Abstract

Osteoporosis is a metabolic bone disease with a high prevalence that affects the population worldwide, particularly the elderly. It is often due to fractures associated with bone fragility that the diagnosis of osteoporosis becomes clinically evident. However, early diagnosis would be necessary to initiate therapy and to prevent occurrence of further fractures, thus reducing morbidity and mortality. X-ray-based imaging plays a key role for fracture risk assessment and monitoring of osteoporosis. Whereas over decades dual-energy X-ray absorptiometry (DXA) has been the main method used and still reflects the reference standard, another modality reemerges with quantitative computed tomography (QCT) because of its three-dimensional advantages and the opportunistic exploitation of routine CT scans. Against this background, this article intends to review and evaluate recent advances in the field of X-ray-based quantitative imaging of osteoporosis at the spine. First, standard DXA with the recent addition of trabecular bone score (TBS) is presented. Secondly, standard QCT, dual-energy BMD quantification, and opportunistic BMD screening in non-dedicated CT exams are discussed. Lastly, finite element analysis and microstructural parameter analysis are reviewed.

中文翻译：

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基于X射线的脊柱骨质疏松症定量成像

摘要

骨质疏松症是一种高发病率的代谢性骨病，影响全世界的人群，尤其是老年人。通常由于与骨脆性有关的骨折，骨质疏松症的诊断在临床上变得很明显。但是，早期诊断对于开始治疗并防止进一步骨折的发生是必要的，从而降低了发病率和死亡率。基于X射线的成像对骨折风险评估和骨质疏松症的监测起着关键作用。几十年来，双能X射线吸收法（DXA）一直是主要方法，但仍能反映参考标准，而另一种形式因其三维扫描仪的三维优势和常规CT的机会性利用而重新出现在定量计算机断层摄影（QCT）中扫描。在这种背景下，本文旨在回顾和评估基于X射线的脊柱骨质疏松症定量成像领域的最新进展。首先，介绍了标准DXA和最近添加的小梁骨评分（TBS）。其次，讨论了标准QCT，双能BMD量化和非专用CT检查中的机会性BMD筛查。最后，对有限元分析和微观结构参数分析进行了综述。