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. 2022 May;10(10):606.
doi: 10.21037/atm-22-1827.

Using QCT to evaluate bone mineral and abdominal adipose changes in patients with primary hyperparathyroidism and comparing it to DXA for bone status assessment: a retrospective case-control study

Liuping Chen #  1 , Yaling Pan #  2 , Fangyuan Zhong  3 , Tian-Jiao Yuan  4   5 , Hanqi Wang  1 , Tongtong Chen  1 , Haiying Lv  1 , Xiaoguang Cheng  6 , Jian-Min Liu  4   5 , Yong Lu  7
Affiliations

Using QCT to evaluate bone mineral and abdominal adipose changes in patients with primary hyperparathyroidism and comparing it to DXA for bone status assessment: a retrospective case-control study

Liuping Chen et al. Ann Transl Med. 2022 May.

Abstract

Background: Patients with primary hyperparathyroidism (PHPT) show changes in bone metabolism and adipose tissue, but the results are inconsistent. Quantitative computed tomography (QCT) was reported useful for detecting bone mineral and adipose tissue change, but information on the role of QCT in PHPT is limited. We aimed to explore the changes of lumbar bone mineral density (BMD) and abdominal adipose tissue in patients with PHPT using QCT based on existed CT images, and to assess the consistency between QCT and dual-energy X-ray absorptiometry (DXA) in assessing bone status.

Methods: This retrospective case-control study was conducted on 48 PHPT patients, with healthy controls (HCs) matched by their age (±3 years) and gender, and the case-to-control ratio was approximately 1:3. Volumetric bone mineral density (vBMD), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and total adipose tissue (TAT) were measured by QCT in both PHPT and control groups and compared with the independent samples T-test. In the PHPT group, areal bone mineral density (aBMD) was measured by DXA. Pearson correlation analysis was used to investigate the association between QCT-derived vBMD and DXA-derived aBMD. Weighted kappa consistency analysis was used to clarify the agreement between QCT and DXA.

Results: Compared with HCs, the PHPT group had significantly lower vBMD (114.30±41.71 vs. 136.92±42.23 mg/cm3; P=0.002) and higher TAT (261.98±74.65 vs. 236.69±69.00 cm2; P=0.033); however, differences in SAT (120.81±40.19 vs. 109.94±36.83 cm2; P=0.085) and VAT (141.17±48.11 vs. 126.75±50.50 cm2; P=0.085) were not statistically significant. There was a strong correlation between QCT-derived vBMD and DXA-derived aBMD (all r>0.68; P<0.001), and a moderate consistency [kappa(w) =0.48; 95% CI: 0.29 to 0.68; P<0.001] was presented when defining bone status according to the respective diagnostic criteria.

Conclusions: Our study may provide useful information regarding bone status and abdominal adipose tissue change in patients with PHPT without requiring additional scan and may further extend the clinical application value of QCT.

Keywords: Primary hyperparathyroidism (PHPT); bone mineral density (BMD); quantitative computed tomography (QCT); subcutaneous adipose tissue (SAT); visceral adipose tissue (VAT).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-1827/coif). All authors report that the study was supported by the Natural Science Foundation of Shanghai (No. 21ZR1439800) and “Yanhai-Ruijin Artificial Intelligence Aided Imaging Diagnostic Platform” Special Fund (No. 2018188). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Abdominal adipose tissue distribution in patients and controls. The blue color represents the fat tissue, and the green dashed line depicts the abdominal wall. The fat inside this wall is VAT, while the fat outside the wall is SAT. TAT = VAT + SAT. (A) A 64-year-old female patient, whose VAT, SAT, and TAT were 240.5 cm2, 149.7 cm2, and 390.2 cm2 respectively. (B) A 64-year-old HC group female whose VAT, SAT, TAT was 90.8 cm2, 117.7 cm2, 208.5 cm2 respectively. VAT, visceral adipose tissue; SAT, subcutaneous adipose tissue; TAT, total fat area; HC, healthy control.
Figure 2
Figure 2
Correlation between PTH and aBMD. aBMD, areal bone mineral density; PTH, parathyroid hormone.
Figure 3
Figure 3
Correlation between DXA-derived aBMD and QCT-derived vBMD. vBMD, volumetric bone mineral density; aBMD, areal bone mineral density; DXA, dual-energy X-ray absorptiometry; QCT, quantitative computed tomography.
See this image and copyright information in PMC

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