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Bone Histomorphometry and 18F-Sodium Fluoride Positron Emission Tomography Imaging: Comparison Between only Bone Turnover-based and Unified TMV-based Classification of Renal Osteodystrophy
Calcified Tissue International ( IF 4.2 ) Pub Date : 2021-06-17 , DOI: 10.1007/s00223-021-00874-9
Louise Aaltonen 1 , Niina Koivuviita 1 , Marko Seppänen 2, 3 , Inari S Burton 4 , Heikki Kröger 4, 5 , Eliisa Löyttyniemi 6 , Kaj Metsärinne 1
Affiliation  

Bone biopsy is the gold standard for characterization of renal osteodystrophy (ROD). However, the classification of the subtypes of ROD based on histomorphometric parameters is not unambiguous and the range of normal values for turnover differ in different publications. 18F-Sodium Fluoride positron emission tomography (18F-NaF PET) is a dynamic imaging technique that measures turnover. 18F-NaF PET has previously been shown to correlate with histomorphometric parameters. In this cross-sectional study, 26 patients on dialysis underwent a 18F-NaF PET and a bone biopsy. Bone turnover-based classification was assessed using Malluche’s historical reference values for normal bone turnover. In unified turnover-mineralization-volume (TMV)-based classification, the whole histopathological picture was evaluated and the range for normal turnover was set accordingly. Fluoride activity was measured in the lumbar spine (L1–L4) and at the anterior iliac crest. On the basis of turnover-based classification of ROD, 12% had high turnover and 61% had low turnover bone disease. On the basis of unified TMV-based classification of ROD, 42% had high turnover/hyperparathyroid bone disease and 23% had low turnover/adynamic bone disease. When using unified TMV-based classification of ROD, 18F-NaF PET had an AUC of 0.86 to discriminate hyperparathyroid bone disease from other types of ROD and an AUC of 0.87, for discriminating adynamic bone disease. There was a disproportion between turnover-based classification and unified TMV-based classification. More research is needed to establish normal range of bone turnover in patients with CKD and to establish the role of PET imaging in ROD.



中文翻译:

骨组织形态计量学和 18F-氟化钠正电子发射断层扫描成像:仅基于骨周转率和基于统一 TMV 的肾性骨营养不良分类之间的比较

骨活检是表征肾性骨营养不良 (ROD) 的金标准。然而,基于组织形态学参数对 ROD 亚型的分类并不明确,并且营业额的正常值范围在不同的出版物中有所不同。18 F-氟化钠正电子发射断层扫描 ( 18 F-NaF PET) 是一种测量营业额的动态成像技术。18 F-NaF PET 先前已被证明与组织形态学参数相关。在这项横断面研究中,26 名透析患者接受了18F-NaF PET 和骨活检。使用 Malluche 的正常骨转换历史参考值评估基于骨转换的分类。在基于统一周转-矿化量 (TMV) 的分类中,评估了整个组织病理学图像,并相应地设定了正常周转的范围。在腰椎(L1-L4)和髂前嵴测量氟化物活性。根据 ROD 基于营业额的分类,12% 的人有高营业额,61% 有低营业额的骨病。在基于 TMV 的 ROD 统一分类的基础上,42% 患有高更新/甲状旁腺功能亢进性骨病,23% 患有低更新/无动力骨病。当使用统一的基于 TMV 的 ROD 分类时,18F-NaF PET 的 AUC 为 0.86,用于区分甲状旁腺功能亢进性骨病与其他类型的 ROD,AUC 为 0.87,用于区分无动力性骨病。基于营业额的分类与统一的基于 TMV 的分类之间存在不均衡。需要更多的研究来确定 CKD 患者骨转换的正常范围,并确定 PET 成像在 ROD 中的作用。

更新日期:2021-06-17
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