DXA测量骨密度的精密度评估及其应用
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摘要
目的通过短期精密度实验,统计分析双能X线吸收测定法(dual energy X-ray absorptiometry,DXA)测量骨密度(bone mineral density,BMD)的最小显著性变化值(least significant change,LSC),并探讨其临床应用价值。方法 4名技术员(A、B、C和D)使用GE Lunar Prodigy型双能X线骨密度仪均分别测量31名受检者(共124名)的腰椎和髋部的BMD,每位受检者连续测量2次,计算其精密度误差(precision error,PE)和LSC。结果 (1)不同技术员测量各部位BMD的各指标水平有差异,同一技术员每个测量位点的PE和LSC也不同;腰椎的PE和LSC较双侧股骨的波动幅度小,本实验中4位技术员之间对于L1～4,左、右股骨颈和左、右全髋部测量的PE变异系数(coefficient of variation,CV)差异皆无统计学意义(P>0.05);(2)本团队测量L1～4的PE为:RMS-SD=0.011 g/cm~2、RMS-CV=0.011,LSC为:LSC-SD=0.031 g/cm~2、LSC-CV=0.031;左全髋的PE为:RMS-SD=0.013 g/cm~2、RMS-CV=0.014,LSC为:LSC-SD=0.036 g/cm~2、LSC-CV=0.039,右全髋的PE为:RMS-SD=0.010 g/cm~2、RMS-CV=0.011,LSC为:LSC-SD=0.026 g/cm~2、LSC-CV=0.030。结论使用DXA测量骨密度的PE小、精密度高;预计随访间隔时间(monitoring time interval,MTI)应随着感兴趣区PE的增加而延长,随着预计BMD年变化的增加而缩短。
Objective To statistically analyze the least significant change(LSC) in the measurement of bone mineral density(BMD) with dual-energy X-ray absorptiometry(DXA), and to explore its clinical value. Methods BMD of the lumbar vertebrae and the hip of 31 subjects were measured using the GE Lunar Prodigy bone densitometer by 4 technicians(A, B, C, and D). Each subject was measured for 2 consecutive times, and the precision error(PE) and LSC were calculated. Results(1) There were difference in BMD measurement of different positions between the technicians. The PE and LSC at each site were different measured by the same technician. The variation of PE and LSC in the lumbar region of interest was smaller than that in the bilateral femurs. In this experiment, there was no statistically significant difference in PE(CV) measured at L1-L4, left and right femur necks, and left and right total hips between 4 technicians(all P>0.05).(2) The PE of L1-L4 measured by the team was RMS-SD=0.011 g/cm~2, RMS-CV=0.011, and the LSC was LSC-SD=0.031 g/cm~2, LSC-CV=0.031.The PE of the left total hip was RMS-SD=0.013 g/cm~2, RMS-CV=0.014, and the LSC was LSC-SD=0.036 g/cm~2, LSC-CV=0.039.The PE of the right total hip was RMS-SD=0.010 g/cm~2, RMS-CV=0.011, and the LSC was LSC-SD=0.026 g/cm~2, LSC-CV=0.030. Conclusion PE is small and accurate when using DXA to measure BMD. The monitoring time interval(MTI) should be extended with the increase of PE in the area of interest and be shortened with the increase of the predicted annual change of BMD.
Objective To statistically analyze the least significant change(LSC) in the measurement of bone mineral density(BMD) with dual-energy X-ray absorptiometry(DXA), and to explore its clinical value. Methods BMD of the lumbar vertebrae and the hip of 31 subjects were measured using the GE Lunar Prodigy bone densitometer by 4 technicians(A, B, C, and D). Each subject was measured for 2 consecutive times, and the precision error(PE) and LSC were calculated. Results(1) There were difference in BMD measurement of different positions between the technicians. The PE and LSC at each site were different measured by the same technician. The variation of PE and LSC in the lumbar region of interest was smaller than that in the bilateral femurs. In this experiment, there was no statistically significant difference in PE(CV) measured at L1-L4, left and right femur necks, and left and right total hips between 4 technicians(all P>0.05).(2) The PE of L1-L4 measured by the team was RMS-SD=0.011 g/cm~2, RMS-CV=0.011, and the LSC was LSC-SD=0.031 g/cm~2, LSC-CV=0.031.The PE of the left total hip was RMS-SD=0.013 g/cm~2, RMS-CV=0.014, and the LSC was LSC-SD=0.036 g/cm~2, LSC-CV=0.039.The PE of the right total hip was RMS-SD=0.010 g/cm~2, RMS-CV=0.011, and the LSC was LSC-SD=0.026 g/cm~2, LSC-CV=0.030. Conclusion PE is small and accurate when using DXA to measure BMD. The monitoring time interval(MTI) should be extended with the increase of PE in the area of interest and be shortened with the increase of the predicted annual change of BMD.
引文
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[2] 张智海,刘忠厚,李娜,等.中国人骨质疏松症诊断标准专家共识(第三稿.2014版)[J].中国骨质疏松杂志,2014,20(9):1007-1010.
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[8] 程晓光.国际临床骨密度学会共识文件(2005年版)[J].中国骨质疏松杂志,2006,12(2):205-209.
[9] 王立,张智海,李茂廷.骨密度测量的精密度及其重要性[J].中国骨质疏松杂志,2011,17(4):317-320.
[10] Sarath L,Robolge S,Janaka L.Effect of leg rotation on bone mineral density measurement[J].J Clin Densitom,2003,3(4):331-336.
[11] 黄际远,宋文忠.双能X射线骨密度测定在骨质疏松诊治中的应用[J].实用医院临床杂志,2008,5(5):127-128.
[12] 朱晓颖,朱汉文,张雪梅.关于ward’s三角区的探讨[J].中国骨质疏松杂志,2005,11(4):460-463.
[13] Morgan SL,Prater GL.Quality in dual-energy X-ray absorptiometry scans[J].Bone,2017,104:13-28.
[14] Carey JJ,Delaney MF.Utility of DXA for monitoring,technical aspects of DXA BMD measurement and precision testing[J].Bone,2017,104:44-53.
[2] 张智海,刘忠厚,李娜,等.中国人骨质疏松症诊断标准专家共识(第三稿.2014版)[J].中国骨质疏松杂志,2014,20(9):1007-1010.
[3] 杜桂迎,余卫,林强,等.WHO双能X线吸收仪骨质疏松症诊断标准及其相关问题[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(3):330-338.
[4] 余卫,夏雏波,王青松,等.双能X线骨密度测量仪测量报告的影像分析及其质量评估[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(4):312-316.
[5] 郭郡浩,施慧鹏,赵燕玲.DXA测量骨密度的精密度评估[J].徐州医学院学报.2010,30(1):40-44.
[6] 周琦,程晓光.骨密度测量中精密度的重要性[J].中国骨质疏松杂志,2002,8(1):94-96.
[7] 金超岭,王猛,李红磊,等.双能X线骨密度仪精密度和和准确度的研究[J].中国骨质疏松杂志,2014,20(12):1425-1427.
[8] 程晓光.国际临床骨密度学会共识文件(2005年版)[J].中国骨质疏松杂志,2006,12(2):205-209.
[9] 王立,张智海,李茂廷.骨密度测量的精密度及其重要性[J].中国骨质疏松杂志,2011,17(4):317-320.
[10] Sarath L,Robolge S,Janaka L.Effect of leg rotation on bone mineral density measurement[J].J Clin Densitom,2003,3(4):331-336.
[11] 黄际远,宋文忠.双能X射线骨密度测定在骨质疏松诊治中的应用[J].实用医院临床杂志,2008,5(5):127-128.
[12] 朱晓颖,朱汉文,张雪梅.关于ward’s三角区的探讨[J].中国骨质疏松杂志,2005,11(4):460-463.
[13] Morgan SL,Prater GL.Quality in dual-energy X-ray absorptiometry scans[J].Bone,2017,104:13-28.
[14] Carey JJ,Delaney MF.Utility of DXA for monitoring,technical aspects of DXA BMD measurement and precision testing[J].Bone,2017,104:44-53.
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