Rose Fluss, Riana Lo Bu, Rafael De la Garza Ramos, Saikiran G Murthy, Reza Yassari, Yaroslav Gelfand
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引用次数: 0
Abstract
Objective: Hounsfield unit (HU) values measured using CT have been increasingly recognized to stand as a reliable corollary to dual-energy x-ray absorptiometry (DEXA) scores in evaluating bone mineral density. The authors examined the correlation between cervical HU values and DEXA T- and Z-scores and determined novel cervical HU thresholds for determining bone quality classification.
Methods: One hundred patients who underwent both cervical spine CT and DEXA, 85 patients who underwent both lumbar CT and DEXA, and 128 patients who underwent cervical and lumbar CT within 24 months at a single institution were included in this retrospective review. Two independent reviewers collected HU values from 3 cervical vertebral levels (C4-6) and 4 lumbar vertebral levels (L1-4), and the averaged values were used. Pearson's correlation coefficient analysis was performed to compare the association of cervical HU values with lumbar HU values and T- and Z-scores. The mean cervical HU values for each DEXA classification were calculated and compared. Receiver operating characteristic (ROC) curves were created to determine the threshold and its sensitivity and specificity for diagnosis.
Results: Cervical (C4-6) HU values and average, lumbar, and femoral T- and Z-scores had significant correlations (0.436 > r > 0.274, all p < 0.01). A strong positive correlation between cervical and lumbar HU values was found (r = 0.79, p < 0.01). The average cervical HU value of healthy patients was 361.2 (95% CI 337.1-385.3); of osteopenic patients, 312.1 (95% CI 290.3-333.8); and of osteoporotic patients, 288.4 (95% CI 262.6-314.3). There was a significant difference between the cervical HU values of healthy and osteopenic patients (p = 0.0134) and between those of healthy and osteoporotic patients (p = 0.0304). The cervical HU value of 340.98 was 73.5% specific and 57.9% sensitive for diagnosing osteopenia with an area under the ROC (AUROC) curve of 0.655. The cervical HU value of 326.5 was 88.9% specific and 63.2% sensitive for diagnosing osteoporosis with an AUROC curve of 0.749.
Conclusions: This is the second large-scale study and first with a patient population from the United States to show that HU values obtained using cervical CT were significantly correlated with bone quality based on DEXA T- and Z-scores and to establish a cervical HU threshold for determining bone quality classification. These results show that cervical HU values can and should be used to predict poor bone quality in surgical cervical spine patients.
目的:越来越多的人认为,在评估骨矿密度时,使用 CT 测量的 HU 值是双能 X 射线吸收测量法(DEXA)评分的可靠佐证。作者研究了颈椎 HU 值与 DEXA T 值和 Z 值之间的相关性,并确定了用于确定骨质分类的新颈椎 HU 临界值:100例同时接受颈椎CT和DEXA检查的患者、85例同时接受腰椎CT和DEXA检查的患者以及128例在24个月内接受颈椎和腰椎CT检查的患者被纳入此次回顾性研究。两名独立审查员收集了 3 个颈椎水平(C4-6)和 4 个腰椎水平(L1-4)的 HU 值,并使用平均值。对颈椎 HU 值与腰椎 HU 值、T 值和 Z 值的相关性进行了皮尔逊相关系数分析比较。计算并比较了每个 DEXA 分级的平均颈椎 HU 值。绘制了接收者操作特征曲线(ROC),以确定诊断的阈值及其敏感性和特异性:颈椎(C4-6)HU 值与平均、腰椎和股骨 T 值和 Z 值有显著相关性(0.436 > r > 0.274,所有 P <0.01)。颈椎和腰椎 HU 值之间存在很强的正相关性(r = 0.79,p < 0.01)。健康患者的平均颈椎 HU 值为 361.2(95% CI 337.1-385.3);骨质疏松患者的平均颈椎 HU 值为 312.1(95% CI 290.3-333.8);骨质疏松患者的平均颈椎 HU 值为 288.4(95% CI 262.6-314.3)。健康和骨质疏松患者的颈椎 HU 值之间存在明显差异(P = 0.0134),健康和骨质疏松患者的颈椎 HU 值之间也存在明显差异(P = 0.0304)。颈椎 HU 值 340.98 对诊断骨质疏松症的特异性为 73.5%,敏感性为 57.9%,ROC 曲线下面积为 0.655。宫颈 HU 值 326.5 对诊断骨质疏松症的特异性为 88.9%,敏感性为 63.2%,AUROC 曲线为 0.749:这是第二项大规模研究,也是第一项以美国患者为研究对象的研究,该研究表明,使用颈椎 CT 获得的 HU 值与基于 DEXA T 值和 Z 值的骨质显著相关,并确定了用于确定骨质分类的颈椎 HU 阈值。这些结果表明,颈椎 HU 值可以而且应该用来预测颈椎手术患者的骨质状况。
期刊介绍:
Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.