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Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA.
Eur Radiol. 2019 Sep; 29(9):4980-4989.ER

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. BMDQCT was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners.

RESULTS

Sixteen patients had incident vertebral fractures showing lower mean BMDQCT than patients without fracture (p = 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMDQCT (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 BMDQCT (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.

Authors+Show Affiliations

Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. m_loeffler@web.de.Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Department of Orthopedic and Trauma Surgery, Medical University Vienna, Vienna, Austria.Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30790025

Citation

Löffler, Maximilian T., et al. "Improved Prediction of Incident Vertebral Fractures Using Opportunistic QCT Compared to DXA." European Radiology, vol. 29, no. 9, 2019, pp. 4980-4989.
Löffler MT, Jacob A, Valentinitsch A, et al. Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA. Eur Radiol. 2019;29(9):4980-4989.
Löffler, M. T., Jacob, A., Valentinitsch, A., Rienmüller, A., Zimmer, C., Ryang, Y. M., Baum, T., & Kirschke, J. S. (2019). Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA. European Radiology, 29(9), 4980-4989. https://doi.org/10.1007/s00330-019-06018-w
Löffler MT, et al. Improved Prediction of Incident Vertebral Fractures Using Opportunistic QCT Compared to DXA. Eur Radiol. 2019;29(9):4980-4989. PubMed PMID: 30790025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA. AU - Löffler,Maximilian T, AU - Jacob,Alina, AU - Valentinitsch,Alexander, AU - Rienmüller,Anna, AU - Zimmer,Claus, AU - Ryang,Yu-Mi, AU - Baum,Thomas, AU - Kirschke,Jan S, Y1 - 2019/02/21/ PY - 2018/08/22/received PY - 2019/01/17/accepted PY - 2018/12/18/revised PY - 2019/2/23/pubmed PY - 2019/11/28/medline PY - 2019/2/22/entrez KW - Bone density KW - Multidetector computed tomography KW - Osteoporosis KW - Photon absorptiometry KW - Spinal fractures SP - 4980 EP - 4989 JF - European radiology JO - Eur Radiol VL - 29 IS - 9 N2 - 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. BMDQCT was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners. RESULTS: Sixteen patients had incident vertebral fractures showing lower mean BMDQCT than patients without fracture (p = 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMDQCT (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 BMDQCT (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. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/30790025/Improved_prediction_of_incident_vertebral_fractures_using_opportunistic_QCT_compared_to_DXA_ L2 - https://dx.doi.org/10.1007/s00330-019-06018-w DB - PRIME DP - Unbound Medicine ER -