Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations

Benedikt J. Schwaiger, Luca Facchetti, Alexandra S. Gersing, Jan Neumann, Thomas M. Link, David L. Kopperdahl, Kwang J. Lee, Lorenzo Nardo, Tony M. Keaveny

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans—as validated in previous studies—as a reference standard. Materials and methods Men with prostate cancer (n = 82, 71.6 ± 8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤ 80 mg/cm3, femoral neck or total hip T-score ≤− 2.5, vertebral strength ≤ 6500 N and femoral strength ≤ 3500 N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. Results All measurements from PET/CT versus MDCT were strongly correlated (R2 = 0.93–0.97; P < 0.0001 for all). Mean differences for total hip areal BMD (0.001 g/cm2, 1.1%), femoral strength (− 60 N, 1.3%), vertebral trabecular BMD (2 mg/cm3, 2.6%) and vertebral strength (150 N; 1.7%) measurements were not statistically significant (P > 0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (− 0.018 g/cm2; − 2.5%; P = 0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). Conclusion Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.

Original languageEnglish (US)
Pages (from-to)62-69
Number of pages8
JournalBone
Volume101
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Multidetector Computed Tomography
Thigh
Bone Density
Prostatic Neoplasms
Bone and Bones
Femur Neck
Pelvic Bones
Finite Element Analysis
Bone Fractures
Hip
Spine
Fluorine
Femur
Calibration
Osteoporosis
Linear Models
Radiation
Neoplasms

Keywords

  • 18F-NaF PET/CT
  • Biomechanical-CT
  • Bone mineral density
  • Bone strength
  • Cancer-induced bone disease
  • Finite element analysis
  • MDCT
  • Prostate cancer

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Physiology
  • Histology

Cite this

Schwaiger, B. J., Facchetti, L., Gersing, A. S., Neumann, J., Link, T. M., Kopperdahl, D. L., ... Keaveny, T. M. (2017). Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations. Bone, 101, 62-69. https://doi.org/10.1016/j.bone.2017.04.008

Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations. / Schwaiger, Benedikt J.; Facchetti, Luca; Gersing, Alexandra S.; Neumann, Jan; Link, Thomas M.; Kopperdahl, David L.; Lee, Kwang J.; Nardo, Lorenzo; Keaveny, Tony M.

In: Bone, Vol. 101, 01.08.2017, p. 62-69.

Research output: Contribution to journalArticle

Schwaiger, BJ, Facchetti, L, Gersing, AS, Neumann, J, Link, TM, Kopperdahl, DL, Lee, KJ, Nardo, L & Keaveny, TM 2017, 'Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations', Bone, vol. 101, pp. 62-69. https://doi.org/10.1016/j.bone.2017.04.008
Schwaiger, Benedikt J. ; Facchetti, Luca ; Gersing, Alexandra S. ; Neumann, Jan ; Link, Thomas M. ; Kopperdahl, David L. ; Lee, Kwang J. ; Nardo, Lorenzo ; Keaveny, Tony M. / Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations. In: Bone. 2017 ; Vol. 101. pp. 62-69.
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abstract = "Purpose Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans—as validated in previous studies—as a reference standard. Materials and methods Men with prostate cancer (n = 82, 71.6 ± 8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤ 80 mg/cm3, femoral neck or total hip T-score ≤− 2.5, vertebral strength ≤ 6500 N and femoral strength ≤ 3500 N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. Results All measurements from PET/CT versus MDCT were strongly correlated (R2 = 0.93–0.97; P < 0.0001 for all). Mean differences for total hip areal BMD (0.001 g/cm2, 1.1{\%}), femoral strength (− 60 N, 1.3{\%}), vertebral trabecular BMD (2 mg/cm3, 2.6{\%}) and vertebral strength (150 N; 1.7{\%}) measurements were not statistically significant (P > 0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (− 0.018 g/cm2; − 2.5{\%}; P = 0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97{\%} (0.89 kappa for repeatability). Conclusion Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.",
keywords = "18F-NaF PET/CT, Biomechanical-CT, Bone mineral density, Bone strength, Cancer-induced bone disease, Finite element analysis, MDCT, Prostate cancer",
author = "Schwaiger, {Benedikt J.} and Luca Facchetti and Gersing, {Alexandra S.} and Jan Neumann and Link, {Thomas M.} and Kopperdahl, {David L.} and Lee, {Kwang J.} and Lorenzo Nardo and Keaveny, {Tony M.}",
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TY - JOUR

T1 - Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations

AU - Schwaiger, Benedikt J.

AU - Facchetti, Luca

AU - Gersing, Alexandra S.

AU - Neumann, Jan

AU - Link, Thomas M.

AU - Kopperdahl, David L.

AU - Lee, Kwang J.

AU - Nardo, Lorenzo

AU - Keaveny, Tony M.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Purpose Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans—as validated in previous studies—as a reference standard. Materials and methods Men with prostate cancer (n = 82, 71.6 ± 8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤ 80 mg/cm3, femoral neck or total hip T-score ≤− 2.5, vertebral strength ≤ 6500 N and femoral strength ≤ 3500 N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. Results All measurements from PET/CT versus MDCT were strongly correlated (R2 = 0.93–0.97; P < 0.0001 for all). Mean differences for total hip areal BMD (0.001 g/cm2, 1.1%), femoral strength (− 60 N, 1.3%), vertebral trabecular BMD (2 mg/cm3, 2.6%) and vertebral strength (150 N; 1.7%) measurements were not statistically significant (P > 0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (− 0.018 g/cm2; − 2.5%; P = 0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). Conclusion Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.

AB - Purpose Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans—as validated in previous studies—as a reference standard. Materials and methods Men with prostate cancer (n = 82, 71.6 ± 8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤ 80 mg/cm3, femoral neck or total hip T-score ≤− 2.5, vertebral strength ≤ 6500 N and femoral strength ≤ 3500 N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. Results All measurements from PET/CT versus MDCT were strongly correlated (R2 = 0.93–0.97; P < 0.0001 for all). Mean differences for total hip areal BMD (0.001 g/cm2, 1.1%), femoral strength (− 60 N, 1.3%), vertebral trabecular BMD (2 mg/cm3, 2.6%) and vertebral strength (150 N; 1.7%) measurements were not statistically significant (P > 0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (− 0.018 g/cm2; − 2.5%; P = 0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). Conclusion Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.

KW - 18F-NaF PET/CT

KW - Biomechanical-CT

KW - Bone mineral density

KW - Bone strength

KW - Cancer-induced bone disease

KW - Finite element analysis

KW - MDCT

KW - Prostate cancer

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