骨质疏松症筛查中CT椎体衰减值的年龄依赖性变化:一项全国性多中心研究。

IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
European Radiology Pub Date : 2025-06-01 Epub Date: 2024-12-10 DOI:10.1007/s00330-024-11263-9
Youngjune Kim, Hae Young Kim, Sungsoo Lee, Sehyun Hong, Joon Woo Lee
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引用次数: 0

摘要

目的:探讨椎体衰减随年龄的变化规律,建立年龄调整CT衰减值临界值诊断骨质疏松。材料与方法:本多中心回顾性研究纳入11246例患者(平均年龄±标准差,50±13岁;7139名男性),在2022年至2023年期间在六个健康筛查中心接受了CT和双能x射线吸收仪(DXA)。利用基于深度学习的软件,测量L1椎体的衰减值。在女性中使用分段线性回归,在男性中使用简单线性回归来评估衰减值如何随年龄变化。进行多变量线性回归分析,以确定年龄是否与CT衰减值相关,而不依赖于DXA t评分。使用分位数回归得出针对90%敏感性或90%特异性的年龄调整截止值。测量年龄调整和年龄未调整截断点的性能,如果95%的置信区间包含90%,则认为达到了目标灵敏度或特异性。结果:男性的衰减值随年龄的增长而下降,而女性的衰减值则随着年龄的增长而急剧下降。结论:与未调整年龄的截断值相比,年龄调整截断值对骨质疏松症的诊断更可靠,因为与DXA t评分无关,椎体衰减值随着年龄的增长而下降。椎体CT衰减如何随年龄变化?结果:与双能x线骨密度t评分无关,男性在CT上的椎体衰减值以恒定的速率下降,而在42岁以上的女性中则突然下降。在机会性骨质疏松筛查中,年龄调整是必要的,尤其是在老年人中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Age-dependent changes in CT vertebral attenuation values in opportunistic screening for osteoporosis: a nationwide multi-center study.

Objectives: To examine how vertebral attenuation changes with aging, and to establish age-adjusted CT attenuation value cutoffs for diagnosing osteoporosis.

Materials and methods: This multi-center retrospective study included 11,246 patients (mean age ± standard deviation, 50 ± 13 years; 7139 men) who underwent CT and dual-energy X-ray absorptiometry (DXA) in six health-screening centers between 2022 and 2023. Using deep-learning-based software, attenuation values of L1 vertebral bodies were measured. Segmented linear regression in women and simple linear regression in men were used to assess how attenuation values change with aging. A multivariable linear regression analysis was performed to determine whether age is associated with CT attenuation values independently of the DXA T-score. Age-adjusted cutoffs targeting either 90% sensitivity or 90% specificity were derived using quantile regression. Performance of both age-adjusted and age-unadjusted cutoffs was measured, where the target sensitivity or specificity was considered achieved if a 95% confidence interval encompassed 90%.

Results: While attenuation values declined consistently with age in men, they declined abruptly in women aged > 42 years. Such decline occurred independently of the DXA T-score (p < 0.001). Age adjustment seemed critical for age ≥ 65 years, where the age-adjusted cutoffs achieved the target (sensitivity of 91.5% (86.3-95.2%) when targeting 90% sensitivity and specificity of 90.0% (88.3-91.6%) when targeting 90% specificity), but age-unadjusted cutoffs did not (95.5% (91.2-98.0%) and 73.8% (71.4-76.1%), respectively).

Conclusion: Age-adjusted cutoffs provided a more reliable diagnosis of osteoporosis than age-unadjusted cutoffs since vertebral attenuation values decrease with age, regardless of DXA T-scores.

Key points: Question How does vertebral CT attenuation change with age? Findings Independent of dual-energy X-ray absorptiometry T-score, vertebral attenuation values on CT declined at a constant rate in men and abruptly in women over 42 years of age. Clinical relevance Age adjustments are needed in opportunistic osteoporosis screening, especially among the elderly.

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来源期刊
European Radiology
European Radiology 医学-核医学
CiteScore
11.60
自引率
8.50%
发文量
874
审稿时长
2-4 weeks
期刊介绍: European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.
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