Efficacy of sternal cortical thickness ratio in adult chest CT in the diagnosis of osteopenia and osteoporosis

doi:10.3969/j.issn.1674-8115.2023.10.008

Abstract

Abstract:

Objective ·To compare the relationship between sternal cortical thickness ratio and bone mineral density in adult emergency inpatients with chest CT plain scan, and evaluate the diagnostic ability of sternal cortical thickness ratio for osteopenia and osteoporosis. Methods ·The bone density was measured by dual energy X-ray absorptiometry (DXA) in hospitalized patients collected in the adult emergency ward of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from November 2020 to October 2022, and the patients were diagnosed as normal bone mass, osteopenia, or osteoporosis according to the bone density. The patients were grouped based on age (>65 years old, ≤65 years old) and osteoporosis status. The sternal cortical thickness ratio measured at the level of tracheal bifurcation in the chest CT scan image of each group was analyzed. Spearman correlation was used to analyze the correlation between the sternal cortical thickness ratio and bone mineral density. The sternal cortical thickness ratio was used to diagnose the osteopenia and the osteoporosis, and the receiver operator characteristic curve (ROC curve) was drawn to obtain the best cut-off value. The diagnostic efficacy of the sternal cortical thickness ratio in the diagnosis of osteopenia and osteoporosis was analyzed. Results ·A total of 198 patients were included in the study, including 78 patients with normal bone mass, 66 patients with osteopenia, and 54 patients with osteoporosis. Among patients aged >65 years old (n=115), the proportion of female patients and the age of patients in the osteoporosis group were significantly higher than those in the normal bone mass group (all P<0.05). However, in patients ≤65 years old (n=83), the difference was not statistically significant (P>0.05). Whether in patients >65 years old or ≤65 years old, the sternal cortical thickness ratio in the normal bone mass group was higher than that in the osteopenia group and the osteoporosis group, and the sternal cortical thickness ratio in the osteopenia group was higher than that in the osteoporosis group (all P<0.05); The sternal cortical thickness ratio in female patients in the normal bone mass group, osteopenia group and osteoporosis group was lower than that in male patients (all P<0.05). The sternal cortical thickness ratio in both male and female patients was positively correlated with bone mineral density (r=0.704, P=0.000; r=0.785, P=0.000; r=0.735, P=0.000; r=0.479, P=0.000). In terms of diagnostic performance, in patients >65 years old, the diagnostic accuracy rate of male patients in the normal bone mass group was higher than that in the osteopenia group and the osteoporosis group, and the diagnosis misdiagnosis rate in the osteoporosis group was lower than that in the normal bone mass group and the osteopenia group; In patients ≤65 years old, the diagnostic accuracy rate of male patients in the osteoporosis group was higher than that in the normal bone mass group and the osteopenia group, and the diagnosis misdiagnosis rate in the normal bone mass group was lower than that in the osteopenia group and the osteoporosis group. Conclusion ·The sternal cortical thickness ratio in both male and female patients is positively correlated with bone mineral density, and the sternal cortical thickness ratio has good diagnostic efficacy for osteopenia and osteoporosis.

Key words: osteoporosis, bone mineral density, sternum, cortical bone, diagnostic value

CLC Number:

R816.8

YU Xi, SUN Junnan, ZHANG Jiaojiao, GAO Yue, WANG Hu, YU Yang, WANG Hairong, HONG Wen. Efficacy of sternal cortical thickness ratio in adult chest CT in the diagnosis of osteopenia and osteoporosis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(10): 1274-1281.

Figures/Tables 8

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References 32

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Item	>65 years					≤65 years
Item	Normal bone mass group (n=33)	Osteopenia group (n=41)	Osteoporosis group (n=41)	F value	P value	Normal bone mass group (n=45)	Osteopenia group (n=25)	Osteoporosis group (n=13)	F value	P value
Male	0.549±0.106	0.398±0.023^①	0.307±0.074^①③	45.035	0.000	0.420±0.107	0.391±0.017^②	0.298±0.023^①③	21.613	0.000
Female	0.464±0.119	0.319±0.046^①	0.214±0.058^①④	52.734	0.000	0.396±0.063	0.348±0.038^①	0.280±0.016^①⑤	15.915	0.000
F value	4.518	47.694	19.729			21.987	10.421	51.454
P value	0.042	0.000	0.000			0.000	0.000	0.000

Item	>65 years					≤65 years
Item	Normal bone mass group (n=33)	Osteopenia group (n=41)	Osteoporosis group (n=41)	F value	P value	Normal bone mass group (n=45)	Osteopenia group (n=25)	Osteoporosis group (n=13)	F value	P value
Male	0.549±0.106	0.398±0.023^①	0.307±0.074^①③	45.035	0.000	0.420±0.107	0.391±0.017^②	0.298±0.023^①③	21.613	0.000
Female	0.464±0.119	0.319±0.046^①	0.214±0.058^①④	52.734	0.000	0.396±0.063	0.348±0.038^①	0.280±0.016^①⑤	15.915	0.000
F value	4.518	47.694	19.729			21.987	10.421	51.454
P value	0.042	0.000	0.000			0.000	0.000	0.000

Gender	>65 years					≤65 years
Gender	r value	Spearman correlation coefficient	F value	T value	P value	r value	Spearman correlation coefficient	F value	T value	P value
Male	0.704	0.732	52.006	2.966	0.000	0.735	0.745	44.550	2.944	0.000
Female	0.785	0.819	93.213	9.310	0.000	0.479	0.732	11.337	3.857	0.000

Gender	>65 years					≤65 years
Gender	r value	Spearman correlation coefficient	F value	T value	P value	r value	Spearman correlation coefficient	F value	T value	P value
Male	0.704	0.732	52.006	2.966	0.000	0.735	0.745	44.550	2.944	0.000
Female	0.785	0.819	93.213	9.310	0.000	0.479	0.732	11.337	3.857	0.000

Group	>65 years					≤65 years
Group	AUC (95%CI)	Sensitivity/%	Specificity/%	Youden index	Cut-off value	AUC (95%CI)	Sensitivity/%	Specificity/%	Youden index	Cut-off value
Male
Osteopenia	0.924 (0.824‒0.977)	90.5	95.0	0.855	0.44	0.741 (0.721‒0.962)	75.0	72.4	0.474	0.42
Osteoporosis	0.813 (0.641‒0.984)	96.6	76.5	0.714	0.34	0.846 (0.756‒0.927)	82.4	83.3	0.765	0.32
Female
Osteopenia	0.897 (0.753‒0.962)	83.3	90.2	0.833	0.39	0.768 (0.610‒0.926)	61.9	93.7	0.556	0.39
Osteoporosis	0.930 (0.852‒0.987)	90.5	85.2	0.757	0.28	0.937 (0.848‒0.998)	80.0	83.3	0.677	0.28