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

Marques, Mary Lucy; Silva, Nuno Pereira da; Heijde, Desirée van der; Reijnierse, M.; Baraliakos, Xenofon; Braun, Jürgen; Gaalen, F. van; Smolen, Josef S

doi:10.1136/rmdopen-2021-002149

Cited by 11 publications

(29 citation statements)

References 28 publications

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“… 28 This methodology was shown by us, in the same patients with r-axSpA from the SIAS cohort, to be feasible and reliable from C3 to L5. 28 Lower HU values denote a lower ldCT attenuation, with less-dense bones presenting lower HU values. While avoiding the overestimation of BMD reported in DXA (ldCT HU measurements are taken from the centre of the vertebra), this methodology enabled bone density assessments in the entire spine.…”

Section: Discussionmentioning

confidence: 76%

“…A standardised protocol was applied in both centres for imaging acquisitions. 18 MRI images were acquired in Leiden and Herne, respectively, on a 3 Tesla MRI (Philips Medical systems, Best, The Netherlands) and 1.5 Tesla MRI (Siemens, Erlangen, Germany) using sagittal T1-weighted and short tau inversion recovery (STIR) sequences with a slice thickness of 3 mm. LdCT images were obtained on 64-section and 16-section CT scanners (Leiden: Aquilion 64, Toshiba Medical Systems, Otawara, Japan; Herne: Somatom Emotion 16, Siemens, Erlangen, Germany).…”

Section: Methodsmentioning

confidence: 99%

“…The effective dose estimates for the whole spine were 3.8 (2.6) mSv and 4.7 (2.4) mSv per ldCT, respectively—further details were previously published. 18 …”

Section: Methodsmentioning

confidence: 99%

“…HU (continuous trabecular bone density score for the whole vertebra) were obtained from one reconstructed cross-sectional slice in a specific region of interest positioned at the centre of each vertebra using OsiriX software (V.6.5.1) ( online supplemental figure S2 ). 18 Vertebrae with incident density abnormalities or artefacts that could affect HU values (eg, sclerosis of the vertebral body, haemangiomas and photon starvation artefacts) were identified. In statistical analysis, the average of the measurements of HU by two readers at each vertebra was used.…”

Section: Methodsmentioning

confidence: 99%

“…Inter-reader reliability for ldCT HU status scores at each vertebra (C3–L5) in the SIAS cohort was previously shown to be good to excellent. 18 In the present study, inter-reader reliability and agreement for MRI-BME and syndesmophyte scores needed to be assessed separately after transformation to the vertebral level. Fleiss kappa (n=3 readers) was used for MRI-BME status scores, and Cohen’s kappa (n=2 readers) for ldCT CTSS change scores.…”

Section: Methodsmentioning

confidence: 99%

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Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis

et al. 2023

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ObjectiveTo investigate whether in radiographic axial spondyloarthritis (r-axSpA) inflammation is associated with lower trabecular bone density (TBD), and subsequently, if a lower TBD increases the likelihood of 2-year bone formation at the same vertebra.MethodsWhole spine (C3–L5) data from patients included in the multicentre 2-year Sensitive Imaging in Ankylosing Spondylitis cohort was used. Two readers measured baseline TBD by Hounsfield units (HU) on low-dose CT (ldCT). Baseline MRI bone marrow oedema (BME) status scores and ldCT syndesmophyte formation and/or growth change-from-baseline scores were assessed by three and two readers, respectively. Average of readers’ continuous measurements or readers’ agreement in binary scores generated within the same vertebra (1—present in ≥1 quadrant/0—absent in all quadrants) were used. Multilevel generalised estimating equations models were used, the unit of analysis being the vertebra.ResultsIn 50 patients with r-axSpA, TBD HU decreased from cranial to caudal vertebrae. Baseline MRI-BME was present in 300/985 (30%) and syndesmophytes in 588/910 (65%) vertebrae, both most prevalent at thoracolumbar region. Syndesmophyte formation or growth was observed in 18% of at-risk vertebrae (124/691). A significant confounder-adjusted association was found between inflammation and lower TBD (regression coefficient=−51; 95% CI−63 to −39). TBD was not associated with 2-year syndesmophyte formation or growth (adjusted OR 1.00; 95% CI 0.99 to 1.00).ConclusionIn r-axSpA, while vertebral inflammation was associated with lower vertebral TBD, lower vertebral TBD itself did not increase the risk for new bone formation at the same vertebra. In preventing syndesmophyte progression, targeting local inflammation seems more important than targeting vertebral trabecular bone loss.

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Section: Discussionmentioning

confidence: 76%

Section: Methodsmentioning

confidence: 99%

“…The effective dose estimates for the whole spine were 3.8 (2.6) mSv and 4.7 (2.4) mSv per ldCT, respectively—further details were previously published. 18 …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis

et al. 2023

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Stepwise asynchronous telehealth assessment of patients with suspected axial spondyloarthritis: results from a pilot study

Hannah,

von Sophie,

Gabriella

et al. 2023

Rheumatol Int

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Patients with axial spondyloarthritis (axSpA) suffer from one of the longest diagnostic delays among all rheumatic diseases. Telemedicine (TM) may reduce this diagnostic delay by providing easy access to care. Diagnostic rheumatology telehealth studies are scarce and largely limited to traditional synchronous approaches such as resource-intensive video and telephone consultations. The aim of this study was to investigate a stepwise asynchronous telemedicine-based diagnostic approach in patients with suspected axSpA. Patients with suspected axSpA completed a fully automated digital symptom assessment using two symptom checkers (SC) (bechterew-check and Ada). Secondly, a hybrid stepwise asynchronous TM approach was investigated. Three physicians and two medical students were given sequential access to SC symptom reports, laboratory and imaging results. After each step, participants had to state if axSpA was present or not (yes/no) and had to rate their perceived decision confidence. Results were compared to the final diagnosis of the treating rheumatologist. 17 (47.2%) of 36 included patients were diagnosed with axSpA. Diagnostic accuracy of bechterew-check, Ada, TM students and TM physicians was 47.2%, 58.3%, 76.4% and 88.9% respectively. Access to imaging results significantly increased sensitivity of TM-physicians (p < 0.05). Mean diagnostic confidence of false axSpA classification was not significantly lower compared to correct axSpA classification for both students and physicians. This study underpins the potential of asynchronous physician-based telemedicine for patients with suspected axSpA. Similarly, the results highlight the need for sufficient information, especially imaging results to ensure a correct diagnosis. Further studies are needed to investigate other rheumatic diseases and telediagnostic approaches.

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CT-based body composition in diffuse large B cell lymphoma patients: changes after treatment and association with survival

Pirosa,

Esposito,

Raia

et al. 2023

Radiol med

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Purpose Primary purpose was to assess changes of bone mineral density (BMD) in diffuse large B cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP (like) chemotherapy regimen. Secondary purposes were to assess other body composition features changes and to assess the association of pre-therapy values and their changes over time with survival. Material and methods Patients selected underwent R-CHOP(like) regimen for DLBCL, and underwent PET-CT before and after treatment. Main clinical data collected included body mass index, date of last follow-up, date of progression, and date of death. From the low-dose CT images, BMD was assessed at the L1 level; the other body composition values, including muscle and fat distribution, were assessed at the L3 level by using a dedicated software. Descriptive statistics were reported as median and interquartile range, or frequencies and percentages. Statistical comparisons of body composition variables between pre- and post-treatment assessments were performed using the Wilcoxon matched pairs signed rank test. Non-normal distribution of variables was tested with the Shapiro–Wilk test. For qualitative variables, the Fisher exact test was used. Log rank test was used to compare survival between different subgroups of the study population defined by specific body composition cutoffs. The significance level was set at p < 0.05. Results Eighty-two patients were included. The mean follow-up was 37.5 ± 21.4 months. A significant difference was found in mean BMD before and after R-CHOP(like) treatment (p < 0.0001). The same trend was observed for mean skeletal muscle area (SMA) (p = 0.004) and mean skeletal muscle index (SMI) (p = 0.006). No significant association was demonstrated between body composition variables, PFS and OS. Conclusion R-CHOP(like) treatment in DLBCL patients was associated with significant reduction of BMD, SMA and SMI.

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

Cited by 11 publications

References 28 publications

Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis

Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis

Stepwise asynchronous telehealth assessment of patients with suspected axial spondyloarthritis: results from a pilot study

CT-based body composition in diffuse large B cell lymphoma patients: changes after treatment and association with survival

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