QCT骨密度测量技术的探讨

目的通过临床资料分析，对QCT骨密度测量中的扫描定位、图像测量等技术问题进行探讨，对椎体松质骨与整体骨的密度变化进行分析，找出规律。方法采用全身螺旋CT扫描机，羟磷灰石体模，QCT骨密度测量系统软件。研究对象为近3年我院体检和检查对象，共1586例（男712例，女874例）。结果①得出了男、女L2-L4平均骨密度的各年龄组均值和标准差，计算了各年龄组腰椎的松质／整体骨密度比值。②根据20～34岁年龄组的资料，获得本地区男、女L2～L4的骨峰值：男性松质骨：（177．13±33．75）mg／cm^3，整体骨：（205．59±36．71）mg／cm^3；女性松质骨：（188．67±38．35）mg／cm^3，整体骨：（216．39±38．82）mg／cm^3。③根据两种分级标准（峰值-13％和峰值-20％）比较了40～59岁年龄组人群的腰椎骨量减少的患病率。结论①男、女L2～L4松质骨与整体骨的密度变化规律基本相同，均随年龄增大而降低。②男性腰椎松质骨与整体骨的骨峰值略低于女性。③腰椎的松质／整体骨密度比值随年龄增长而减小，说明皮质骨密度降低速度低于松质骨。④根据40～59岁年龄组人群的腰椎骨量减少的患病率的比较，认为采用骨峰值-20％和骨峰值-40％作为骨量减少和骨质疏松的诊断指标更合理。     

QCT骨密度测量技术若干问题的探讨

目的 通过实验和临床研究，对QCT骨密度测量技术中的扫描部位选择，扫描条件选择，不同软组织厚度对测量的影响和测量体模的选择和使用问题进行探讨。方法 采用全身螺旋CT扫描机，羟磷灰石固体标准体模和羟磷灰石等效液体体模，QCT骨密度测量系统软件，通过对猪脊柱标本进行不同扫描条件的扫描测量，观察不同的射线管电压、电流，不同的层厚对结果的影响；通过对人体各腰椎的检查对比，探讨检查部位的选择；通过对不同深度的水中骨标本的扫描测量，探讨不同厚度的软组织对测量的影响；对比了固体标准体模和羟磷灰石等效液体体模的使用效果。结果 ①人体的5个腰椎中，第1、5腰椎骨密度变化较大，扫描定位时倾斜角度也较大；腰椎中间层面骨密度较低，上下层面骨密度增高。②射线管曝光的毫安量对测量无影响；高射线管电压可使体模转换曲线斜率略减小而骨组织部位的CT值同时降低，对骨密度影响较小；层厚增加可使腰椎骨密度增大。③不同深度的水(100mm、150mm、200mm)轻度影响体模转换曲线的斜率，也同时影响水中骨标本的CT值，但对骨密度结果无明显影响。④使用固体标准体模和羟磷灰石等效液体体模测量骨密度结果无明显差别。结论 ①选择第2、3、4腰椎进行骨密度测量，取其平均值做为临床判断指标较为方便合理。②虽然射线管的电压，毫安量对骨密度结果影响不明显，但扫描测量时，应当尽量采用统一的曝光条件，层厚对骨密度测量影响较大，应当保证相同的层厚；尽量采用统一的重建区域大小。③由于不同深度的水同步影响体模转换曲线的斜率和水中骨标本的CT值，所以只要同时扫描测量体模和骨组织，对骨密度测量结果不会产生明显影响。④选择使用固体标准体模或羟磷灰石等效液体体模测量对骨密度测量结果无明显影响。     

深圳地区QCT骨密度正常值调查与临床诊断标准的探讨

目的　通过对深圳地区正常人群腰椎骨密度测量 ,获得本地区QCT骨密度正常参考值。方法　采用CT扫描机 ,羟磷灰石固体体模和QCT骨密度测量软件 ,选择了无骨质疏松疾病的正常人 1 0 2 8例 ,扫描第 3、第 4腰椎中层横断面 ,做QCT骨密度测量。对测量结果进行统计处理 ,得到男女人群骨峰值和年龄组均值。通过对年龄组数据进行不同标准的统计处理 ,探讨较为合理的诊断标准。通过不同的测量方法 (单纯松质和包括皮质 )的对比 ,探讨QCT与其他方法的差异。结果　根据 2 1～ 35岁年龄段统计出的骨峰值男性第 3腰椎为 1 65 85± 30 1 7,第 4腰椎为 1 70 95± 31 81。女性第 3腰椎为 1 75 33± 2 6 95 ,第 4腰椎为 1 81 97± 2 7 63。采用 4种不同的骨峰值降低标准统计骨质疏松症检出率 ,发现M 2 5 %组检出率偏高 ,M 30 %与M 2S较接近。包括皮质骨的测量降低敏感性。结论　进行深圳地区骨密度正常值调查 ,获得了男女人群骨峰值和年龄组均值 ,临床诊断建议采用骨峰值 30 %作为QCT测量诊断骨质疏松症的基本界限     

膝骨性关节炎软骨下骨髓水肿样变的研究进展

膝骨性关节炎相关的骨髓水肿样变(knee osteoarthritis-associated bone marrow edema-like lesions,KOA-BMLs)是一种常见的MRI影像学特征,主要表现为T2成像上软骨下骨的异常骨髓高信号.KOA-BMLs的形成可能与下肢力线以及软骨下骨灌注异常有关,而相关的...     

中老年女性骨关节炎患者骨密度的特点

目的　通过测量骨关节炎患者腰椎和髋部骨密度 ,探讨骨关节炎患者骨密度的特点及骨关节炎与骨质疏松症的关系。方法　本组研究对象均为中老年女性膝关节骨关节炎患者 ,其中 5 9例测量了腰椎和髋部骨密度 ,12例仅测量了腰椎骨密度。所有患者均按Kellgren分级标准对膝关节进行了评分。结果　绝经后妇女膝关节X线评分随Kellgren分级级数的增高患者腰椎骨密度均值逐渐增高 ,4级骨关节炎患者腰椎骨密度均值明显高于 2级患者 (P <0 0 5 ) ,而髋部骨密度均值随Kellgren分级级数的增高差异无显著性。如以低于同性别同部位峰值骨量的 2 0SD为骨质疏松诊断标准 ,腰椎和髋部符合骨质疏松症诊断的分别为 4 3 7%和 77%。在控制年龄和骨关节炎的影响后 ,股骨颈骨密度与体重指数的偏相关系数为 0 4 0 7(P <0 0 1)。结论　中老年女性骨关节炎患者中同时患有骨质疏松症的比例较高 ,同髋部骨密度测量相比 ,腰椎骨密度测量受骨关节炎影响较大。     

MRI-measured bone marrow adipose tissue is inversely related to DXA-measured bone mineral in Caucasian women

Introduction Recent studies suggest that bone marrow adipose tissue (BMAT) might play a role in the pathogenesis of osteoporosis. Previous research using regional magnetic resonance spectroscopy methods to measure BMAT has reported inconsistent findings on the relationship between BMAT and dual-energy absorptiometry (DXA)-measured bone mineral density (BMD). Methods In the present study, total body and pelvic BMAT were evaluated in 56 healthy women (age 18–88 yrs, mean ± SD, 47.4 ± 17.6 yrs; BMI, 24.3 ± 4.2 kg/m²) with T1-weighted whole-body magnetic resonance imaging (MRI). BMD was measured using the whole-body DXA mode (GE Lunar DPX, software version 4.7). Results A strong negative correlation was observed between pelvic BMAT and BMD (total-body BMD, R = −0.743, P < 0.001; pelvic BMD, R = −0.646, P < 0.001), and between total-body BMAT and BMD (total-body BMD, R = −0.443, P < 0.001; pelvic BMD, R = −0.308, P < 0.001). The inverse association between pelvic BMAT and BMD remained strong after adjusting for age, weight, total body fat, and menopausal status (partial correlation: total-body BMD, R = −0.553, P < 0.001; pelvic BMD, R = −0.513, P < 0.001). BMAT was also highly correlated with age (pelvic BMAT, R = 0.715, P < 0.001; total-body BMAT, R = 0.519, P < 0.001). Conclusion MRI-measured BMAT is thus strongly inversely correlated with DXA-measured BMD independent of other predictor variables. These observations, in the context of DXA technical concerns, support the growing evidence linking BMAT with low bone density.     

Volumetric bone mineral density using peripheral quantitative computed tomography in Japanese women

The present study evaluated a commercial device for peripheral quantitative computed tomography (pQCT) and examined the age-related changes in normal Japanese women. The volumetric bone mineral density (vBMD) of the distal radius [integral bone mineral density (BMD_I), trabecular bone mineral density (BMD_T) and cortical with subcortical bone mineral density (BMD_SC)] was measured using pQCT (Norland-Stratec XCT960) in 617 healthy women aged 20–79 years and 75 subjects with osteoporosis aged 60–89 years who exhibited at least one vertebral fracture. The short-term precision errors in vivo (CV, %) were 1.1% for BMD_I 1.1% for BMD_T and 1.2% for BMD_SC. The correlations between pQCT and dual-energy X-ray absorptiometry measurements (Lunar DPX) of the lumbar spine werer0.8 (BMD_I, BMD_T and BMD_SC). The maximal mean vBMD values were observed between 20 and 49 years; BMD_I BMD_T and BMD_SC all showed a linear postmenopausal decline averaging 1.1% per year. The overall decreases in vBMD from the peak values in those 70–79 years were 34%, 32% and 33% in BMD_I, BMD_T and BMD_SC, respectively. The diagnostic sensitivity of osteoporosis was expressed as aT-score.T-scores using pQCT were –3.0 (BMD_I), –2.4 (BMD_T) and –2.9 (BMD_SC). Bone mineral measurement of the distal radius may be useful in the evaluation of age-related bone loss and for the diagnosis of osteoporosis.     

单能X线和定量CT测量骨密度的相关性研究

目的：比较跟骨单能X线（SXA）测定值和腰椎定量CT（QCT）测定值的相关性,旨在为临床上合理地应用跟骨SXA测定仪。方法：应用单能X线和定量CT骨密度测定仪测量了201例正常或病人的跟骨及椎体骨密度,对测量结果进性了统计学相关性分析。结果：男女人群SXA和QCT的总相关系数分别为0．653和0．638;P＜0．001,骨质疏松组SXA与QCT的测定值有非常显的相关性（P＜0．001）,骨量正常组和骨量减少组则无显的相关性（P＞0．05）,从年龄上40岁以上女性与60岁以上男性SXA与QCT的测定值有非常显的相关性。结论：SXA测定不能代替QCT测定,但SXA机型小,轻便且价廉,尤其在40岁以上的女性和在60岁以上的老年男性,以及患有面骨质疏松的病人,他们的测量结果与QCT有着显的相关性,故在临床上不失为诊断绝经后妇女和老年性骨质疏松的一种手段。     

老年2型糖尿病双能X线及定量CT测量骨密度的临床分析

目的 探讨老年2型糖尿病临床与不同骨密度(BMD)测定方法之间的关系和特点。方法 测定45例老年2型糖尿病患者的空腹(FBG)及餐后血糖(PBG)、糖化血红蛋白(HbAlc)、胆固醇(TC)、甘油三脂(TG)、骨钙素(BGP)、血清Ⅰ型胶原C端肽(CICP)、血清骨特异性碱性磷酸酶(B-ALP)、尿吡啶啉(Pyd)、脱氧吡啶啉(D-Pyd)、尿羟脯胺酸(Hyp),对同一病人同时行双能X线测定(DEXA)及定量CT测定(QCT),并进行分组比较。结果 本组45例病人中同时用DEXA及QCT测定骨密度均有骨质疏松者18例,占45％(18/40),其中男性4例,女性14例,女性占骨质疏松组的77.78％(14/18)。单用DEXA测量出骨质疏松者23例,单用QCT测量出骨质疏松者21例,其中5例有2例示QCT正常,而用DEXA测定有骨质疏松;3例用QCT测定已有腰椎骨质疏松,而DEXA示腰椎正常,但股骨颈部有骨质疏松。结论 老年2型糖尿病的骨质疏松与糖尿病病程、餐后血糖、胆固醇密切相关。骨形成指标(BGP、CICP)在骨质疏松组中非但不降,反比非骨质疏松组有明显升高。本研究显示老年2型糖尿病同时用DEXA及QCT测定骨密度有很好的相关性,r=0.770,P<0.01,故仅做腰椎QCT也可作为老年2型糖尿病骨质疏松的诊断依据。     

Ex vivo characterization of articular cartilage and bone lesions in a rabbit ACL transection model of osteoarthritis using MRI and micro-CT

OBJECTIVE: To characterize the rabbit anterior cruciate ligament transection (ACLT) model of osteoarthritis (OA) at various stages of disease using high-resolution 3-D medical imaging systems, which, in turn, will facilitate future longitudinal studies evaluating disease progression and response to therapy in live animals. METHODS: Degenerative changes in femorotibial cartilage, volumetric bone mineral density (vBMD), bone volume fraction (BV/TV), and osteophyte volume were characterized ex vivo using 4-T magnetic resonance imaging (MRI) and micro-computed tomography (micro-CT) at 4, 8, and 12 weeks post-ACLT. These changes were subsequently correlated to macroscopic joint evaluation. RESULTS: Macroscopic assessment demonstrated progressive cartilage degeneration post-surgery, which was significantly correlated to MRI evaluation (r=0.82, P<0.0001). Linear regression analysis indicated that vBMD and BV/TV are linearly related such that as vBMD increases, BV/TV increases (P<0.0001). Micro-CT revealed bone loss at 4 and 8 weeks post-ACLT, but recovery to control values at 12 weeks post-ACLT. Volumetric BMD was not strongly correlated with macroscopic assessment of articular cartilage degeneration (r=-0.35, P<0.0001). Quantitative measurement of osteophyte volume demonstrated a statistically significant difference (with respect to control groups) at both 8 and 12 weeks post-ACLT, but not at 4 weeks post-ACLT. CONCLUSIONS: The rabbit ACLT model of OA demonstrates progressive cartilage degeneration and intermediate bone changes at 4, 8, and 12 weeks post-surgery. Cartilage and bone lesions were characterized ex vivo using 4-T MRI and micro-CT, and MRI assessment of cartilage degeneration was correlated to macroscopic grading.     

长期维持血液透析患者腰椎QCT骨密度定量检测结果分析

目的：探讨长期维持性血液透析患者的骨质疏松症发病率,为临床诊断和治疗提供依据。方法整理在本院进行腰椎QCT骨密度测量中的透析患者45例,其中男25例、女20例,年龄25～77岁、平均56．1岁,透析时间20～134个月、平均56．3个月;随机选取健康人群45例,其中男17例、女28例,年龄30～78岁、平均49．2岁。按男女性别分为透析组与对照组。年龄、性别差异无统计学意义（ P＞0．05）。利用SPSS19．0对数据进行处理,计量资料采用方式表示,采用配对样本T检验、独立样本T检验,P＜0．05表示差异有显著性;计数资料采用卡方检验。结果长期维持血液透析患者的腰椎骨密度要低于健康人群的骨密度（ P＜0．05）;骨质疏松症发病率要高;骨密度改变与透析时间无统计学意义（ P＞0．05）。结论长期维持血液透析患者的腰椎骨密度低于健康人群,骨质疏松症的发病率高。     

腰椎间盘突出症与腰椎骨密度的相关性研究

目的 研究腰椎间盘突出症(lambar disc herniation,LDH)与骨质疏松(osteoporosis,OP)的相关性,探讨腰椎间盘突出症对骨密度的影响.方法 选取腰椎间盘突出症组患者82例,对照组健康体检人群41例,利用定量CT(quantitative computed tomography,QCT)测定其骨密度(bone mineral density,BMD),分析比较两组的骨密度值.并对腰椎间盘突出症组患者病程:≤1年与＞1年,腹肌肌力≤3级与≥4级骨密度值变化进行比较分析.结果 腰椎间盘突出症组患者的骨密度值较对照组低,骨量减少者在腰椎间盘突出症组中的构成比较对照组高,但差异均无统计学意义(P>0.05).其病程、腹肌肌力对腰椎间盘突出症组患者骨密度值变化的影响无统计学差异(P>0.05).结论 腰椎间盘突出症对骨密度有一定的影响,但两者的关系不显著,腰椎间盘突出症并非骨质疏松的独立影响因素.     

Bone mineral density measured by dual-energy X-ray absorptiometry in healthy finnish women

Summary A cross-sectional study of 351 healthy Finnish women aged 20–76 years was done to establish reference values of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA). The effects of age and of several physical and lifestyle factors on BMD of the lumbar spine and proximal femur (femoral neck, trochanter, and Ward's triangle area) were investigated. Altogether 58 women were excluded from the final analysis due to significant spinal osteoarthritis or other diseases or drugs known to influence calcium or bone metabolism. The precision of the method was 0.9, 1.2, 2.7, and 2.4% in the lumbar, femoral neck, Ward's triangle and trochanter area, respectively. Lumbar BMD was increased by 30% (P<0.001) in 15 patients with osteoarthritis (21% of women 50 years or older), but it was apparently unaffected in 5 cases with aortic calcification. Except for the trochanter area, BMD diminished along with age, and this was significant after the menopause. The peak of mean BMD was observed at the age of 31–35 years in the spine and at the age of 20–25 years in the femoral neck and Ward's triangle. BMD was in a positive relationship to weight both in premenopausal and postmenopausal women and to the use of oral contraceptives in premenopausal women and to that of estrogen replacement therapy in postmenopausal women. Labors and pregnancies had a weak positive effect on BMD in premenopausal women. As compared with nonusers premenopausal women who had used alcohol showed a slightly decreased BMD of Ward's triangle. In postmenopausal women there was a positive correlation between alcohol intake and BMD.