Construction and Application of Rib Fracture Diagnosis Model Based on YOLOv3 Algorithm.

OBJECTIVES: The artificial intelligence-aided diagnosis model of rib fractures based on YOLOv3 algorithm was established and applied to practical case to explore the application advantages in rib fracture cases in forensic medicine. METHODS: DICOM format CT images of 884 cases with rib fractures caused by thoracic trauma were collected, and 801 of them were used as training and validation sets. A rib fracture diagnosis model based on YOLOv3 algorithm and Darknet53 as the backbone network was built. After the model was established, 83 cases were taken as the test set, and the precision rate, recall rate, F1-score and radiology interpretation time were calculated. The model was used to diagnose a practical case and compared with manual diagnosis. RESULTS: The established model was used to test 83 cases, the fracture precision rate of this model was 90.5%, the recall rate was 75.4%, F1-score was 0.82, the radiology interpretation time was 4.4 images per second and the identification time of each patient's data was 21 s, much faster than manual diagnosis. The recognition results of the model was consistent with that of the manual diagnosis. CONCLUSIONS: The rib fracture diagnosis model in practical case based on YOLOv3 algorithm can quickly and accurately identify fractures, and the model is easy to operate. It can be used as an auxiliary diagnostic technique in forensic clinical identification.

Prevalence of Lumbar Spondylolisthesis in Middle-Aged People in Beijing Community.

OBJECTIVE: Lumbar spondylolisthesis (LS) is a common lumbar disease, and the prevalence of LS in different countries or regions was not consistent in the past. This study intends to make statistics on the prevalence of lumbar spondylolisthesis in middle-aged people in Beijing community. METHODS: This is an epidemiological study. 4548 people in Beijing community aged 50 to 64 years were recruited from the local communities by advertisements placed in housing estates and community centres for people to take part in a prospective cohort study from August from September 2013 to March 2014. There is no intervention on the subjects. RadiAnt DICOM Viewer is adopted to read the lateral CT positioning images of all the studied objects, adjust the image as bone window, observe and evaluate the slide of L1 to L5 vertebra in the lateral CT positioning image. RESULTS: Among the 4,548 subjects included in the study, 2,490 (54.75%) were male and 2,058 (45.25%) were female. A total of 785 subjects had lumbar spondylolisthesis, with a total incidence of 17.26%. There was no significant difference between prevalence of males and females in the subgroup 50-54 years old (13.55% males / 12.53% females) and 55-59 years old (14.77% males / 14.93% females). But the prevalence of LS in 60-64 years old females (28.57%) increased significantly, compared with 55-59 years old females (14.93%) and 60-64 years old males (18.76%). There were 847 levels that had slipped, L5S1 > L4/5 > L3/4 > L2/3 > L1/2. The retrolisthesis was the most, accounting for 61.51% (521/847), and the anterolisthesis was 38.49% (326/847), including anterolisthesis gradeI for 95.71% (312/326), anterolisthesis gradeII for 4.29% (14/326). Neither of anterolisthesis and retrolisthesis presented more than grade III. Among all the subjects, 318 had anterolisthesis, with a total incidence of 6.99%, and 467 subjects only had retrolisthesis. CONCLUSION: The total prevalence of LS in the middle-aged people in Beijing community was 17.26%, 15.98% in males and 18.80% in females, and women are more likely to suffer from LS after 60 years old.

Semi-quantitative grading and extended semi-quantitative grading for osteoporotic vertebral deformity: a radiographic image database for education and calibration.

The Genant's semi-quantitative (GSQ) criteria is currently the most used approach in epidemiology studies and clinical trials for osteoporotic vertebral deformity (OVD) evaluation with radiograph. The qualitative diagnosis with radiological knowledge helps to minimize false positive readings. However, unless there is a face-to-face training with experienced readers, it can be difficult to apply GSQ criteria by only reading the text description of Genant et al. (in 1993), even for a musculoskeletal radiologist. We propose an expanded semi-quantitative (eSQ) OVD classification with the following features: (I) GSQ grade-0.5 is noted as minimal grade (eSQ grade-1) for OVDs with height loss <20%; (II) GSQ mild grade (grade-1) is the same as eSQ mild grade (grade-2); (III) GSQ moderate grade (grade-2) is subdivided into eSQ grade-3 (moderate, >25%-1/3 height loss) and eSQ grade-4 (moderately-severe, >1/3-40% height loss); (IV) GSQ severe grade is subdivided into eSQ grade-5 (severe, >40%-2/3 height loss) and eSQ grade-6 (collapsed, with >2/3 height loss). We advocate to estimate vertebral height loss with adjacent vertebral heights as the reference (rather than using individual vertebra's posterior height as the reference). This article presents radiographs of 36 cases with OVD, together with gradings using GSQ criteria and eSQ criteria. The examples in this article can serve as teaching material or calibration database for readers who will use GSQ criteria or eSQ criteria. Our approach for quantitative measurement is explained graphically.

Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men.

OBJECTIVE: The objective of this study was to investigate the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. METHODS: A total of 313 males older than 60 years, who underwent both spinal QCT and lumbar spine and hip DXA in our department, were included. The diagnostic criteria established by the World Health Organisation in 1994 were used for DXA to diagnose osteoporosis, and the criteria recommended by the International Society of Clinical Densitometry were used for QCT. The osteoporosis detection rate by the two techniques was calculated, and the difference was compared. The minor discordance was considered present when the different diagnostic classes between the two techniques were adjacent. Major discordance was present when the diagnosis by one technique was osteoporosis and the other was normal. The computed tomography images were reviewed by radiologists to assess whether vertebral fracture, aorta calcification or degeneration was present. RESULTS: In the 313 participants (mean age, 79.6 ± 7.2 years), the osteoporosis detection rate was 10.9% for DXA (lumbar spine and hip) and 45.1% for QCT, a significant difference (p < 0.001). The major discordance, minor discordance and concordance of diagnosis between the two techniques were seen in 8.3%, 50.8% and 40.9%, respectively. QCT detected osteoporosis better than DXA. The causes of this discordance were degeneration of spine, abdominal aorta calcification and vertebral fractures. CONCLUSION: Our study demonstrated that discordance was common when using QCT and DXA to diagnose osteoporosis and that spinal degeneration, aorta calcification and fracture obscure the bone mineral density measurement of spine by DXA. QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: This study investigated the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. The results demonstrated that QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. This work may help clinicians make an appropriate choice of technique for the accurate diagnosis of osteoporosis and identify the patients at high risk of osteoporosis who should be treated early to prevent fractures. This may influence the therapeutic plan and the overall prognosis of patients.

The spatial differences in bone mineral density and hip structure between low-energy femoral neck and trochanteric fractures in elderly Chinese using quantitative computed tomography.

The purpose of this study was to investigate the differences in bone mineral density (BMD) and hip structure between femoral neck and trochanteric fractures in elderly Chinese individuals using quantitative computed tomography (QCT). A total of 625 Chinese patients (mean age 75.8 years) who sustained low-energy hip fractures (female: 293 femoral neck, 175 trochanteric; male: 82 femoral neck, 75 trochanteric) were recruited. Each patient underwent a hip QCT scan. The areal BMD (aBMD) of the contralateral normal hip was obtained using a computed tomography X-ray absorptiometry module. Using the bone investigation toolkit (BIT) module, the femoral neck was divided into four quadrants: supero-anterior (SA), infero-anterior (IA), infero-posterior (IP), and supero-posterior (SP). Estimated cortical thickness, cortical BMD, and trabecular BMD were measured in each quadrant. Using the hip structure analysis (HSA) function, several parameters were calculated. Stratified by sex, covariance analyses were applied to compare the femoral neck fractures group with trochanteric fractures group after adjustments for age, height, and weight. In women, trochanteric fractures exhibited lower trabecular BMD and estimated cortical thickness at three quadrants of the femoral neck (IA: P = 0.02, P < 0.01; IP: P < 0.01, P = 0.01; SP: P = 0.01, P < 0.01), and lower aBMD at the trochanter area (P < 0.01); femoral neck fractures exhibited lower cortical BMD and estimated cortical thickness at the SA quadrant (P = 0.04, P = 0.01). Differences in HSA parameters were not statistically significant. Among all parameters, the most valuable ones to discrimination of hip fracture type are estimated cortical thickness of the SA quadrant of femoral neck and the aBMD of the trochanter area. In men, only lower cortical BMD at the SP quadrant and aBMD at the trochanter were found in the trochanteric fractures (P = 0.02, P < 0.01). QCT outcomes indicate that spatial differences are helpful to explore the pathogenesis of different type of hip fractures. In women, trochanteric fractures are related to severer osteoporosis, whereas cortical fragility in the SA region of the femoral neck predominates in cases of femoral neck fractures. In men, trochanteric fractures are related to more bone loss of trochanter.

Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography.

BACKGROUND/OBJECTIVE: This study is a case-control study to explore risk and protective factors, including clinical data and bone mineral density (BMD), affecting vertebral body fragility fracture in elderly men and postmenopausal women. In addition, we investigate the effectiveness of lumbar spine BMD by quantitative computed tomography (QCT) in discriminating vertebral fragility fracture. METHODS: In this case-control study, 52 males and 198 females with vertebral fragility fracture were compared with sex- and age-matched healthy controls to analyse the risk factors that may affect vertebral fragility fracture. The L1-L3 vertebral BMDs were measured by QCT. The difference in risk factors between fracture cases and controls were analysed using student t test and Mann-Whitney U test. The correlation between BMD, age, height and weight were analysed using univariate analysis. Multiple logistic regression analysis was used to study statistically significant indexes. The receiver operating characteristic curve was used to calculate the cut-off values for positive and negative predictive values of BMD for vertebral fracture discrimination. RESULTS: In males, body weight and BMD were significantly different between the fracture group and the control group, whereas BMD was only weakly correlated with age (r = -0.234). In females, only BMD was significantly different between the fracture and control groups. BMD was weakly correlated with height (r = 0.133) and weight (r = 0.120) and was moderately correlated with age (r = -0.387). There was no correlation between BMD and the remaining variables in this study. In both men and women, the BMD (p = 0.000) was the independent protective factor against vertebral fracture. The cut-off values of vertebral BMD for fractures were 64.16 mg/cm3 for males and 55.58 mg/cm3 for females. QCT-measured BMD has a high positive predictive value and negative predictive value for discriminating vertebral fragility fracture across a range of BMD values. CONCLUSION: This study suggests that BMD is closely related to vertebral fragility fracture and that QCT is an effective technique to accurately discriminate vertebral fragility fracture. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: The spine BMD measured by QCT is closely related to fracture, which may allow clinicians to more accurately discriminate which individuals are likely to experience vertebral fragility fracture.

The protocol for the Prospective Urban Rural Epidemiology China Action on Spine and Hip status study.

The Prospective Urban Rural Epidemiology (PURE) China Action on Spine and Hip status (CASH) study focused on the prevalence of osteoporosis and spinal fracture in China. The aim of the PURE CASH study is to determine the prevalence of osteoporosis and spinal fracture, and explore the potential relationship between spinal fracture and bone mineral density (BMD). This study is a prospective large-scale population study with a community-based sampling and recruitment strategy. The aim is to determine the prevalence of osteoporosis and vertebral fracture in this population, to evaluate the association between vertebral fractures and BMD values, and to assess the prediction power of BMD for incident fractures. Participants in the PURE CASH study are all from the PURE study in China, recruited from 12 centers in 7 Chinese provinces. The inclusion criteria are that participants should be aged more than 40 years and able to give informed consent. Exclusion criteria are pregnant women, individuals with metal implants in the lumbar spine, use of medications or the existence of any disease or condition known to have a major influence on BMD, and inability to give informed consent. A total of 3,457 participants undergo a quantitative computed tomography (QCT) scan of the upper abdomen. The scanning parameters are as follows: 120 kVp at all centers, mAs between 75 and 200, FOV 40 cm×40 cm. The BMD values of L1 to L3 are measured, and the average BMD calculated. The American College of Radiology QCT criteria for the diagnosis of osteoporosis is applied to determine the presence of osteoporosis. The scout view images of T4-L4 vertebrae are reviewed by two experienced radiologists for semi-quantification of vertebral fractures according to Genant's method.

Correlation between Non-Alcoholic Fatty Liver Disease and Visceral Adipose Tissue in Non-Obese Chinese Adults: A CT Evaluation.

Objective: To investigate the correlation between non-alcoholic fatty liver disease and visceral adipose tissue in non-obese Chinese adults using computed tomography (CT). Materials and Methods: The study included 454 subjects undergoing abdominal CT scan. Degree of CT attenuation in liver and spleen, and the degree of fat infiltration in liver were evaluated according to three indices: the attenuation value of liver parenchyma (CTLP), the attenuation ratio of liver and spleen (LSratio) and the attenuation difference between liver and spleen (LSdif). Visceral fat area (VFA) and total fat area (TFA) at L2/3 and L4/5 levels were measured, and the abdominal subcutaneous fat area (SFA) was calculated. Bivariate correlation analysis was carried out to determine the correlation among these factors. Results: In men, VFA, SFA and TFA at L2/3 and L4/5 levels showed significant differences in terms of the three indices to distinguish fatty liver from non-fatty liver (all, p < 0.001). In men, all the three indices showed negative correlation with TFA, SFA and VFA (all, p < 0.001). The negative correlation between the three indices and VFA at the L2/3 level was higher than at L4/5 level (r = -0.476 vs. r = -0.340 for CTLP, r = -0.502 vs. r = -0.413 for LSratio, r = -0.543 vs. r = -0.422 for LSdif, p < 0.001, respectively). The negative correlation between LSratio, LSdif and VFA at L2/3 and L4/5 levels was higher than SFA at the corresponding level. In women, all the three indices showed negative correlation with VFA and TFA at L2/3 and L4/5 levels, and the negative correlation between CTLP and VFA was higher at L2/3 level than at L4/5 level (r = -0.294 vs. r = -0.254, p < 0.001). Conclusion: In non-obese Chinese adults, the degree of hepatic fatty infiltration showed a strong correlation with abdominal fat on CT. VFA at L2/3 level was more closely related to fatty liver compared with VFA at L4/5 level.

Effects of Structural Changes in Subchondral Bone on Articular Cartilage in a Beagle Dog Model.

OBJECTIVE: Using MR T2-mapping and histopathologic score for articular cartilage to evaluate the effect of structural changes in subchondral bone on articular cartilage. METHODS: Twenty-four male Beagle dogs were randomly divided into a subchondral bone defect group (n = 12) and a bone cement group (n = 12). Models of subchondral bone defectin the medial tibial plateau and subchondral bone filled with bone cement were constructed. In all dogs, the left knee joint was used as the experimental sideand the right knee as the sham side. The T2 value for articular cartilage at the medial tibial plateau was measured at postoperative weeks 4, 8, 16, and 24. The articular cartilage specimens were stained with hematoxylin and eosin, and evaluated using the Mankin score. RESULTS: There was a statistically significant difference (P < 0.05) in Mankin score between the bone defect group and the cement group at postoperative weeks 16 and 24. There was a statistically significant difference in the T2 values between the bone defect group and its sham group (P < 0.05) from week 8, and between the cement group and its sham group (P < 0.05) from week 16. There was significant difference in T2 values between the two experimental groups at postoperative week 24 (P < 0.01). The T2 value for articular cartilage was positively correlated with the Mankin score (ρ = 0.758, P < 0.01). CONCLUSION: Structural changes in subchondral bone can lead to degeneration of the adjacent articular cartilage. Defects in subchondral bone cause more severe degeneration of cartilage than subchondral bone filled with cement. The T2 value for articular cartilage increases with the extent of degeneration. MR T2-mapping images and the T2 value for articular cartilage can indicate earlycartilage degeneration.

Heterogeneity in Spinal Bone Mineral Density Among Young Adults From Three Eastern Provincial Capital Cities in Mainland China.

This study compares spinal volumetric bone mineral density (vBMD) with spinal areal bone mineral density (aBMD) among young adults from 3 eastern provincial capital cities in Mainland China. A total of 416 young adults (age range: 20-40 yr) from 3 eastern provincial capital cities (Beijing, Shanghai, and Guangzhou) in Mainland China were recruited in this study. From each subject, the vBMD of the lumbar spine was measured by the Mindways quantitative computed tomography system. Moreover, the aBMD of the lumbar spine, measured by the dual-energy X-ray absorptiometry, was extracted from a previous multicenter large-scale study, and the 420 participants were matched by age, gender, height, weight, as well as geographic territory. The vBMD and the aBMD values were further compared and analyzed. Generally, the bone mineral density (BMD) results were significantly different among participants from the 3 cities (p <0.05). Specifically, both vBMD and aBMD values of participants from Beijing were significantly different from those from Guangzhou (p <0.05). Additionally, a statistically significant difference in aBMD values was also found between participants from Beijing and Shanghai (p <0.05). However, no significant differences were found between participants from Shanghai and Guangzhou in terms of the aBMD and vBMD values (p1 > 0.05 and p2 > 0.05). Interestingly, the overall mean vBMD value was 5.9% greater in women than those in men for all the 3 cities (p <0.001). This study demonstrated an overall heterogeneity in spinal BMD among young adults from 3 eastern provincial capital cities in Mainland China. Specifically, the taller and heavier young adults from the northern part of China have smaller spinal vBMD but higher spinal aBMD values than those who were shorter and lighter from the southern part of China.

Comparison of the antiviral effects of different nucleos(t)ide analogues in chinese patients with chronic hepatitis B: a head-to-head study.

BACKGROUND/AIMS: To assess the antiviral efficacy of lamivudine (LAM), entecavir (ETV), telbivudine (LDT), and lamivudine and adefovir dipivoxil (CLA) combination in previously untreated hepatitis B patients at different time points during a 52-week treatment period. PATIENTS AND METHODS: A total of 164 patients were included in this prospective, open-label, head-to-head study. Serum levels of alanine transaminase (ALT), hepatitis B virus (HBV) DNA, and hepatitis B e antigen (HBeAg) were measured at baseline, and at 12, 24, and 52 weeks of treatment. RESULTS: Median reductions in serum HBV DNA levels at 52 weeks (log 10 copies/mL) were as follows: LAM, 3.98; ETV, 3.89; LDT, 4.11; and CLA, 3.36. The corresponding HBV DNA undetectability rates were 83%, 96%, 91%, and 89%, respectively. These two measures showed no significant intergroup differences. Clinical efficacy appeared related to HBV DNA level reduction after 24 weeks of therapy. Patients were divided into three groups based on HBV DNA levels at week 24: Undetectable (<10(3) copies/mL), detectable but <10(4) copies/mL, and >10(4) copies/mL. Patients with levels below quantitation limit (QL) were analyzed at 52 weeks for HBV DNA undetectability rate (94%), ALT normalization rate (83%), and viral breakthrough rate (0%). The corresponding values in the QL-10(4) copies/mL group were 50%, 75%, and 13%, whereas those in the above 10(4) copies/mL group were 53%, 65%, and 18%. There were significant differences at week 52 for HBV DNA levels and viral breakthrough rate between the three groups. CONCLUSIONS: Different nucleos(t)ide (NUC) analogues tested exhibited no significant differences in effectiveness for Chinese NUC-naive HBV patients during 1-year treatment period.

LMP1 stimulates the transcription of eIF4E to promote the proliferation, migration and invasion of human nasopharyngeal carcinoma.

Eukaryotic translation initiation factor 4E (eIF4E) is the rate-limiting translation initiation factor for many oncogenes. Previous studies have shown eIF4E overexpression in nasopharyngeal carcinoma (NPC). We aimed to study whether viral oncogene latent membrane protein 1 (LMP1) stimulates the transcription of eIF4E to promote NPC malignancy. In NPC cell lines (CNE1 and CNE2), ectopic LMP1 significantly increased the mRNA and protein levels of eIF4E and the transcriptional activity of the eIF4E promoter in a LMP1-plasmid-transfected dose-dependent manner. As a backward experiment, knocking down of LMP1 significantly reduced eIF4E mRNA in B95-8 cells. In the high LMP1 expression condition, knocking down of c-Myc significantly reduced eIF4E mRNA in both NPC and B95-8 cells, and knocking down of eIF4E significantly inhibited the tumor proliferation, migration and invasion promoted by LMP1. The results indicated that LMP1 stimulates the transcription of eIF4E via c-Myc to promote NPC. To the best of our knowledge, this is the first evidence that LMP1 stimulates the transcription of eIF4E. This might be an important cause of the overexpression of eIF4E in NPC and be the novel mechanism by which LMP1 initiates cancer. LMP1-stimulated eIF4E initiates the translation of those oncogenes transcriptionally activated by LMP1 to amplify and pass down the carcinogenesis signals launched by LMP1.

Magnetic resonance imaging and histopathological analysis of experimental muscle injuries in a rabbit.

OBJECTIVE: To investigate the correlation of magnetic resonance imaging (MRI) with histopathological changes, and to evaluate T2 mapping in assessing muscle trauma in a rabbit model of muscle injury. METHODS: We divided 35 rabbits into seven groups that each represented a different time point after intramuscular hemorrhage and muscle injury. Hemorrhage was created by injecting autologous blood into the left legs, and muscle injury was created by scalpel incision of the biceps femoris of the right legs. At different time points, the rabbits underwent T1-weighted imaging and T2-weighted imaging (T1WI and T2WI) and T2 mapping. T2 relaxation times were measured, and the corresponding samples were evaluated for pathological changes RESULTS: After 2 h, the intramuscular hemorrhage model demonstrated an increased signal intensity on both T1WI and T2WI. Histological examination showed erythrocytes within the muscle bundle. On days 1 and 3, the MRI signals were decreased, and there were no significant changes after day 7. From 2 h to 3 days, the muscle-injury model showed a high signal on both T1WI and T2WI. Corresponding pathological changes included rupture and edema of muscle fibers, and inflammation. The abnormal signals were reduced on day 7. After day 14, the T2WI intensity remained high. T1WI showed no abnormal changes, but some models showed a high signal, representing fresh bleeding and fatty tissue. T2 relaxation times were significantly different between the central and marginal regions, and between the marginal and normal regions. CONCLUSION: MRI clearly demonstrates intramuscular hemorrhage and muscle injury, which correlate well with histopathological changes. T2 mapping is useful in assessing the extent of injury.

Correlation between the prevalence of herniation pits and the α angle of the hip: computed tomography evaluation in healthy Chinese adults.

BACKGROUND: Herniation pits (HPs) commonly develop over time at the femoral head-neck junction in adults, but their cause is still under debate. The purpose of study reported here was to investigate the correlation between the prevalence of HPs of the femoral neck and the alpha angle of the hips of healthy Chinese adults, by using computed tomography (CT). METHODS: Six hundred and seventy Chinese adults (representing 1145 hips) who had no known diseases affecting the proximal femur and had no symptoms of femoroacetabular impingement underwent a 64-slice CT scan for medical purposes that included the hip in the scan range. Their CT data were analyzed for the prevalence of HPs in the femoral necks and for hip alpha angles. RESULTS: The overall prevalence of femoral-neck HPs was 12.5% (143 of 1145 hips). The prevalence in the left versus right femoral necks was 12.1% (69 of 569 hips) versus 12.8% (74 of 576 hips). There was no statistically significant difference between the two sides (χ2 = 0.136; p = 0.712). The prevalence of HPs was greater in men than in women (15.9% vs 7.7%; p < 0.01) and greater in adults older than 30 years than in adults younger than 30 years (χ2= 14.547; p < 0.01). The alpha angles were greater in the 143 proximal femora with HPs than in the 1002 without pits (39.95° ± 6.01° vs 37.97° ± 5.14°; p < 0.01). CONCLUSIONS: The prevalence of HPs of the femoral neck in healthy adults was 12.5%, and the prevalence was greater in men than in women. There is a correlation between the prevalence of HPs and the contour of the femoral head-neck junction. The formation of pits may be attributed to the combination of degeneration and morphologic variances in the femoral head-neck junction.

Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women.

Objective. To compare the osteoporosis detection rates in postmenopausal women when measuring bone mineral density (BMD) with quantitative computed tomography (QCT) in the spine versus dual X-ray absorptiometry (DXA) in the spine and hip and to investigate the reasons for the discrepancy between the two techniques. Methods. Spinal volumetric BMD was measured with QCT, and areal spinal and hip BMDs were measured with DXA in 140 postmenopausal women. We calculated the osteoporosis detection rate for the two methods. Lumbar CT images of patients who had a discrepancy between QCT and DXA findings were reviewed to evaluate vertebral fractures, spinal degeneration, and abdominal aortic calcification. Results. For the entire 140 patients, the detection rate was 17.1% for DXA and 46.4% for QCT, a significant difference (P < 0.01). Of the 41 patients with conflicting diagnoses, 7 whose diagnosis by QCT was osteoporosis had vertebral fractures even though their DXA findings did not indicate osteoporosis. Varying degrees of spinal degeneration were seen in all of the 41 patients. Conclusion. QCT may avoid the overestimation of BMD by DXA associated with spinal degeneration, abdominal aortic calcification, and other sclerotic lesions. It may be more sensitive than DXA for detecting osteoporosis in postmenopausal women.

[Skeletal disease in primary hyperparathyroidism: X-ray, CT and MR imaging founding].

OBJECTIVE: To analyze the X-ray, CT and MR imaging findings in skeletal disease with primary hyperparathyroidism (PHPT), so as to discuss the clinic feature and differential diagnosis. METHODS: Thirty patients with PHPT were confirmed by surgery and pathological examination. In 15 patients the lesion were found in femur. There were 15 tibia, 12 fibula, and 14 iliac lesions. In three patients lesions were found in vertebrae. Three patients had lesions in humeri. In five patients lesions were found in rib. Twelve patients had lesions in phalanges. Thirty patients were studied preoperatively with radiographs, CT and MR imaging. The imaging findings were compared with the pathologic diagnosis and confirmed by double blind method. RESULTS: Radiographs of the bone in 30 patients showed generalised osteopaenia. There were 20 (66.7%) cases with bone resorption, which include 12 (40.0%) cases with subperiosteal resorption, 11 (36.7%) cases with cortical bone resorption, and 10 (33.3%) cases with subchondral resorption. There were 19 (63.3%) cases with osteitis fibrosa cystica/brown tumor. There were 5 (16.7%) patients sustained a pathological fracture. CONCLUSION: X-ray, CT and MR imaging founding reflect the imaging and pathology features in skeletal disease of PHPT. The iliac lesions could been found in common, and usually eroding sacroiliac joint. Skeletal disease of PHPT should be differentiated from osteolytic metastatic tumor of bone, osteodysplasia fibrosa, giant cell tumor of bone and aneurysmal bone cysts.