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Publications

Journal Article Ppublish

PubMed: 42412514 DOI: 10.1093/bjr/tqag160

Vertebral computed tomography attenuation to case-find low bone density in people undergoing lung cancer screening.

Br J Radiol 99(1187):2316-2325

Authors: Nikita Patel, Katrina Dahl, Rachael O'Rourke, Anne Williamson, Joseph C Lee, Kwun M Fong, Ian A Yang, Henry M Marshall

Affiliations

  • Thoracic Research Centre, The University of Queensland, Brisbane 4032, Australia. The Department of Thoracic Medicine Department, The Prince Charles Hospital, Brisbane 4032, Australia. Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia.
  • Thoracic Research Centre, The University of Queensland, Brisbane 4032, Australia. Medical Imaging Department, The Prince Charles Hospital, Brisbane 4032, Australia.
  • Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia. Department of Nuclear Medicine, The Prince Charles Hospital, Brisbane 4032, Australia.

Abstract

OBJECTIVE

Lung cancer screening (LCS) participants are "high-risk" for osteoporotic fracture. We compared lumbar vertebral Hounsfield unit CT-attenuation (VHU) from LCS images with standard dual-energy X-ray absorptiometry (DXA), quantitative CT (QCT) and clinical fracture risk tools to identify participants with low bone mineral density (BMD), prevalent vertebral fracture (VF) and incident osteoporotic fracture.

METHODS

LCS participants were cross-sectionally analyzed at a 2-year follow-up time point. BMD was assessed from paired LCS chest low-dose CT (VHU and spine QCT) and DXA scans (T-scores). FRAX and Garvan 10-year fracture risks were calculated from questionnaires. VFs were assessed semi-quantitatively from CT scans; 2-year incident VFs were identified by comparing baseline and 2-year follow-up CT scans. Participants self-reported 2-year incident osteoporotic fractures. Method discrimination for low DXA-BMD (T-score < -1), prevalent VFs and incident fractures was compared.

RESULTS

In 91 participants (M:F = 0.75), VHU moderately discriminated low DXA-BMD moderately (AUC, 0.74), similar to QCT (AUC, 0.73), FRAX (AUC, 0.82) and Garvan (AUC, 0.78) (P > .05). VHU performed similarly to DXA spine T-score, QCT, FRAX, and Garvan in discrimination for both prevalent VF (AUC, 0.71) and incident fractures (AUC, 0.71). Correlation and inter-method reliability between VHU and DXA-T-scores were fair (R = 0.42, ĸ < 0.3).

CONCLUSION

In LCS, VHU is a convenient alternative to case-finding screenees with occult osteoporosis, having comparable discrimination to standard methods for low BMD and osteoporotic fractures.

ADVANCES IN KNOWLEDGE

Within-population comparison of osteoporosis assessment methods, shows that VHU can comparably "case-find" LCS participants with occult osteoporotic disease and incident fractures, warranting larger prospective studies.

MeSH

Lung, Tomography, Neoplasms, Radiology, Lung Neoplasms, Osteoporosis, Bone Density, Osteoporotic Fractures, Spine