背景:乳腺癌(BrCa)是一种主要的恶性肿瘤,八分之一的患者发生转移,近一半的目标是骨头,导致严重的并发症,如疼痛,骨折,流动性受损。结构刚度,对骨骼强度至关重要,溶骨性病变受损,强调受影响地区的脆弱性和骨折风险增加。历史上,二维X光片已被用来预测这些骨折风险;然而,它们在捕获骨骼三维结构和材料变化方面的局限性引起了人们的关注。基于CT的结构刚度分析(CTRA)的最新进展,提供一个有希望的,更准确的非侵入性3D方法。本研究旨在评估CTRA在监测溶骨性病变进展和治疗反应方面的疗效。表明其在指导治疗策略方面优于现有方法。
方法:27只雌性裸鼠接受MDA-MB-231人乳腺癌细胞或生理盐水对照的股骨髓内接种。他们被分为控制,癌症控制,伊班膦酸盐,和紫杉醇组。每周使用双平面射线照相术监测溶骨进展,定量计算机断层扫描(QCT),和双能X射线吸收法(DEXA)。CTRA用于预测骨折风险,使用对侧股骨正常化。统计分析,包括Kruskal-Wallis和ANOVA,评估组间和随时间的结果差异。
结果:双平面射线照片显示随着时间的推移治疗效果;然而,对照组和其他治疗组之间只有某些时间特异性差异是可识别的.值得注意的是,X射线评分中的观察者主观性变得明显,具有显著的运营商间差异。DEXA测量的干phy端骨矿物质含量(BMC)在组间没有显着差异。尽管骨干BMC强调了一些差异,它没有显示在特定时间点的治疗之间的显着差异,表明DEXA区分治疗效果的能力有限。相比之下,CTRA一致证明了不同治疗方法的差异,有效捕获骨刚性随时间的变化,和轴向-(EA),弯曲-(EI),CTRA方法的扭转刚度(GJ)结果在特定时间点成功区分了治疗之间的差异。
结论:传统方法,如双平面射线照片和DEXA,表现出固有的局限性,特别是观察者偏见和时间特异性无效。我们的研究强调了CTRA实时捕获的能力,骨骼结构的进行性变化,有可能更准确地预测裂缝,并提供更客观的分析。最终,这种创新方法可以弥合临床指南中现有的差距,为手术和非手术治疗引入增强的临床决策支持工具(CDST)。
BACKGROUND: Breast cancer (BrCa) is a predominant malignancy, with metastasis occurring in one in eight patients, nearly half of which target the bone, leading to serious complications such as pain, fractures, and compromised mobility. Structural rigidity, crucial for bone strength, becomes compromised with osteolytic lesions, highlighting the vulnerability and increased fracture risk in affected areas. Historically, two-dimensional radiographs have been employed to predict these fracture risks; however, their limitations in capturing the three-dimensional structural and material changes in bone have raised concerns. Recent advances in CT-based Structural Rigidity Analysis (CTRA), offer a promising, more accurate non-invasive 3D approach. This study aims to assess the efficacy of CTRA in monitoring osteolytic lesions\' progression and response to therapy, suggesting its potential superiority over existing methodologies in guiding treatment strategies.
METHODS: Twenty-seven female nude rats underwent femoral intra-medullary inoculation with MDA-MB-231 human breast cancer cells or saline control. They were divided into Control, Cancer Control, Ibandronate, and Paclitaxel groups. Osteolytic progression was monitored weekly using biplanar radiography, quantitative computed tomography (QCT), and dual-energy X-ray absorptiometry (DEXA). CTRA was employed to predict fracture risk, normalized using the contralateral femur. Statistical analyses, including Kruskal-Wallis and ANOVA, assessed differences in outcomes among groups and over time.
RESULTS: Biplanar radiographs showed treatment benefits over time; however, only certain time-specific differences between the Control and other treatment groups were discernible. Notably, observer subjectivity in X-ray scoring became evident, with significant inter-operator variations. DEXA measurements for metaphyseal Bone Mineral Content (BMC) did not exhibit notable differences between groups. Although diaphyseal BMC highlighted some variance, it did not reveal significant differences between treatments at specific time points, suggesting a limited ability for DEXA to differentiate between treatment effects. In contrast, the CTRA consistently demonstrated variations across different treatments, effectively capturing bone rigidity changes over time, and the axial- (EA), bending- (EI), and torsional rigidity (GJ) outcomes from the CTRA method successfully distinguished differences among treatments at specific time points.
CONCLUSIONS: Traditional approaches, such as biplanar radiographs and DEXA, have exhibited inherent limitations, notably observer bias and time-specific inefficacies. Our study accentuates the capability of CTRA in capturing real-time, progressive changes in bone structure, with the potential to predict fractures more accurately and provide a more objective analysis. Ultimately, this innovative approach may bridge the existing gap in clinical guidelines, ushering in enhanced Clinical Decision Support Tool (CDST) for both surgical and non-surgical treatments.