0:00

This patient has undergone lung cancer screening

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cts for five years.

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Let's take a look at the spine and the vertebral bodies.

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The CT scan on the left is from April, 2024.

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The CT scan on the left is from April, 2019,

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five years ago when this patient began

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lung cancer screening.

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At that time, we can see that most

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of the vertebral bodies are well preserved in height

0:25

and we have a mild superior nplate compression deformity

0:28

of a lower thoracic vertebral body

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below which the vertebral bodies are normal.

0:34

Fast forward five years to 2024

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and we now have multiple compression deformities.

0:40

One in the mid thoracic spine, an inferior

0:44

compression deformity here,

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that mild superior PL compression deformity

0:48

has gotten a little bit worse.

0:50

And we have a new L one vertebral

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body compression deformity.

0:54

Let's measure the density of the vertebral bodies.

0:57

Since L one has a compression deformity that's new,

1:00

we can't use L one to measure the vertebral body density.

1:04

You can see there's areas of increased sclerosis along the

1:07

end plate, which will artificially increase the

1:10

density of the bone.

1:11

So in this case, we switched the T 12 vertebral body level.

1:14

In that case, we're gonna place a region of interest

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and we have 97 ounces

1:19

of units measurement on this current exam in 2024.

1:22

If we compare that to 2019,

1:25

the bone mineral density was in the osteopenia range.

1:28

At 112, I'll say there is some error bar

1:32

around the a hundred

1:33

and 130 ounce categories

1:36

as I interpret lung cancer screening cts

1:38

and I make my own ROIs to measure bone mineral density

1:42

whenever a patient has had a DEXA scan.

1:44

I'm also looking up those results to see

1:47

how well my measurement is correlating

1:49

with the DEXA scan results.

1:51

And I would say probably 80% of time using these a hundred,

1:55

130 household units in my own experience has corresponded

1:59

with what is seeing seen in the DEXA scan

2:01

and we'll say in the other 20% of the time,

2:04

my measurement might suggest

2:06

osteoporosis when DEXA is osteopenia,

2:09

and I might measure osteopenia when DEXA is normal.

2:13

So I think these hunding, the density thresholds,

2:16

maybe overestimate the severity of bone mineral density,

2:20

and I don't think that they underestimate the

2:22

severity of bone mineral density.

2:24

The important thing is to look at the thoracic spine,

2:27

measure bone mineral density

2:29

and consider recommendations for DEXA scanning

2:32

so the appropriate diagnostics

2:33

and therapeutics can be put in place

2:36

to prevent the further development of compression fractures,

2:40

multiple compression fractures,

2:42

and the associated morbidity mortality that is associated

2:45

with these findings, particularly in patients

2:47

who have concomitant lung disease,

2:50

but increased risk of pneumonia hospitalization

2:53

for pneumonia and pneumonia related mortality.