Göğüs cerrahisi hasta popülasyonunda osteoporoz sıklığı: Toraks bilgisayarlı tomografi tetkiklerinden fırsatçı değerlendirme

Yıl 2023, Cilt: 28 Sayı: 1, 81 - 88, 20.01.2023

Mahmut Subaşı , Abdulkadir Eren

https://doi.org/10.21673/anadoluklin.1145900

Öz

Amaç: Göğüs cerrahisi hastalarında osteoporoz sıklığını araştırmak ve doktorlar için klinik önemini vurgulamak.

Yöntemler: 306 hastanın toraks bilgisayarlı tomografileri (BT) T12 vertebra medüller yoğunluğu (Hounsfield unit-HU) açısından incelendi. Erkekler ve kadınlar; “70 yaş altı” ve “70 yaş ve üzeri” gruplar karşılaştırıldı. Yaş parametresinin osteoporozu öngörmedeki tanısal performansını değerlendirmek için alıcı işlem karakteristikleri (receiver operating characteristic-ROC) analizi ve lojistik regresyon analizi kullanıldı. Bu çalışma grubunda tespit edilen kosta kortikal defektleri ve nedenleri açıklandı.

Bulgular: 51 hastanın (veya %16,7) HU’ları 110’un altında idi (osteoporoz); 177’sinin (%57,8) 160’ın üzerindeydi (normal). 78 kişi (%25,5) için HU değerleri 111 ila 159 (sınır) arasında değişmekte idi. Erkekler ve kadınlar arasında anlamlı bir fark yoktu. 70 yaş altı nüfus ile 70 yaş üstü nüfus arasındaki farkın istatistiksel olarak anlamlı olduğu belirlendi (p<0,001). Osteoporozu tahmin etmek için yaş, 0.857’lik bir eğri altında kalan alan (CI 0.806-0.908) sergiledi. Osteoporozun yüzde 95,7 doğruluk oranıyla (p<0,001) yaşa göre doğru bir şekilde öngörüldüğü gösterildi. Kadınlarda eşik değer 57, erkeklerde 55 idi. 6 kişide BT taramalarında kosta korteks defektleri görülürken 2 hastada ise ameliyat sırasında kırık meydana geldi.

Sonuç: Bu popülasyonun yalnızca %57,8’i normal aralıkta kemik yoğunluğuna sahipti. Yaş, osteoporozu öngörmede yüksek doğruluk ile değerli bir parametre olabilir. Kadınlarda 57, erkeklerde 55 yaş üstü osteoporoz varlığı değerlendirilmeli, operasyon ve postoperatif bakım sırasında kemikleri korumaya yönelik önlemler alınmalıdır. 

Anahtar Kelimeler

Göğüs cerrahisi, osteoporoz, tomografi

Destekleyen Kurum

yok

The frequency of osteoporosis in the thoracic surgery patient population: An opportunity assessment from thorax computed tomography scans

Öz

Aim: To investigate the frequency of osteoporosis in thoracic surgery patients and highlight the clinical significance for physicians.

Methods: Thoracic computed tomographies (CT) of 306 patients were examined for medullary density of the T12 vertebra. Men and women, as well as those under 70 and over 70, were compared in terms of Hounsfield units (HU). To evaluate the diagnostic performance of the age parameter in predicting osteoporosis, receiver operating characteristic (ROC) analysis, and logistic regression analysis were used. The rib cortical defects identified in this study group and their causes were explained.

Results: HUs of 51 subjects (or 16.7%) were less than 110 (osteoporosis); 177 people (57.8%) were higher than 160 (normal). HU values ranged from 111 to 159 (borderline) for 78 individuals (25.5%). There was no significant difference between males and females. It was discovered that the difference between the population under 70 and the population over 70 was statistically significant (p<0.001). For predicting osteoporosis, the age exhibited an area under the curve of 0.857 (CI 0.806-0.908). The threshold value was 57 for women and 55 for men. Osteoporosis was shown to be accurately predicted by age with a 95.7 percent accuracy rate (p<0.001). Six patients were determined to have rib cortical defects seen on CT scans during the evaluation for osteoporosis, and two more patients had fractures noted during surgery.

Conclusion: Within the 306 patients, only 57.8% had bone density within the normal range. The age parameter is valuable with high accuracy (95%) in predicting osteoporosis. The presence of osteoporosis over the age of 57 in women and over 55 in men should be evaluated and measures should be taken to protect the bones during the operation and postoperative care. 

Anahtar Kelimeler

Osteoporosis, thoracic surgery, tomography

Kaynakça

• Byrd CT, Williams KM, Backhus LM. A brief overview of thoracic surgery in the United States. J Thorac Dis. 2022;14(1):218-26.
• Patil V, Reddy AD, Kale A, Vadlamudi A, Kishore JVS, Jani C. Incidental Identification of Vertebral Fragility Fractures by Chest CT in COVID-19-Infected Individuals. Cureus. 2022;14(5):e24867.
• Zhu Y, Triphuridet N, Yip R, et al. Opportunistic CT screening of osteoporosis on thoracic and lumbar spine: a meta-analysis. Clin Imaging. 2021;80:382-90.
• Hendrickson NR, Pickhardt PJ, Del Rio AM, Rosas HG, Anderson PA. Bone Mineral Density T-Scores Derived from CT Attenuation Numbers (Hounsfield Units): Clinical Utility and Correlation with Dual-energy X-ray Absorptiometry. Iowa Orthop J. 2018;38:25-31.
• Zhang D, Wu Y, Luo S, Wang F, Li L. Characteristics of Lumbar Bone Density in Middle-Aged and Elderly Subjects: A Correlation Study between T-Scores Determined by the DEXA Scan and Hounsfield Units from CT. J Healthc Eng. 2021;2021:5443457.
• Çağırıcı U, Çıkırıkçıoğlu M, Posacıoğlu H, Atay Y, Yağdı T, Bilkay Ö. Iatrogenic Fracture of The Ribs During Thoracotomy. TJTES. 2000;6(2):134-7.
• Coffey MR, Bachman KC, Ho VP, et al. Iatrogenic rib fractures and the associated risks of mortality. Eur J Trauma Emerg Surg. 2022;48(1):231-41.
• Aparisi Gómez MP, Ayuso Benavent C, Simoni P, Aparisi F, Guglielmi G, Bazzocchi A. Fat and bone: the multiperspective analysis of a close relationship. Quant Imaging Med Surg. 2020;10(8):1614-35.
• Martel D, Monga A, Chang G. Osteoporosis Imaging. Radiol Clin North Am. 2022;60(4):537-45.
• Kling JM, Clarke BL, Sandhu NP. Osteoporosis prevention, screening, and treatment: a review. J Womens Health (Larchmt). 2014;23(7):563-72.
• Dündar I, Özkaçmaz S, Durmaz F, et al. Detection of incidental findings on chest CT scans in patients with suspected COVID-19 pneumonia. Eastern J Med. 2021; 26(4): 566-74.
• Jiang YW, Xu XJ, Wang R, Chen CM. Radiomics analysis based on lumbar spine CT to detect osteoporosis. Eur Radiol. 2022 30:1–8.
• Pan Y, Shi D, Wang H, et al. Automatic opportunistic osteoporosis screening using low-dose chest computed tomography scans obtained for lung cancer screening. Eur Radiol. 2020;30(7):4107-16.
• Cheon H, Choi W, Lee Y, et al. Assessment of trabecular bone mineral density using quantitative computed tomography in normal cats. J Vet Med Sci. 2012;74(11):1461-7.
• Abbouchie H, Raju N, Lamanna A, Chiang C, Kutaiba N. Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population. Clin Radiol. 2022;77(7):e540-8.
• Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158(8):588-95.
• McNabb-Baltar J, Manickavasagan HR, Conwell DL, et al. A Pilot Study to Assess Opportunistic Use of CT-Scan for Osteoporosis Screening in Chronic Pancreatitis. Front Physiol. 2022;13:866945.
• Li N, Li XM, Xu L, Sun WJ, Cheng XG, Tian W. Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women. Int J Endocrinol. 2013;2013:895474.
• Ullrich BW, Schwarz F, McLean AL, et al. Inter-Rater Reliability of Hounsfield Units as a Measure of Bone Density: Applications in the Treatment of Thoracolumbar Fractures. World Neurosurg. 2022;158:e711-6.
• Krishnaraj A, Barrett S, Bregman-Amitai O, et al. Simulating Dual-Energy X-Ray Absorptiometry in CT Using Deep-Learning Segmentation Cascade. J Am Coll Radiol. 2019;16(10):1473-9.
• Krenzlin H, Schmidt L, Jankovic D, et al. Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures. Medicina (Kaunas). 2022;58(6):748.
• de Mattos JN, Santiago Escovar CE, Zereu M, et al. Computed tomography on lung cancer screening is useful for adjuvant comorbidity diagnosis in developing countries. ERJ Open Res. 2022;8(2):00061-2022.
• Han K, You ST, Lee HJ, Kim IS, Hong JT, Sung JH. Hounsfield unit measurement method and related factors that most appropriately reflect bone mineral density on cervical spine computed tomography. Skeletal Radiol. 2022;51(10):1987-93.