-298.
[11]	Shuo Chen, Feng Chen, Fei Cheng, Jie Xiang. Pancreas infarction after liver transplantation for glycogen storage disease type Ⅰ complicated with pancreatitis: a case report [J]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(05): 300-302.
[12]	Lang Jin, Jie Shi, Zheng Huang, Yongwei Jia, Jianpo Zhang, Licheng Wei, Haolei Jin. 3D printing digital technology assists the modified cross-PVP on the effect of spine-pelvic sagittal balance in severe osteoporotic vertebral compression fractures [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 263-268.
[13]	Juan Wang, Jun Gao, Yilan Zhou, Xiaohong Li, Bingwei Shi, Meizhen Pan. Relationship between serum IL-2, IL-17 and bone mineral density and their predictive value for osteoporosis [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 295-300.
[14]	Zhonghua Yang, Xiaohan Ma, Lei Diao, Jing Hu, Xi Chen. Diagnostic value of double-balloon enteroscopy in patients with negative computed tomography enterography results [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 475-479.
[15]	Yuxian Wu, Yayuan Feng, Lei Huo, Ningyang Jia, Juan Zhang. Study on the diagnostic value of imaging in primary hepatic lymphoma [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(05): 349-353.

模态框（Modal）标题

Please choose a citation manager

Content to export