Assessing Thoracic Vertebral Bone Mineral Density (T8-T10) for Osteoporosis Diagnosis During CT Lung Cancer Screening in Older Adults

Abstract

Song Li,1,* Nandong Hu,2,* Zicheng Wei,2 Jiangchuan Wang,2 Rongzhou Wang,2 Xifa Gao,2 Yingping Qiu,2 Xiao Chen2 1Department of Radiology, The Second Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, 230040, People’s Republic of China; 2Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiao Chen; Yingping Qiu, Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing, 210029, People’s Republic of China, Tel [phone], Email [email protected]; [email protected]: Osteoporosis diagnosis often utilizes quantitative computed tomography (QCT). This study explored the validity of applying lumbar bone mineral density (LBMD) standards to thoracic vertebrae (T8-T10) for osteoporosis detection during CT lung cancer screenings. This study investigated the utility of thoracic BMD (BMD-T8-T10) for detecting osteoporosis in older persons during CT lung cancer screening.Methods: We studied 701 participants who underwent QCT scans for both LBMD and BMD-T8-T10. Osteoporosis was diagnosed using ACR criteria based on LBMD. We determined BMD-T8-T10 thresholds via a receiver operating characteristic (ROC) curve and translated BMD-T8+T9+T10 to LBMD (TTBMD) using linear regression. Kappa test was used to evaluate the accuracy of BMD-T8-T10 thresholds and TTBMD in diagnosing osteoporosis.Results: Raw BMD-T8-T10 poorly identified osteoporosis (kappa = 0.51). ROC curve analysis identified BMD-T8-T10 thresholds for osteopenia (138 mg/cm3) and osteoporosis (97 mg/cm3) with areas under the curve of 0.97 and 0.99, respectively. We normalized BMD-T8-T10 to TTBMD based on the formula: TTBMD = 0.9 × BMD-T8-T10 - 2.56. These thresholds (kappa = 0.74) and TTBMD performed well in detecting osteoporosis/osteopenia (kappa = 0.74).Conclusion: Both calculating BMD-T8-T10 threshold (138.0 mg/cm3 for osteopenia and 97 mg/cm3 for osteoporosis) and normalizing BMD-T8-T10 to LBMD demonstrated good performance in identifying osteoporosis in older adults during CT lung cancer screening.Keywords: quantitative computed tomography, thoracic vertebral bone mineral density, osteoporosis, Computed tomography, lung cancer

Keywords

• quantitative computed tomography
• thoracic vertebral bone mineral density
• osteoporosis
• computed tomography
• lung cancer