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; Yaling Pan; Fangyuan Zhong; Tian-Jiao Yuan; Hanqi Wang; Tongtong Chen; Haiying Lv; Xiaoguang Cheng; Jian-Min Liu; Yong Lu

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

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

Authors

Liuping Chen^#¹, Yaling Pan^#², Fangyuan Zhong³, Tian-Jiao Yuan^{4

5}, Hanqi Wang¹, Tongtong Chen¹, Haiying Lv¹, Xiaoguang Cheng⁶, Jian-Min Liu^{4

5}, Yong Lu⁷

Affiliations

¹ Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
² Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
³ Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵ Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai, China.
⁶ Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
⁷ Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

^# Contributed equally.

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).