TY - JOUR
T1 - Quantitative CT Detects Undiagnosed Low Bone Mineral Density in Oncologic Patients Imaged with 18F-FDG PET/CT
AU - Kay, Fernando U.
AU - Ho, Vinh
AU - Dosunmu, Edmund B.
AU - Chhabra, Avneesh
AU - Brown, Keenan
AU - Duan, Xinhui
AU - Öz, Orhan K.
N1 - Funding Information:
O.K.O. is supported by the Wechun Pak Professorship in Bone Biophysics. This study has been partially supported by NIH grant 3R01NS049517-05S1. We are grateful to the technologists at Parkland Hospital for acquisition of the scans.
Funding Information:
Received for publication June 11, 2020; revision accepted October 6, 2020. From the *Department of Radiology, University of Texas Southwestern Medical Center, Dallas; and †Mindways Software, Inc, Austin, TX. Conflicts of interest and sources of funding: Purchase of the QCT PRO software was funded by NIH grant 3R01NS049517-05S1. K.B. is a shareholder and employee of Mindways Software, Inc. None declared to all other authors. Correspondence to: Fernando U. Kay, MD, PhD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. E-mail: fernando. kay@utsouthwestern.edu. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/21/4601–0008 DOI: 10.1097/RLU.0000000000003416
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Purpose We assessed the prevalence of low bone mineral density (BMD) in oncologic patients undergoing 18F-FDG PET/CT. Patients and Methods This is a retrospective analysis of 100 patients who underwent 18F-FDG PET/CT at a single center from October 2015 till May 2016. Quantitative CT (QCT) was used to assess BMD at the lumbar spine (BMDQCT) and femoral necks (BMDCTXA). SUVmax was used to evaluate metabolic activity of the bone marrow. Risk of osteoporosis-related fractures was calculated with femoral neck BMDCTXA and the FRAX algorithm, which was compared against measurements of CT attenuation of the trabecular bone at L1 (L1HU). Results Osteoporosis and osteopenia were respectively present in 16% and 46% of patients 50 years and older. Bone marrow SUVmax was correlated with BMD at the lumbar spine (ρ = 0.36, P < 0.001). Increased age and low marrow SUVmax were associated with low BMDQCT at the lumbar spine (both P < 0.001), whereas increased age, female sex, and low marrow SUVmax were associated with low BMDCTXA at the femoral necks (P < 0.001, P < 0.001, P = 0.01, respectively). L1HU had an area under the curve of 0.95 (95% confidence interval [CI], 0.90-0.99) for detecting increased risk for osteoporosis-related fracture, with best threshold of 125.8 HU (95% CI, 115.7-144.9) yielding sensitivity of 100% (95% CI, 0.92-1.00), specificity of 0.90 (95% CI, 0.76-0.97), and accuracy of 0.91 (95% CI, 0.79-0.97). Conclusions Low BMD is frequent in oncologic patients undergoing 18F-FDG PET/CT. Decreased 18F-FDG avidity of the bone marrow correlates with decreased BMD, validating the link between osteoporosis and bone marrow fat. L1HU could be a simple and accurate approach for detecting patients at risk for osteoporosis-related fractures using PET/CTdata.
AB - Purpose We assessed the prevalence of low bone mineral density (BMD) in oncologic patients undergoing 18F-FDG PET/CT. Patients and Methods This is a retrospective analysis of 100 patients who underwent 18F-FDG PET/CT at a single center from October 2015 till May 2016. Quantitative CT (QCT) was used to assess BMD at the lumbar spine (BMDQCT) and femoral necks (BMDCTXA). SUVmax was used to evaluate metabolic activity of the bone marrow. Risk of osteoporosis-related fractures was calculated with femoral neck BMDCTXA and the FRAX algorithm, which was compared against measurements of CT attenuation of the trabecular bone at L1 (L1HU). Results Osteoporosis and osteopenia were respectively present in 16% and 46% of patients 50 years and older. Bone marrow SUVmax was correlated with BMD at the lumbar spine (ρ = 0.36, P < 0.001). Increased age and low marrow SUVmax were associated with low BMDQCT at the lumbar spine (both P < 0.001), whereas increased age, female sex, and low marrow SUVmax were associated with low BMDCTXA at the femoral necks (P < 0.001, P < 0.001, P = 0.01, respectively). L1HU had an area under the curve of 0.95 (95% confidence interval [CI], 0.90-0.99) for detecting increased risk for osteoporosis-related fracture, with best threshold of 125.8 HU (95% CI, 115.7-144.9) yielding sensitivity of 100% (95% CI, 0.92-1.00), specificity of 0.90 (95% CI, 0.76-0.97), and accuracy of 0.91 (95% CI, 0.79-0.97). Conclusions Low BMD is frequent in oncologic patients undergoing 18F-FDG PET/CT. Decreased 18F-FDG avidity of the bone marrow correlates with decreased BMD, validating the link between osteoporosis and bone marrow fat. L1HU could be a simple and accurate approach for detecting patients at risk for osteoporosis-related fractures using PET/CTdata.
KW - biomarkers
KW - diagnostic screening programs
KW - medical oncology
KW - osteoporosis
KW - positron emission tomography/computed tomography
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U2 - 10.1097/RLU.0000000000003416
DO - 10.1097/RLU.0000000000003416
M3 - Article
C2 - 33234926
AN - SCOPUS:85097311297
SN - 0363-9762
VL - 46
SP - 8
EP - 15
JO - Clinical nuclear medicine
JF - Clinical nuclear medicine
IS - 1
ER -