胸部日常CT在老年人骨质疏松性骨折中的诊断价值
摘要
目的评价胸部日常CT在老年人骨质疏松(OP)性骨折中的诊断价值。方法回顾收集2015年1月～2017年12月在本院进行双能x线(DXA)和胸部CT扫描的老年患者的相关资料;依据金标准DXA检查鉴别OP患者,计算胸椎CT诊断的灵敏度、特异度和最佳阈值,并比较DXA和胸部日常CT诊断OP骨折的能力。结果共收集236例患者,DXA诊断含109例(46.19%)OP;胸部日常CT诊断:T1最佳阈值为129.74 HU,灵敏度、特异度和约登指数分别为83.49%、81.10%和64.59%,T6最佳阈值为118.85 HU,灵敏度、特异度和约登指数分别为82.57%、78.74%和61.31%;患者中有72名为OP骨折,使用T1、T6诊断出比例分别是84.72%、83.33%,与DXA相比诊断准确性呈更高趋势。结论胸部日常CT对OP及相关骨折的诊断能力较强,可用于诊断、筛查、预测及疗效评价,尤其值得无DXA设备的基层医院推广应用。
引文
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[3] Pickhardt PJ,Pooler BD,Lauder T,et al.Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications[J].Ann Intern Med,2013,158(8):588-595.
[4] Marinova M,Edon B,Wolter K,et al.Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis[J].Curr Med Res Opin,2015,31(10):1871-1881.
[5] Buckens CF,Dijkhuis G,de Keizer B,et al.Opportunistic screening for osteoporosis on routine computed tomography?An external validation study[J].Eur Radiol,2015,25(7):2074-2079.
[6] Lee SY,Kwon SS,Kim HS,et al.Reliability and validity of lower extremity computed tomography as a screening tool for osteoporosis[J].Osteoporos Int,2015,26(4):1387-1394.
[7] Watts NB,Lewiecki EM,Miller PD,et al.National Osteoporosis Foundation 2008 Clinician's Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist[J].J Clin Densitom,2008,11(4):473-477.
[8] 余丽娟.早期积极康复护理对老年骨质疏松性股骨骨折预后及生活质量的影响[J].当代护士(上旬刊),2018,25(13):77-79.
[9] Emohare O,Cagan A,Morgan R,et al.The use of computed tomography attenuation to evaluate osteoporosis following acute fractures of the thoracic and lumbar vertebra[J].Geriatr Orthop Surg Rehabil,2014,5(2):50-55.
[10] Pickhardt PJ,Pooler BD,Lauder T,et al.Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications[J].Ann Intern Med,2013,158(8):588-595.
[11] Krueger D,Fidler E,Libber J,et al.Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women[J].J Clin Densitom,2014,17(1):60-65.