Bone mineral densitometry. Health and Public Policy Committee, American College of Physicians.
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Intrasubject reproducibility with repeated determination of vertebral mineral density from a given set of CT images was investigated. The region of interest (ROI) in 10 patient scans was selected by four independent operators either manually or with an automated procedure separating cortical and spongeous bone, the operators being requested to interact in ROI selection. The mean intrasubject variation was found to be much lower with the automated process (0.3 to 0.6%) than with the conventional method (2.5 to 5.2%). In a second study, 10 patients were examined twice to determine the reproducibility of CT slice selection by the operator. The errors were of the same order of magnitude as in ROI selection.
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Chest x-ray films obtained by means of a portable x-ray apparatus were reviewed in 101 patients with skin burns and/or burns of the airways. The densitometric difference between measurements at a specific area in the sixth intercostal space lateral to the right hilus, and another measurement area in the mediastinum at the level of the sixth thoracic vertebral body correlated inversely with a radiographic adult respiratory distress syndrome score as suggested by Rommelsheim and Thelen. Our findings suggest that the densitometric difference between mediastinum and lung may aid in the evaluation of ARDS, especially if x-rays have different exposure parameters.
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In order to evaluate the age-related changes of the bone mineral content (BMC), 281 clinically healthy women (20-80 year old) underwent single photon abosorptiometry (SPA) on the distal third of the radius (where there is a prevalence of cortical bone); 161 subjects of this group were examined also by dual photon absorptiometry (DPA) of the lumbar tract of the spine (L2-L4) (trabecular bone). The relationship of trabecular BMC with age is described by a cubic polynomial regression (r = 0.46; p less than 0.0001) that shows an increase in BMC until 31 years of age followed by a decrease with a minimum at the age of 78; afterwards trabecular BMC adds an apparent increase. No increase in the rate of trabecular BMC loss was seen after the menopause. A positive correlation was found between body weight and vertebral BMC. The behaviour of cortical BMC with age is described by a quadratic regression (r = 0.42; p less than 0.0001) that shows an increase until 32 years of age followed by a decrease. Cortical BMC shows a significant decrease after menopause. No correlation was found between body weight and cortical BMC. These findings underline the different behaviour of trabecular and cortical bone tissue with age; in addition, the relation between trabecular (but not cortical) BMC and body weight argues for an important role of biomechanical factors in the local modulation of bone mass.
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