Opportunistic use of chest CT for screening osteoporosis and predicting the risk of incidental fracture in breast cancer patients: A retrospective longitudinal study
Abstract:This study aimed to investigate the diagnostic performance of chest computed tomography (CT) for opportunistic screening and longitudinal follow-up of osteoporosis in breast cancer patients, compared to dual-energy X-ray absorptiometry (DXA). The association between L1 vertebral attenuation on chest CT and incidental fracture was also evaluated. We retrospectively reviewed 414 consecutive breast cancer patients who underwent both non-enhanced chest CT and DXA within a 3-month interval and had at least two DXA … Show more
“…All these results and the tendency are similar to the lumbar spine or low-dose chest CT measured by PB-QCT ( Ghildiyal et al, 2018 ; Cheng et al, 2021 ). The reliability and accuracy of HU to BMD measurement and determining osteoporosis have been proven in the literature with many reports ( Lee et al, 2013 ; Park et al, 2020 ), but in its current state, it is not ready for clinical implementation. There is a lack of exchangeability among different machines that limits its broad applicability ( Gausden et al, 2017 ).…”
Background: The diagnosis of osteoporosis is still one of the most critical topics for orthopedic surgeons worldwide. One research direction is to use existing clinical imaging data for accurate measurements of bone mineral density (BMD) without additional radiation.Methods: A novel phantom-less quantitative computed tomography (PL-QCT) system was developed to measure BMD and diagnose osteoporosis, as our previous study reported. Compared with traditional phantom-less QCT, this tool can conduct an automatic selection of body tissues and complete the BMD calibration with high efficacy and precision. The function has great advantages in big data screening and thus expands the scope of use of this novel PL-QCT. In this study, we utilized lung cancer or COVID-19 screening low-dose computed tomography (LDCT) of 649 patients for BMD calibration by the novel PL-QCT, and we made the BMD changes with age based on this PL-QCT.Results: The results show that the novel PL-QCT can predict osteoporosis with relatively high accuracy and precision using LDCT, and the AUC values range from 0.68 to 0.88 with DXA results as diagnosis reference. The relationship between PL-QCT BMD with age is close to the real trend population (from ∼160 mg/cc in less than 30 years old to ∼70 mg/cc in greater than 80 years old for both female and male groups). Additionally, the calculation results of Pearson’s r-values for correlation between CT values with BMD in different CT devices were 0.85–0.99.Conclusion: To our knowledge, it is the first time for automatic PL-QCT to evaluate the performance against dual-energy X-ray absorptiometry (DXA) in LDCT images. The results indicate that it may be a promising tool for individuals screened for low-dose chest computed tomography.
“…All these results and the tendency are similar to the lumbar spine or low-dose chest CT measured by PB-QCT ( Ghildiyal et al, 2018 ; Cheng et al, 2021 ). The reliability and accuracy of HU to BMD measurement and determining osteoporosis have been proven in the literature with many reports ( Lee et al, 2013 ; Park et al, 2020 ), but in its current state, it is not ready for clinical implementation. There is a lack of exchangeability among different machines that limits its broad applicability ( Gausden et al, 2017 ).…”
Background: The diagnosis of osteoporosis is still one of the most critical topics for orthopedic surgeons worldwide. One research direction is to use existing clinical imaging data for accurate measurements of bone mineral density (BMD) without additional radiation.Methods: A novel phantom-less quantitative computed tomography (PL-QCT) system was developed to measure BMD and diagnose osteoporosis, as our previous study reported. Compared with traditional phantom-less QCT, this tool can conduct an automatic selection of body tissues and complete the BMD calibration with high efficacy and precision. The function has great advantages in big data screening and thus expands the scope of use of this novel PL-QCT. In this study, we utilized lung cancer or COVID-19 screening low-dose computed tomography (LDCT) of 649 patients for BMD calibration by the novel PL-QCT, and we made the BMD changes with age based on this PL-QCT.Results: The results show that the novel PL-QCT can predict osteoporosis with relatively high accuracy and precision using LDCT, and the AUC values range from 0.68 to 0.88 with DXA results as diagnosis reference. The relationship between PL-QCT BMD with age is close to the real trend population (from ∼160 mg/cc in less than 30 years old to ∼70 mg/cc in greater than 80 years old for both female and male groups). Additionally, the calculation results of Pearson’s r-values for correlation between CT values with BMD in different CT devices were 0.85–0.99.Conclusion: To our knowledge, it is the first time for automatic PL-QCT to evaluate the performance against dual-energy X-ray absorptiometry (DXA) in LDCT images. The results indicate that it may be a promising tool for individuals screened for low-dose chest computed tomography.
“…If the L1 vertebra was non-homogeneous, not visualized, or fractured, the measurement was performed from the next intact vertebra (thoracic 12th vertebra) ( 21 ). Based on previous studies, a vertebral BMD value of 100 HU was accepted as lower density ( 13 , 22 ). Figure 2 Computed tomography (CT) images showing region of interest (ROI) placement in the first lumbar vertebra (L1) of a patient.…”
Section: Methodsmentioning
confidence: 99%
“…It has been shown that frailty caused by decreased function and strength of the musculoskeletal system due to aging affects the prognosis of various diseases ( 11 ). Recent feasibility studies suggest that vertebral attenuation can be used to assess the loss of bone mineral density (BMD) in the screening of osteoporosis characterized by low bone mass and quality, increasing bone fragility and fracture risk ( 12 , 13 ). A low BMD value has been reported to be a critical prognostic factor in many benign and malignant diseases such as coronary artery disease, chronic obstructive pulmonary disease (COPD), cerebrovascular conditions, and breast cancer ( 13 , 14 , 15 ).…”
Section: Introductionmentioning
confidence: 99%
“…Recent feasibility studies suggest that vertebral attenuation can be used to assess the loss of bone mineral density (BMD) in the screening of osteoporosis characterized by low bone mass and quality, increasing bone fragility and fracture risk ( 12 , 13 ). A low BMD value has been reported to be a critical prognostic factor in many benign and malignant diseases such as coronary artery disease, chronic obstructive pulmonary disease (COPD), cerebrovascular conditions, and breast cancer ( 13 , 14 , 15 ). In addition, there is pre-existing evidence indicating that in the presence of systemic inflammation, bone loss and reduced BMD can be seen due to the interaction of inflammatory mediators (interleukin, cytokines, etc.)…”
Purpose
:
To evaluate the prognostic value of the vertebral bone mineral density (BMD) on chest computed tomography (CT) in COVID-19 patients.
Methods
:
The chest CT of hospitalized patients with COVID-19 pneumonia were evaluated for Pneumonia Severity Score (PSS) as the ratio of the volume of involved lung parenchyma to the total lung volume. In addition, BMD was manually measured from the vertebral corpus using axial CT images. The relationships of clinical variables, PSS and vertebral BMD with patient outcomes, namely mortality, intensive care unit (ICU) admission and mechanical ventilation were investigated. Lower BMD was defined as ≤100 HU.
Results
:
The study included 209 patients (118 males, 56.4%). As a result of the univariate analysis, the rates of mortality, ICU admission and mechanical ventilation were 17.2% (n=36), 24.8% (n=52), and 20.6% (n=43), respectively, and they were significantly higher among the patients with lower BMD (38.1 vs. 13.0%,
p
<0.001; 33.4 vs. 21.2%,
p
=0.002; and 38.1 vs. 8.2%,
p
<0.001, respectively). In the mortality group, PSS was significantly higher (median, 9 vs. 5;
p
<0.001) and vertebral BMD was significantly lower (median, 83 vs. 139;
p
<0.001). Severe clinical incidence was significantly higher in patients with lower BMD compared to those with higher BMD (39.7 vs 24.7% and
p
=0.028). There was a significant correlation between clinical classification and lower BMD (r=0.152 and
p
=0.028). The multivariate analysis revealed vertebral BMD [odds ratio (OR), 1.028; 95% CI, 1.011-1.045,
p
=0.001) and lower BMD (OR, 4.682; 95% CI, 1.784-12.287,
p
=0.002) as significant independent predictors of mortality.
Conclusion
:
Vertebral BMD is a strong independent predictor of mortality that is reproducible and can be easily evaluated on the chest CT images of COVID-19 patients.
“…Opportunistic screening using chest computed tomography, in 414 consecutive breast cancer patients, who underwent both DXA and computed tomography, was recently tested. A moderate correlation between L1 attenuation and DXA T-score was observed, and women with attenuation values 90 HU or lower had higher fracture risk [30]. Screening using vertebral fracture assessment (VFA) to identify vertebral fractures in SUPERB-cohort of 3028 women in Sweden, was able to identify additional women at high fracture risk.…”
Section: New Studies On Reducing the Treatment Gapmentioning
Purpose of reviewTo provide an update on the most important new cohort studies within osteoporosis and their bearing on clinical management and directions for future research.Recent findingsWe identified a collection of new observational cohort studies - including new reports from already established large cohorts - and intervention studies providing new insights into osteoporosis pathophysiology, risk finding, intervention, and treatment barriers.SummaryRecent cohort studies in osteoporosis highlight the importance of timely identification and treatment of people who are at high risk of suffering osteoporotic fractures. Physical performance is a strong indicator of fracture risk and one that is tightly linked to a number of chronic conditions, not least inflammatory conditions like rheumatoid arthritis. Advances in case finding may involve opportunistic screening for low bone mineral density and vertebral fractures of radiology images obtained for other purposes, polygenic risk scores, and routinely collected medication and comorbidity information.
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