A meta-analysis of the diagnostic accuracy of Hounsfield units on computed topography relative to dual-energy X-ray absorptiometry for the diagnosis of osteoporosis in the spine surgery population

Ahern, Daniel P; McDonnell, Jake; Riffault, Mathieu; Evans, Shane; Wagner, Scott C.; Vaccaro, Alexander R.; Hoey, David A.; Butler, Joseph S.

doi:10.1016/j.spinee.2021.03.008

Cited by 40 publications

(30 citation statements)

References 33 publications

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“…Further, a change in surgical strategy might be implemented when instrumenting an osteoporotic spine, avoiding ending a construct at a biomechanically stressed level, to prevent junctional failure or end of construct failure. Additionally, the use of cementaugmented screws might be evaluated to minimize the risk of mechanical failure [13].…”

Section: Discussionmentioning

confidence: 99%

“…Mean HU values were measured on three non-sequential axial images within the L3 vertebral body: immediately caudal to the superior end plate, mid-body, and cranial to the inferior end plate, as described by Schreiber et al [12]. According to a recent meta-analysis by Ahern et al [13], a threshold of 135 HU was set to diagnose osteoporosis.…”

Section: Radiographic Analysesmentioning

confidence: 99%

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Risk factors for L5 pedicle fractures after single-level posterior spinal fusion

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Radiographic Analysesmentioning

confidence: 99%

Risk factors for L5 pedicle fractures after single-level posterior spinal fusion

et al. 2022

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“…A recent meta-analysis tested the diagnostic accuracy of HU on CT scans relative to DXA for the diagnosis of osteoporosis in spine surgery populations. 28 In patients with mean age around 60 years or more, a threshold of 135 HU (or below) to diagnose lumbar osteoporosis was proposed. Notwithstanding, a large heterogeneity between studies was observed warranting caution in the interpretation of these results.…”

Section: Spondyloarthritis Spondyloarthritis Spondyloarthritismentioning

confidence: 99%

Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis

et al. 2022

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ObjectiveStudying vertebral bone loss in radiographic axial spondyloarthritis (r-axSpA) has been challenging due to ectopic bone formation. We cross-sectionally analysed low-dose CT (ldCT) trabecular bone density Hounsfield units (HU) measurements and calculated inter-reader reliability at the vertebral level in patients with r-axSpA.MethodsLdCT scans of 50 patients with r-axSpA from the sensitive imaging in ankylosing spondylitis study, a multicentre 2-year prospective cohort were included. Trabecular bone HU taken from a region of interest at the centre of each vertebra (C3-L5) were independently assessed by two trained readers. HU mean (SD), and range were provided at the vertebral level, for each reader and centre separately. Inter-reader reliability and agreement were assessed using intraclass correlation coefficients (ICC; single measurements, absolute agreement, two-way mixed effects models); smallest detectable difference and Bland-Altman plots.ResultsOverall, 1100 vertebrae were assessed by each reader. HU values decreased from cranial to caudal vertebrae. For readers 1 and 2 respectively, the highest mean (SD) HU value was obtained at C3 (354(106) and 355(108)), and the lowest at L3 (153(65) and 150 (65)). Inter-reader reliability was excellent (ICC(2,1):0.89 to 1.00). SDD varied from 4 to 8. For most vertebrae, reader 1 scored somewhat higher than reader 2 (mean difference of scores ranging from −0.6 to 2.9 HU). Bland-Altman plots showed homoscedasticity.ConclusionLdCT measurement of HU is a feasible method to assess vertebral bone density in r-axSpA with excellent inter-reader reliability from C3 to L5. These results warrant further validation and longitudinal assessment of reliability.

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“…Interessant sind die Daten einer jüngst publizierten Übersichtsarbeit zu HE-Cut-off-Werten im Rahmen der OPO-Diagnostik [ 1 ]. In Tab.…”

Section: Diskussionunclassified

Insuffizienzfrakturen der Wirbelsäule in Abhängigkeit von der spongiösen Knochendichte

Schröder¹,

Flachsmeyer²,

Kullen³

et al. 2022

Orthopädie

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Zusammenfassung Hintergrund Das Risiko für osteoporotische Insuffizienzfrakturen (Fx) am Achsenskelett steigt mit zunehmender Abnahme der Knochendichte, wobei sich thorakal und thorakolumbal eine Häufung findet. Um die unterschiedliche Verteilung von Fx entlang der Wirbelsäule (WS) besser zu verstehen, wurden morphologische und osteodensitometrische Untersuchungen mittels Computertomographie (CT) in den verschiedenen WS-Abschnitten durchgeführt. Zudem war zu klären, ob die bei CT-Untersuchungen aus anderen Indikationen gefunden Hounsfield-Einheiten (HE) mit der Knochendichte korrelieren und Anlass für eine osteologische Diagnostik sein könnten. Material und Methoden Von 26 Körperspenden wurden die gesamten WS in einem Plexiglas-Wasser-Phantom fixiert und mittels hochauflösende Spiral-CT analysiert. Zusätzlich erfolgte die Messung der CT-morphologischen Spongiosadichte in HE von C3 bis S2 (624 Wirbelkörper). Der Knochenmineralgehalt (KMG, mg/ml) wurde ermittelt und zur Abschätzung einer Osteoporose (OPO) herangezogen. Ergebnisse Bei allen WS lag eine OPO vor. Bei einem KMG unterhalb von 60 mg/ml fanden sich signifikant vermehrte Sinterungsfrakturen im thorakalen und thorakolumbalen Bereich. Osteoporotische Insuffizienzfrakturen im HWS-Bereich fanden sich insgesamt nicht. Die Spongiosadichte war signifikant höher in den zervikalen (Median 188,6 HE) als in den lumbalen (Median 63,6 HE) und sakralen (Median 25,5 HE) Wirbelkörpern aller untersuchten WS. Schlussfolgerung Ein KMG-Verlust der Wirbelkörperspongiosa führt zu einem erhöhten Fx-Risiko, welches sich auch bei den verwendeten WS findet. Jedoch wird im zervikalen Bereich ein scheinbarer Schwellenwert für das Auftreten von Sinterungsfrakturen nicht unterschritten. Einen Schwellenwert für HE zu finden, wäre für die klinische Praxis relevant.

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A meta-analysis of the diagnostic accuracy of Hounsfield units on computed topography relative to dual-energy X-ray absorptiometry for the diagnosis of osteoporosis in the spine surgery population

Cited by 40 publications

References 33 publications

Risk factors for L5 pedicle fractures after single-level posterior spinal fusion

Risk factors for L5 pedicle fractures after single-level posterior spinal fusion

Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis

Insuffizienzfrakturen der Wirbelsäule in Abhängigkeit von der spongiösen Knochendichte

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