術前腰椎CTを活用した簡便な骨粗鬆症判定の試み
はじめに：骨強度の評価は脊椎手術の治療戦略を立てる上で極めて重要であるが，DXA法による骨密度検査は全ての施設で簡便に施行できる検査ではなく，骨粗鬆症評価に手術に至ることも少なくない．そこで今回我々は椎体CT Hounsfield unit（HU）値を用いた骨粗鬆症判定の有用性について検討した．対象と方法：対象は2019～21年に当院で腰椎CTとDXAによる骨密度測定の両検査を6ヶ月以内に受けた138例．3機種のCTで撮影した腰椎CTを用いてT12-L4の椎体海綿骨HU値を測定し，椎体HU値とDXA T-scoreや脆弱性骨折の有無との関連を調査した．更に骨粗鬆症（T-score≦－2.5）の...
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| Published in | Journal of Spine Research Vol. 15; no. 1; pp. 3 - 12 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.01.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2022-0060 |
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| Abstract | はじめに：骨強度の評価は脊椎手術の治療戦略を立てる上で極めて重要であるが，DXA法による骨密度検査は全ての施設で簡便に施行できる検査ではなく，骨粗鬆症評価に手術に至ることも少なくない．そこで今回我々は椎体CT Hounsfield unit（HU）値を用いた骨粗鬆症判定の有用性について検討した．対象と方法：対象は2019～21年に当院で腰椎CTとDXAによる骨密度測定の両検査を6ヶ月以内に受けた138例．3機種のCTで撮影した腰椎CTを用いてT12-L4の椎体海綿骨HU値を測定し，椎体HU値とDXA T-scoreや脆弱性骨折の有無との関連を調査した．更に骨粗鬆症（T-score≦－2.5）の判定閾値や脆弱性骨折ありの判定閾値についてROC曲線を用いて検討した．結果：椎体HU値と腰椎・大腿骨近位部T-scoreは相関関係にあり，脆弱性骨折を有する患者では有しない患者と比較し椎体HU値は有意に低値であった．骨粗鬆症及び骨折ありの判定閾値は74.1と69.1であった．結語：椎体HU値はDXA T-scoreと相関関係にあり，骨強度の術前把握に有用な指標である． |
|---|---|
| AbstractList | はじめに：骨強度の評価は脊椎手術の治療戦略を立てる上で極めて重要であるが，DXA法による骨密度検査は全ての施設で簡便に施行できる検査ではなく，骨粗鬆症評価に手術に至ることも少なくない．そこで今回我々は椎体CT Hounsfield unit（HU）値を用いた骨粗鬆症判定の有用性について検討した．対象と方法：対象は2019～21年に当院で腰椎CTとDXAによる骨密度測定の両検査を6ヶ月以内に受けた138例．3機種のCTで撮影した腰椎CTを用いてT12-L4の椎体海綿骨HU値を測定し，椎体HU値とDXA T-scoreや脆弱性骨折の有無との関連を調査した．更に骨粗鬆症（T-score≦－2.5）の判定閾値や脆弱性骨折ありの判定閾値についてROC曲線を用いて検討した．結果：椎体HU値と腰椎・大腿骨近位部T-scoreは相関関係にあり，脆弱性骨折を有する患者では有しない患者と比較し椎体HU値は有意に低値であった．骨粗鬆症及び骨折ありの判定閾値は74.1と69.1であった．結語：椎体HU値はDXA T-scoreと相関関係にあり，骨強度の術前把握に有用な指標である． |
| Author | 髙橋, 佳史 長本, 行隆 岩﨑, 幹季 松本, 富哉 奥田, 眞也 古家, 雅之 |
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| References | 11) Zou D, Li W, Deng C, et al: The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J. 2019; 28: 1758-1766 18) Graffy PM, Lee SJ, Ziemlewicz TJ, et al: Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening. AJR Am J Roentgenol. 2017; 209: 491-496 1) DeWald CJ, Stanley T: Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine. 2006; 31: S144-S151 9) 林 達郎, 周 向栄, 陳 華岳, 他: X線CT画像における脊椎椎体部の骨密度の調査. 生体医工学. 2007; 4: 256-266 7) Genant HK, Wu CY, van Kuijk C, et al: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993; 8 (9): 1137-1148 5) 宗圓 聰, 福永仁夫, 杉本利嗣, 他: 原発性骨粗鬆症の診断基準 (2012年度改訂版). Osteoporosis Japan. 2013; 21: 9-21 10) 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 Clin Densitom. 2015; 18 (3): 393-407 12) Anderson PA, Morgan SL, Krueger D, et al: Use of bone health evaluation in orthopedic surgery: 2019 ISCD official position. J Clin Densitom. 2019; 22: 517-543 14) Leslie WD: Clinical review: ethnic differences in bone mass--clinical implications. J Clin Endocrinol Metab. 2012; 97: 4329-4340 3) Schreiber JJ, Anderson PA, Rosas HG, et al: Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Jt Surg Am. 2011; 93: 1057-1563 4) Pickhardt PJ, Pooler BD, Lauder T, et al: Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013; 158: 588-595 17) 林 達郎, 周 向栄, 陳 華岳, 他: X線CT画像からの人体の椎体海綿骨部における低骨密度領域の分布に関する研究. 生体医工学. 2008; 46: 451-457 13) Steiger P, Cummings SR, Black DM, et al: Age-related decrements in bone mineral density in women over 65. J Bone Miner Res. 1992; 7 (6): 625-632 2) Bjerke BT, Zarrabian M, Aleem IS, et al: Incidence of osteoporosis-related complications following posterior lumbar fusion. Glob Spine J. 2018; 8: 563-569 15) Finkelstein JS, Lee ML, Sowers M, et al: Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab. 2002; 87: 3057-3067 8) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843: 1-129 6) Lee SJ, Binkley N, Lubner MG, et al: Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int. 2016; 27: 1131-1136 16) Hayashi T, Chen H, Miyamoto K, et al: Analysis of bone mineral density distribution at trabecular bones in thoracic and lubar vertebrae using X-ray CT images. J Bone Miner Metab. 2011; 29: 174-185 |
| References_xml | – reference: 14) Leslie WD: Clinical review: ethnic differences in bone mass--clinical implications. J Clin Endocrinol Metab. 2012; 97: 4329-4340 – reference: 2) Bjerke BT, Zarrabian M, Aleem IS, et al: Incidence of osteoporosis-related complications following posterior lumbar fusion. Glob Spine J. 2018; 8: 563-569 – reference: 13) Steiger P, Cummings SR, Black DM, et al: Age-related decrements in bone mineral density in women over 65. J Bone Miner Res. 1992; 7 (6): 625-632 – reference: 15) Finkelstein JS, Lee ML, Sowers M, et al: Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab. 2002; 87: 3057-3067 – reference: 16) Hayashi T, Chen H, Miyamoto K, et al: Analysis of bone mineral density distribution at trabecular bones in thoracic and lubar vertebrae using X-ray CT images. J Bone Miner Metab. 2011; 29: 174-185 – reference: 5) 宗圓 聰, 福永仁夫, 杉本利嗣, 他: 原発性骨粗鬆症の診断基準 (2012年度改訂版). Osteoporosis Japan. 2013; 21: 9-21 – reference: 1) DeWald CJ, Stanley T: Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine. 2006; 31: S144-S151 – reference: 10) 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 Clin Densitom. 2015; 18 (3): 393-407 – reference: 3) Schreiber JJ, Anderson PA, Rosas HG, et al: Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Jt Surg Am. 2011; 93: 1057-1563 – reference: 17) 林 達郎, 周 向栄, 陳 華岳, 他: X線CT画像からの人体の椎体海綿骨部における低骨密度領域の分布に関する研究. 生体医工学. 2008; 46: 451-457 – reference: 4) Pickhardt PJ, Pooler BD, Lauder T, et al: Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013; 158: 588-595 – reference: 11) Zou D, Li W, Deng C, et al: The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J. 2019; 28: 1758-1766 – reference: 6) Lee SJ, Binkley N, Lubner MG, et al: Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int. 2016; 27: 1131-1136 – reference: 8) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843: 1-129 – reference: 7) Genant HK, Wu CY, van Kuijk C, et al: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993; 8 (9): 1137-1148 – reference: 12) Anderson PA, Morgan SL, Krueger D, et al: Use of bone health evaluation in orthopedic surgery: 2019 ISCD official position. J Clin Densitom. 2019; 22: 517-543 – reference: 9) 林 達郎, 周 向栄, 陳 華岳, 他: X線CT画像における脊椎椎体部の骨密度の調査. 生体医工学. 2007; 4: 256-266 – reference: 18) Graffy PM, Lee SJ, Ziemlewicz TJ, et al: Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening. AJR Am J Roentgenol. 2017; 209: 491-496 |
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| Title | 術前腰椎CTを活用した簡便な骨粗鬆症判定の試み |
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