矢状线重建 CT 测得的骨密度与轴向 CT 高度相关，但这两种测量结果与 DEXA T 分数的相关性一般

IF 0.4 Q4 CLINICAL NEUROLOGY Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2024-03-22 DOI:10.1016/j.inat.2024.101980

Shivam N. Upadhyaya , Charles H. Crawford III , Grant O. Schmidt , Derek Arrington , John R. Dimar II , Steven D. Glassman , Jeffrey L. Gum , Amer H. Ahmad , Leah Y. Carreon

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引用次数: 0

摘要

背景在对考虑接受脊柱手术的患者进行术前评估时，双能 X 射线吸收测量法（DEXA）传统上一直被用来诊断骨矿密度（BMD）低下这一风险因素。由于订购 DEXA 可能会增加成本并延误诊断，脊柱外科医生最近开始使用计算机断层扫描（CT）测量的 Hounsfield 单位（HU）来衡量 BMD。我们的研究旨在评估腰椎 CT 扫描中 DEXA 和 HU 之间的关联。方法确定了 42 名在一年内接受 DEXA 和腰椎 CT 扫描的患者（32 名女性，10 名男性，平均年龄 = 67.7 岁）。从臀部、前臂和 L1-L4 采集 DEXA T 值。使用矢状面和轴向面上 L1-L4 椎体中部松质区内的最大感兴趣区来确定 HU。与骨质疏松病例（轴位 HU = 119.8，矢状位 HU = 122.9）和正常病例（轴位 HU = 141.2，矢状位 HU = 142.3）相比，骨质疏松病例的 HU 有明显的统计学差异（轴位 HU = 59.2，矢状位 HU = 61.1，p = 0.006）。脊柱 T 评分与 CT HU 之间存在中度相关性（轴位 HU：r2 = 0.50，矢状位 HU：r2 = 0.49，p <；0.001），轴位 HU（r2 = 0.48，p <；0.000）和矢状位 HU（r2 = 0.48，p <；0.000）与髋关节 T 评分之间存在微弱相关性，与前臂 T 评分没有相关性。临床相关性目前的研究结果表明，矢状位和轴位椎体HU测量值之间有很强的相关性，这支持了这两种测量技术在临床上的应用。T-scores和HU之间的弱相关性与之前的研究一致，因此有必要在未来进行研究，以确定哪种方式能更好地预测脊柱手术患者的术后机械故障。

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Bone density measured on sagittal reconstructed CT is highly correlated with axial CT but both measurements are only moderately correlated with DEXA T-scores

Background

During the preoperative evaluation of a patient being considered for spinal surgery, Dual-energy x-ray absorptiometry (DEXA) has been traditionally used to diagnose poor bone mineral density (BMD) as a risk factor. As ordering a DEXA can add cost and delay diagnosis, spine surgeons have more recently began to use Hounsfield Units (HU) measured on computed tomography scans (CT) as a measure of BMD. The aim of our study was to evaluate associations between DEXA and HU on lumbar spine CT scans.

Methods

Forty-two patients (32 female, 10 male, mean age = 67.7 years) with DEXA and lumbar spine CT scans performed within one year of each other were identified. DEXA T-scores were collected from the hip, forearm and L1-L4. HU was determined using the maximum region of interest within the cancellous area in the mid-vertebral body from L1-L4 in the sagittal and axial planes.

Results

Using the lowest T-score, 8 (19 %) cases were osteoporotic and 25 (60 %) were osteopenic. Statistically significant differences in HU were seen in osteoporotic cases (Axial HU = 59.2, Sagittal HU = 61.1, p = 0.006) compared to osteopenic (Axial HU = 119.8, Sagittal HU = 122.9) and normal cases (Axial HU = 141.2, Sagittal HU = 142.3). There were moderate associations between the spine T-scores and CT HUs (Axial HU:r² = 0.50, Sagittal HU:r² = 0.49, p < 0.001), weak associations between the Axial HU (r² = 0.48, p < 0.000) and Sagittal HU (r² = 0.48, p < 0.000) with hip T-scores, and no correlations with forearm T-scores. There were strong associations between Axial HU and Sagittal HU (r² = 0.98, p < 0.001).

Clinical relevance

The results of the current study show a strong association between the sagittal and axial vertebral HU measurements, which supports the clinical use of either measurement technique. The weak correlation between T-scores and HU is consistent with prior studies and warrants future studies to determine which modality will better predict postoperative mechanical failures in patients undergoing spinal surgery.