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Multidetector computed tomography-based microstructural analysis reveals reduced bone mineral content and trabecular bone changes in the lumbar spine after transarterial chemoembolization therapy for hepatocellular carcinoma.

Takasu M, Yamagami T, Nakamura Y, Komoto D, Kaichi Y, Tani C, Date S, Kiguchi M, Awai K - PLoS ONE (2014)

Bottom Line: It is well recognized that therapeutic irradiation can result in bone damage.Of these indices, CTDIv (CT) had the highest area under the curve (AUC) (0.735).Correlation analyses of tBMD with cumulative radiation dose revealed weak correlations between tBMD and CTDIv (CT) (r2 = 0.194, P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

ABSTRACT

Purpose: It is well recognized that therapeutic irradiation can result in bone damage. However, long-term bone toxicity associated with computed tomography (CT) performed during interventional angiography has received little attention. The purpose of this study was to determine the prevalence of osteoporosis and trabecular microstructural changes in patients after transarterial chemoembolization (TACE) for hepatocellular carcinoma therapy using an interventional-CT system.

Materials and methods: Spinal microarchitecture was examined by 64-detector CT in 81 patients who underwent TACE, 35 patients with chronic hepatitis, and 79 controls. For each patient, the volumetric CT dose index (CTDIv) during TACE (CTDIv (TACE)), the dose-length product (DLP) during TACE (DLP (TACE)), and CTDIv and DLP of routine dynamic CT scans (CTDIv (CT) and DLP (CT), respectively), were calculated as the sum since 2008. Using a three dimensional (3D) image analysis system, the tissue bone mineral density (tBMD) and trabecular parameters of the 12th thoracic vertebra were calculated. Using tBMD at a reported cutoff value of 68 mg/cm3, the prevalence of osteoporosis was assessed.

Results: The prevalence of osteoporosis was significantly greater in the TACE vs. the control group (39.6% vs. 18.2% for males, P<0.05 and 60.6% vs. 34.8% for females, P<0.01). Multivariate regression analysis demonstrated that sex, age, and CTDIv (CT) significantly affected the risk of osteoporosis. Of these indices, CTDIv (CT) had the highest area under the curve (AUC) (0.735). Correlation analyses of tBMD with cumulative radiation dose revealed weak correlations between tBMD and CTDIv (CT) (r2 = 0.194, P<0.001).

Conclusion: The prevalence of osteoporosis was significantly higher in post TACE patients than in control subjects. The cumulative radiation dose related to routine dynamic CT studies was a significant contributor to the prevalence of osteoporosis.

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Sagittal reconstructed fluorodeoxyglucose-positron-emission tomography (FDG-PET)-CT image (a) and MDCT image (c) of the spine obtained from a 62-year-old man after eight transarterial chemoembolization procedures for hepatocellular carcinomas.FDG-PET-CT reveals diffusely decreased FDG uptake within the lower thoracic to lumbar spine (*). Sagittal reconstructed FDG-PET-CT image is accompanied by that of a 72-year old woman performed five years after resection of a uterine cervical cancer, in which there is normal spinal FDG uptake, for comparison (b). Sagittal reconstructed CT shows a vertebral fracture of the 12th thoracic vertebra.
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pone-0110106-g001: Sagittal reconstructed fluorodeoxyglucose-positron-emission tomography (FDG-PET)-CT image (a) and MDCT image (c) of the spine obtained from a 62-year-old man after eight transarterial chemoembolization procedures for hepatocellular carcinomas.FDG-PET-CT reveals diffusely decreased FDG uptake within the lower thoracic to lumbar spine (*). Sagittal reconstructed FDG-PET-CT image is accompanied by that of a 72-year old woman performed five years after resection of a uterine cervical cancer, in which there is normal spinal FDG uptake, for comparison (b). Sagittal reconstructed CT shows a vertebral fracture of the 12th thoracic vertebra.

Mentions: Recently, a case of 12th thoracic vertebral fracture that occurred after multiple TACE procedures to treat multiple hepatocellular carcinomas was seen. Fluorodeoxyglucose (FDG)-positron-emission tomography (FDG-PET)-CT performed to screen for pathologic fractures revealed diffusely decreased FDG uptake within the lower thoracic to lumbar spine (Figure 1). This finding gave us the impression that this area might have corresponded to the radiation field during the TACE procedures because the liver and vessels such as hepatic arteries, their branches, superior mesenteric artery, and portal vein, which are repeatedly imaged during TACE procedures, are all located around the same spinal level. Therefore, we hypothesized that radiation exposure from CT scans during angiographies led to decreased bone density and bone strength associated with secondary osteoporosis.


Multidetector computed tomography-based microstructural analysis reveals reduced bone mineral content and trabecular bone changes in the lumbar spine after transarterial chemoembolization therapy for hepatocellular carcinoma.

Takasu M, Yamagami T, Nakamura Y, Komoto D, Kaichi Y, Tani C, Date S, Kiguchi M, Awai K - PLoS ONE (2014)

Sagittal reconstructed fluorodeoxyglucose-positron-emission tomography (FDG-PET)-CT image (a) and MDCT image (c) of the spine obtained from a 62-year-old man after eight transarterial chemoembolization procedures for hepatocellular carcinomas.FDG-PET-CT reveals diffusely decreased FDG uptake within the lower thoracic to lumbar spine (*). Sagittal reconstructed FDG-PET-CT image is accompanied by that of a 72-year old woman performed five years after resection of a uterine cervical cancer, in which there is normal spinal FDG uptake, for comparison (b). Sagittal reconstructed CT shows a vertebral fracture of the 12th thoracic vertebra.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4199685&req=5

pone-0110106-g001: Sagittal reconstructed fluorodeoxyglucose-positron-emission tomography (FDG-PET)-CT image (a) and MDCT image (c) of the spine obtained from a 62-year-old man after eight transarterial chemoembolization procedures for hepatocellular carcinomas.FDG-PET-CT reveals diffusely decreased FDG uptake within the lower thoracic to lumbar spine (*). Sagittal reconstructed FDG-PET-CT image is accompanied by that of a 72-year old woman performed five years after resection of a uterine cervical cancer, in which there is normal spinal FDG uptake, for comparison (b). Sagittal reconstructed CT shows a vertebral fracture of the 12th thoracic vertebra.
Mentions: Recently, a case of 12th thoracic vertebral fracture that occurred after multiple TACE procedures to treat multiple hepatocellular carcinomas was seen. Fluorodeoxyglucose (FDG)-positron-emission tomography (FDG-PET)-CT performed to screen for pathologic fractures revealed diffusely decreased FDG uptake within the lower thoracic to lumbar spine (Figure 1). This finding gave us the impression that this area might have corresponded to the radiation field during the TACE procedures because the liver and vessels such as hepatic arteries, their branches, superior mesenteric artery, and portal vein, which are repeatedly imaged during TACE procedures, are all located around the same spinal level. Therefore, we hypothesized that radiation exposure from CT scans during angiographies led to decreased bone density and bone strength associated with secondary osteoporosis.

Bottom Line: It is well recognized that therapeutic irradiation can result in bone damage.Of these indices, CTDIv (CT) had the highest area under the curve (AUC) (0.735).Correlation analyses of tBMD with cumulative radiation dose revealed weak correlations between tBMD and CTDIv (CT) (r2 = 0.194, P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

ABSTRACT

Purpose: It is well recognized that therapeutic irradiation can result in bone damage. However, long-term bone toxicity associated with computed tomography (CT) performed during interventional angiography has received little attention. The purpose of this study was to determine the prevalence of osteoporosis and trabecular microstructural changes in patients after transarterial chemoembolization (TACE) for hepatocellular carcinoma therapy using an interventional-CT system.

Materials and methods: Spinal microarchitecture was examined by 64-detector CT in 81 patients who underwent TACE, 35 patients with chronic hepatitis, and 79 controls. For each patient, the volumetric CT dose index (CTDIv) during TACE (CTDIv (TACE)), the dose-length product (DLP) during TACE (DLP (TACE)), and CTDIv and DLP of routine dynamic CT scans (CTDIv (CT) and DLP (CT), respectively), were calculated as the sum since 2008. Using a three dimensional (3D) image analysis system, the tissue bone mineral density (tBMD) and trabecular parameters of the 12th thoracic vertebra were calculated. Using tBMD at a reported cutoff value of 68 mg/cm3, the prevalence of osteoporosis was assessed.

Results: The prevalence of osteoporosis was significantly greater in the TACE vs. the control group (39.6% vs. 18.2% for males, P<0.05 and 60.6% vs. 34.8% for females, P<0.01). Multivariate regression analysis demonstrated that sex, age, and CTDIv (CT) significantly affected the risk of osteoporosis. Of these indices, CTDIv (CT) had the highest area under the curve (AUC) (0.735). Correlation analyses of tBMD with cumulative radiation dose revealed weak correlations between tBMD and CTDIv (CT) (r2 = 0.194, P<0.001).

Conclusion: The prevalence of osteoporosis was significantly higher in post TACE patients than in control subjects. The cumulative radiation dose related to routine dynamic CT studies was a significant contributor to the prevalence of osteoporosis.

Show MeSH
Related in: MedlinePlus