低剂量CT肺癌筛查中的自动化机会性骨密度评估：新发椎体骨折与死亡率。
完整摘要 · 中文译文
背景 用于肺癌筛查的低剂量CT（LDCT）可实现机会性容积骨密度（vBMD）评估，但其预后价值尚不明确。目的 评估全自动LDCT衍生vBMD对椎体骨折的预测价值及其与重度吸烟者死亡率的相关性。材料与方法 本二次分析纳入来自国家肺筛查试验（NLST）CT组的重度吸烟（≥30包年）55-74岁个体，NLST是一项比较多中心随机对照试验，对LDCT与X线摄影进行比较（参与者招募时间为2002年8月至2004年4月）。使用自动化SpineQ软件（Bonescreen）测量胸椎和腰椎vBMD（正常，≥120 mg/cm3；骨量减低[骨量减少]，80至<120 mg/cm3；骨质疏松，<80 mg/cm3）和椎体骨折（Genant分级）。结局包括1年和2年新发椎体骨折以及6年死亡率（主动随访至2009年）。泊松模型和Cox模型校正了人口学变量、可获得的合并症和基线椎体骨折。结果 NLST CT组纳入26 722名参与者，本分析纳入21 856名（平均年龄，61岁±5[SD]；12 854名男性参与者）。2年椎体骨折发生率（n=18 211名接受2年LDCT的参与者）在骨量正常者为0.9%，在骨量减低者为2.0%（校正相对危险度，2.07[95% CI：1.70，2.53]），在骨质疏松者为5.9%（校正相对危险度，3.40[95% CI：2.69，4.30]）。死亡风险（n=21 447名已完成 随访[中位数，6.65年]）与男性骨质疏松性体积骨密度（vBMD）相关（校正风险比，1.24 [95% CI：1.02，1.50]）。结论 全自动机会性评估脊柱vBMD可预测椎体骨折风险，且经校正后与男性死亡率相关。根据现行骨质疏松指南，骨质疏松性vBMD且重度吸烟者的2年骨折发生率超过5%的治疗阈值。临床试验注册号 NCT00047385 © RSNA，2026 本文补充材料可获取。另请参阅本期Bredella的社论。
完整摘要 · 英文原文
Background Low-dose CT (LDCT) for lung cancer screening enables opportunistic volumetric bone mineral density (vBMD) assessment, but its prognostic value is unclear. Purpose To evaluate fully automated LDCT-derived vBMD for predicting vertebral fractures and its association with mortality in individuals who heavily smoke. Materials and Methods This secondary analysis included 55-74-year-old individuals who heavily smoked (≥30 pack-years) from the CT arm of the National Lung Screening Trial (NLST), a multicenter randomized controlled trial of LDCT versus radiography (participants recruited August 2002 to April 2004). Automated SpineQ software (Bonescreen) was used to measure thoracic and lumbar vBMD (normal, ≥120 mg/cm3; low bone mass [osteopenia], 80 to <120 mg/cm3; osteoporosis, <80 mg/cm3) and vertebral fractures (Genant scale). The outcomes included 1- and 2-year incident vertebral fractures and 6-year mortality (active follow-up to 2009). Poisson and Cox models were adjusted for demographic variables, available comorbidities, and baseline vertebral fractures. Results The NLST included 26 722 participants in the CT arm, with 21 856 included in the present analysis (mean age, 61 years ± 5 [SD]; 12 854 male participants). The 2-year vertebral fracture incidence (n = 18 211 participants with 2-year LDCT) was 0.9% for those with normal bone mass, 2.0% for those with low bone mass (adjusted relative risk, 2.07 [95% CI: 1.70, 2.53]), and 5.9% for those with osteoporosis (adjusted relative risk, 3.40 [95% CI: 2.69, 4.30]). Mortality risk (n = 21 447 participants with completed follow-up [median, 6.65 years]) was associated with osteoporotic vBMD in men (adjusted hazard ratio, 1.24 [95% CI: 1.02, 1.50]). Conclusion Fully automated opportunistic assessment of spinal vBMD predicted vertebral fracture risk and was associated with mortality in men after adjustment. Individuals with osteoporotic vBMD who heavily smoked had a 2-year fracture incidence above the 5% treatment threshold according to current osteoporosis guidelines. Clinical trial registration no. NCT00047385 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Bredella in this issue.