中国定量CT(QCT)骨质疏松症诊断指南(2018)
|
摘要
骨密度测量在骨质疏松症防治中具有重要作用,定量CT(quantitative computed tomography,QCT)因其成像技术优势,近年来在骨质疏松症的临床和科研以及健康管理中的应用越来越广。为了更好地规范QCT在骨质疏松症诊疗和健康管理中的应用,中国老年学和老年医学学会、中华医学会健康管理学分会联合11个学术团体,组织全国著名的专家对近年来国内外QCT的研究进展和临床文献进行认真复习,并重点结合中国国内研究的最新数据和研究成果,参考国际临床骨密度学会、美国放射学院和中国老年学和老年医学学会骨质疏松分会已经发布的相关指南,制定了本QCT诊断指南。为临床医务工作者在QCT临床应用方面提供科学、具体的指导,促进骨质疏松症的规范诊疗。
The measurement of bone mineral density(BMD) plays a very important role in the management of osteoporosis. Due to its technical superiority, quantitative computed tomography(QCT) gained increasing application in the clinical practice and research of osteoporosis, as well as in the health management. In order to standardize the good practice of QCT in the management of osteoporosis and health check-up, the Osteoporosis Society of Chinese Geriatric(OSCG) Society and Chinese Society of Health Management, along with 11 societies and organizations, conducted a nationwide, multi-center big data study, and set up a committee consisted of well-known experts across China. Members of this committee reviewed the literatures on QCT application and research, in particular the newest data and research performed in China, based on the QCT guidelines by the International Society of Clinical Densitometry(ISCD), American College of Radiology(ACR) and OSCG, developed this QCT diagnosis criteria guideline, with the aim of providing scientific and detailed guidance for the medical professionals to follow in their clinical practice, and to promote the standardized diagnosis of osteoporosis.
The measurement of bone mineral density(BMD) plays a very important role in the management of osteoporosis. Due to its technical superiority, quantitative computed tomography(QCT) gained increasing application in the clinical practice and research of osteoporosis, as well as in the health management. In order to standardize the good practice of QCT in the management of osteoporosis and health check-up, the Osteoporosis Society of Chinese Geriatric(OSCG) Society and Chinese Society of Health Management, along with 11 societies and organizations, conducted a nationwide, multi-center big data study, and set up a committee consisted of well-known experts across China. Members of this committee reviewed the literatures on QCT application and research, in particular the newest data and research performed in China, based on the QCT guidelines by the International Society of Clinical Densitometry(ISCD), American College of Radiology(ACR) and OSCG, developed this QCT diagnosis criteria guideline, with the aim of providing scientific and detailed guidance for the medical professionals to follow in their clinical practice, and to promote the standardized diagnosis of osteoporosis.
引文
[1] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5):413-443.
[2] 《中国老年骨质疏松症诊疗指南(2018)》工作组,中国老年学和老年医学学会骨质疏松分会,马远征,等.中国老年骨质疏松症诊疗指南(2018)[J].中华健康管理学杂志,2018,12(6):484.
[3] Shepherd JA,Schousboe JT,Broy SB,et al.Executive summary of the 2015 ISCD position development conference on advanced measures from DXA and QCT:fracture prediction beyond BMD[J].J Clin Densitom,2015,18(3):274-286.
[4] Engelke K,Lang T,Khosla S,et al.Clinical use of quantitative computed tomography-based advanced techniques in the management of osteoporosis in adults:the 2015 ISCD official positions-part III[J].J Clin Densitom,2015,18(3):393-407.
[5] Engelke K,Fuerst T,Dardzinski B,et al.Odanacatib treatment affects trabecular and cortical bone in the femur of postmenopausal women:results of a two-year placebo-controlled trial[J].J Bone Miner Res,2015,30(1):30-38.
[6] Engelke K.Quantitative computed tomography-current status and new developments[J].J Clin Densitom,2017,20(3):309-321.
[7] Zhang Y,Zhou Z,Wu C,et al.Population-stratified analysis of bone mineral density distribution in cervical and lumbar vertebrae of Chinese from quantitative computed tomography[J].Korean J Radiol,2016,17(5):581-589.
[8] Yu A,Carballido-Gamio J,Wang L,et al.Spatial differences in the distribution of bone between femoral neck and trochanteric fractures[J].J Bone Miner Res,2017,32(8):1672-1680.
[9] Xu XM,Li N,Li K,et al.Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men[J].J Orthop Transla,2018.https://doi.org/10.1016/j.jot.2018.11.003.
[10] Wang L,Museyko O,Su Y,et al.QCT of the femur:Comparison between QCT Pro CTXA and MIAF femur[J].Bone,2019,120:262-270.
[11] Cheng XG,Li K,Ou SX,et al.Heterogeneity in spinal bone mineral density among young adults from three eastern provincial capital cities in mainland China[J].J Clin Densitom,2017,20(2):198-204.
[12] 程晓光,李勉文,李娜,等.定量CT骨密度测量(QCT)在骨质疏松症诊治中的临床应用2007国际临床骨密度学会(ISCD)共识摘录[J].中国骨质疏松杂志,2012,18(11):969-974.
[13] Engelke K,Adams JE,Armbrecht G,et al.Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults:the 2007 ISCD Official Positions[J].J Clin Densitom,2008,11(1):123-162.
[14] 程晓光,李娜.美国放射学院(ACR)关于定量CT(QCT)骨密度测量操作指南[J].中国骨质疏松杂志,2013,19(9):991-997.
[15] American College of Radiology.ACR practice guideline for the performance of quantitative computed tomography(QCT) bone densitometry (Resolution 33) [EB/OL].(2008-03-19)[2019-02-28].http://www.acr.org/media/ACR/Documents/PGTS/guidelines/QCT.pdf.
[16] American College of Radiology.ACR-SPR-SSR practice guideline for the performance of quantitative computed tomography(QCT) bone densitometry[EB/OL].(2014-06-16)[2019-02-28].http://www.acr.org/～/media/ACR/Documents/PGTS/guidelines/QCT.pdf.
[17] 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.
[18] 邓德茂,何欣,李家言,等.绝经妇女腰椎及髋关节定量CT骨密度测量诊断骨质疏松的初步研究[J].中国骨质疏松杂志,2012,18(11):1008-1010.
[19] 中华医学会放射学分会心胸学组.低剂量螺旋CT肺癌筛查专家共识[J].中华放射学杂志,2015,49(5):328-335.
[20] 周清华,王颖,黄云超,等.中国肺癌低剂量螺旋CT筛查指南(2018年版)[J].中国肺癌杂志,2018,21(2):67-75.
[21] 韩雪莉.迭代模型重建技术在低剂量胸部CT联合腰椎QCT扫描中的研究[D].郑州:郑州大学,2018.
[22] 蒋耀军,吴艳,张永高,等.低管电流联合多模型迭代重建技术对腰椎定量CT准确度的应用价值[J].中华放射医学与防护杂志,2018,38(1):59-63.
[23] Wu Y,Jiang Y,Han X,et al.Application of low-tube current with iterative model reconstruction on philips brilliance iCT elite FHD in the accuracy of spinal QCT using a European spine phantom[J].Quant Imaging Med Surg,2018,8(1):32-38.
[24] 过哲,付晓霞,唐雪,等.中国健康定量CT大数据项目研究方案[J].中华健康管理学杂志,2018,12(6):510-513.
[25] 刘桐希,李香凝,曾庆,等.胸部低剂量CT筛查联合定量CT骨密度测量在健康体检中的应用[J].中华健康管理学杂志,2018,12(3):269-271.
[26] Xu L,Duanmu Y,Blake GM,et al.Validation of goose liver fat measurement by QCT and CSE-MRI with biochemical extraction and pathology as reference[J].Eur Radiol,2018,28(5):2003-2012.
[27] Cheng X,Zhang Y,Wang C,et al.The optimal anatomic site for a single slice to estimate the total volume of visceral adipose tissue by using the quantitative computed tomography (QCT) in Chinese population[J].Eur J Clin Nutr,2018,72(11):1567-1575.
[28] 张昕,王峻,苏晋生,等.定量CT与双能X线吸收测定仪测量腰椎各椎体间骨密度差异性研究[J].中国医学影像学杂志,2011,19(12):884-886.
[29] 陈祥述,程晓光,彭俊红,等.采用欧洲腰椎体模对多中心腰椎定量CT的精密度和准确度评估[J].中国医学影像学杂志,2011,19(12):912-917.
[30] Lees B,Garland SW,Walton C,et al.Evaluation of the European spine phantom in a multi-centre clinical trial[J].Osteoporo Int,1997,7(6):570-574.
[31] 李娜,李新民,孙伟杰,等.腰椎定量CT与双能X线骨密度测量对老年患者骨质疏松检出率的比较分析[J].中华骨质疏松和骨矿盐疾病杂志,2012,5(2):83-88.
[32] 李凯,李新民,闫东,等.腰椎QCT与DXA对老年骨质疏松的诊断差异[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(3):271-276.
[33] Li N,Li XM,Xu L,et al.Comparison of QCT and DXA:Osteoporosis detection rates in postmenopausal women[J].Int J Endocrinol,2013,2013:895474.
[34] 王予生,过哲,李端端,等.定量CT腰椎骨密度测量的低剂量研究[J].中国骨质疏松杂志,2012,18(11):992-995.
[35] Damilakis J,Adams JE,Guglielmi G,et al.Radiation exposure in X-ray-based imaging techniques used in osteoporosis[J].Eur Radiol,2010,20(11):2707-2714.
[36] Cheng X,Wang L,Wang Q,et al.Validation of quantitative computed tomography-derived areal bone mineral density with dual energy X-ray absorptiometry in an elderly Chinese population[J].Chin Med J(Engl),2014,127(8):1445-1449.
[37] Cann CE,Adams JE,Brown JK,et al.CTXA hip--an extension of classical DXA measurements using quantitative CT[J].PLoS One,2014,9(3):e91904.
[38] 程晓光,王玲,苏永彬,等.重视老年髋部骨折患者术前骨密度与骨结构的影像学评价[J].中国骨与关节杂志,2017,6(8):561-564.
[2] 《中国老年骨质疏松症诊疗指南(2018)》工作组,中国老年学和老年医学学会骨质疏松分会,马远征,等.中国老年骨质疏松症诊疗指南(2018)[J].中华健康管理学杂志,2018,12(6):484.
[3] Shepherd JA,Schousboe JT,Broy SB,et al.Executive summary of the 2015 ISCD position development conference on advanced measures from DXA and QCT:fracture prediction beyond BMD[J].J Clin Densitom,2015,18(3):274-286.
[4] Engelke K,Lang T,Khosla S,et al.Clinical use of quantitative computed tomography-based advanced techniques in the management of osteoporosis in adults:the 2015 ISCD official positions-part III[J].J Clin Densitom,2015,18(3):393-407.
[5] Engelke K,Fuerst T,Dardzinski B,et al.Odanacatib treatment affects trabecular and cortical bone in the femur of postmenopausal women:results of a two-year placebo-controlled trial[J].J Bone Miner Res,2015,30(1):30-38.
[6] Engelke K.Quantitative computed tomography-current status and new developments[J].J Clin Densitom,2017,20(3):309-321.
[7] Zhang Y,Zhou Z,Wu C,et al.Population-stratified analysis of bone mineral density distribution in cervical and lumbar vertebrae of Chinese from quantitative computed tomography[J].Korean J Radiol,2016,17(5):581-589.
[8] Yu A,Carballido-Gamio J,Wang L,et al.Spatial differences in the distribution of bone between femoral neck and trochanteric fractures[J].J Bone Miner Res,2017,32(8):1672-1680.
[9] Xu XM,Li N,Li K,et al.Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men[J].J Orthop Transla,2018.https://doi.org/10.1016/j.jot.2018.11.003.
[10] Wang L,Museyko O,Su Y,et al.QCT of the femur:Comparison between QCT Pro CTXA and MIAF femur[J].Bone,2019,120:262-270.
[11] Cheng XG,Li K,Ou SX,et al.Heterogeneity in spinal bone mineral density among young adults from three eastern provincial capital cities in mainland China[J].J Clin Densitom,2017,20(2):198-204.
[12] 程晓光,李勉文,李娜,等.定量CT骨密度测量(QCT)在骨质疏松症诊治中的临床应用2007国际临床骨密度学会(ISCD)共识摘录[J].中国骨质疏松杂志,2012,18(11):969-974.
[13] Engelke K,Adams JE,Armbrecht G,et al.Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults:the 2007 ISCD Official Positions[J].J Clin Densitom,2008,11(1):123-162.
[14] 程晓光,李娜.美国放射学院(ACR)关于定量CT(QCT)骨密度测量操作指南[J].中国骨质疏松杂志,2013,19(9):991-997.
[15] American College of Radiology.ACR practice guideline for the performance of quantitative computed tomography(QCT) bone densitometry (Resolution 33) [EB/OL].(2008-03-19)[2019-02-28].http://www.acr.org/media/ACR/Documents/PGTS/guidelines/QCT.pdf.
[16] American College of Radiology.ACR-SPR-SSR practice guideline for the performance of quantitative computed tomography(QCT) bone densitometry[EB/OL].(2014-06-16)[2019-02-28].http://www.acr.org/～/media/ACR/Documents/PGTS/guidelines/QCT.pdf.
[17] 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.
[18] 邓德茂,何欣,李家言,等.绝经妇女腰椎及髋关节定量CT骨密度测量诊断骨质疏松的初步研究[J].中国骨质疏松杂志,2012,18(11):1008-1010.
[19] 中华医学会放射学分会心胸学组.低剂量螺旋CT肺癌筛查专家共识[J].中华放射学杂志,2015,49(5):328-335.
[20] 周清华,王颖,黄云超,等.中国肺癌低剂量螺旋CT筛查指南(2018年版)[J].中国肺癌杂志,2018,21(2):67-75.
[21] 韩雪莉.迭代模型重建技术在低剂量胸部CT联合腰椎QCT扫描中的研究[D].郑州:郑州大学,2018.
[22] 蒋耀军,吴艳,张永高,等.低管电流联合多模型迭代重建技术对腰椎定量CT准确度的应用价值[J].中华放射医学与防护杂志,2018,38(1):59-63.
[23] Wu Y,Jiang Y,Han X,et al.Application of low-tube current with iterative model reconstruction on philips brilliance iCT elite FHD in the accuracy of spinal QCT using a European spine phantom[J].Quant Imaging Med Surg,2018,8(1):32-38.
[24] 过哲,付晓霞,唐雪,等.中国健康定量CT大数据项目研究方案[J].中华健康管理学杂志,2018,12(6):510-513.
[25] 刘桐希,李香凝,曾庆,等.胸部低剂量CT筛查联合定量CT骨密度测量在健康体检中的应用[J].中华健康管理学杂志,2018,12(3):269-271.
[26] Xu L,Duanmu Y,Blake GM,et al.Validation of goose liver fat measurement by QCT and CSE-MRI with biochemical extraction and pathology as reference[J].Eur Radiol,2018,28(5):2003-2012.
[27] Cheng X,Zhang Y,Wang C,et al.The optimal anatomic site for a single slice to estimate the total volume of visceral adipose tissue by using the quantitative computed tomography (QCT) in Chinese population[J].Eur J Clin Nutr,2018,72(11):1567-1575.
[28] 张昕,王峻,苏晋生,等.定量CT与双能X线吸收测定仪测量腰椎各椎体间骨密度差异性研究[J].中国医学影像学杂志,2011,19(12):884-886.
[29] 陈祥述,程晓光,彭俊红,等.采用欧洲腰椎体模对多中心腰椎定量CT的精密度和准确度评估[J].中国医学影像学杂志,2011,19(12):912-917.
[30] Lees B,Garland SW,Walton C,et al.Evaluation of the European spine phantom in a multi-centre clinical trial[J].Osteoporo Int,1997,7(6):570-574.
[31] 李娜,李新民,孙伟杰,等.腰椎定量CT与双能X线骨密度测量对老年患者骨质疏松检出率的比较分析[J].中华骨质疏松和骨矿盐疾病杂志,2012,5(2):83-88.
[32] 李凯,李新民,闫东,等.腰椎QCT与DXA对老年骨质疏松的诊断差异[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(3):271-276.
[33] Li N,Li XM,Xu L,et al.Comparison of QCT and DXA:Osteoporosis detection rates in postmenopausal women[J].Int J Endocrinol,2013,2013:895474.
[34] 王予生,过哲,李端端,等.定量CT腰椎骨密度测量的低剂量研究[J].中国骨质疏松杂志,2012,18(11):992-995.
[35] Damilakis J,Adams JE,Guglielmi G,et al.Radiation exposure in X-ray-based imaging techniques used in osteoporosis[J].Eur Radiol,2010,20(11):2707-2714.
[36] Cheng X,Wang L,Wang Q,et al.Validation of quantitative computed tomography-derived areal bone mineral density with dual energy X-ray absorptiometry in an elderly Chinese population[J].Chin Med J(Engl),2014,127(8):1445-1449.
[37] Cann CE,Adams JE,Brown JK,et al.CTXA hip--an extension of classical DXA measurements using quantitative CT[J].PLoS One,2014,9(3):e91904.
[38] 程晓光,王玲,苏永彬,等.重视老年髋部骨折患者术前骨密度与骨结构的影像学评价[J].中国骨与关节杂志,2017,6(8):561-564.