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Summary <p>CT-based opportunistic screening using artificial intelligence finds a high prevalence (43%) of osteoporosis in CT scans obtained for planning of&#xa0;transcatheter aortic valve replacement. Thus, opportunistic screening may be a cost-effective way to assess osteoporosis in high-risk populations.</p> Background <p>Osteoporosis is an underdiagnosed condition associated with fractures and frailty, but may be detected in routine computed tomography (CT) scans.</p> Methods <p>Volumetric bone mineral density (vBMD) was measured in clinical routine thoraco-abdominal CT scans of 207 patients for planning of transcatheter aortic valve replacement (TAVR) using an artificial intelligence (AI)-based algorithm.</p> Results <p>43% of patients had osteoporosis (vBMD &lt; 80 mg/cm<sup>3</sup> L1-L3) and were elderly (83.0 {interquartile range [IQR]: 78.0–85.5} vs. 79.0 {IQR: 71.8–84.0} years, <i>p</i> &lt; 0.001), more often female (55.1 vs. 28.8%, <i>p</i> &lt; 0.001), and had a higher Society of Thoracic Surgeon’s score for mortality (3.0 {IQR:1.8–4.6} vs. 2.1 {IQR: 1.4–3.2}%, <i>p</i> &lt; 0.001). In addition to lumbar vBMD (58.2 ± 14.7 vs. 106 ± 21.4 mg/cm<sup>3</sup>, <i>p</i> &lt; 0.001), thoracic vBMD (79.5 ± 17.9 vs. 127.4 ± 26.0 mg/cm<sup>3</sup>, <i>p</i> &lt; 0.001) was also significantly reduced in these patients and showed high diagnostic accuracy for osteoporosis&#xa0;assessment (area under curve: 0.96, <i>p</i> &lt; 0.001). Osteoporotic patients were significantly more often at risk for falls (40.4 vs. 22.9%, <i>p</i> = 0.007) and required help in activities of daily life (ADL) more frequently (48.3 vs. 33.1%, <i>p</i> = 0.026), while direct-to-home discharges were fewer (88.8 vs. 96.6%, <i>p</i> = 0.026). In-hospital bleeding complications (3.4 vs. 5.1%), stroke (1.1 vs. 2.5%), and death (1.1 vs. 0.8%) were equally low, while in-hospital device success was equally high (94.4 vs. 94.9%, <i>p</i> &gt; 0.05 for all comparisons). However, one-year probability of survival was significantly lower (84.0 vs. 98.2%, log-rank <i>p</i> &lt; 0.01).</p> Conclusion <p>Applying an AI-based algorithm to TAVR planning CT scans can reveal a high rate of 43% patients having osteoporosis. Osteoporosis may represent a marker related to frailty and worsened outcome in TAVR patients.</p> Graphical Abstract <p></p>

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Opportunistic computed tomography (CT) assessment of osteoporosis in patients undergoing transcatheter aortic valve replacement (TAVR)

  • 期刊论文

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  • 发表日期：

    2025年7月17日

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  • Michael Paukovitsch,
  • Tom Fechner,
  • Dominik Felbel,
  • Johannes Moerike,
  • Wolfgang Rottbauer,
  • Steffen Klömpken,
  • Horst Brunner,
  • Christopher Kloth,
  • Meinrad Beer,
  • Anjany Sekuboyina,
  • Dominik Buckert,
  • Jan S. Kirschke,
  • Nico Sollmann

摘要

Summary

CT-based opportunistic screening using artificial intelligence finds a high prevalence (43%) of osteoporosis in CT scans obtained for planning of transcatheter aortic valve replacement. Thus, opportunistic screening may be a cost-effective way to assess osteoporosis in high-risk populations.

Background

Osteoporosis is an underdiagnosed condition associated with fractures and frailty, but may be detected in routine computed tomography (CT) scans.

Methods

Volumetric bone mineral density (vBMD) was measured in clinical routine thoraco-abdominal CT scans of 207 patients for planning of transcatheter aortic valve replacement (TAVR) using an artificial intelligence (AI)-based algorithm.

Results

43% of patients had osteoporosis (vBMD < 80 mg/cm3 L1-L3) and were elderly (83.0 {interquartile range [IQR]: 78.0–85.5} vs. 79.0 {IQR: 71.8–84.0} years, p < 0.001), more often female (55.1 vs. 28.8%, p < 0.001), and had a higher Society of Thoracic Surgeon’s score for mortality (3.0 {IQR:1.8–4.6} vs. 2.1 {IQR: 1.4–3.2}%, p < 0.001). In addition to lumbar vBMD (58.2 ± 14.7 vs. 106 ± 21.4 mg/cm3, p < 0.001), thoracic vBMD (79.5 ± 17.9 vs. 127.4 ± 26.0 mg/cm3, p < 0.001) was also significantly reduced in these patients and showed high diagnostic accuracy for osteoporosis assessment (area under curve: 0.96, p < 0.001). Osteoporotic patients were significantly more often at risk for falls (40.4 vs. 22.9%, p = 0.007) and required help in activities of daily life (ADL) more frequently (48.3 vs. 33.1%, p = 0.026), while direct-to-home discharges were fewer (88.8 vs. 96.6%, p = 0.026). In-hospital bleeding complications (3.4 vs. 5.1%), stroke (1.1 vs. 2.5%), and death (1.1 vs. 0.8%) were equally low, while in-hospital device success was equally high (94.4 vs. 94.9%, p > 0.05 for all comparisons). However, one-year probability of survival was significantly lower (84.0 vs. 98.2%, log-rank p < 0.01).

Conclusion

Applying an AI-based algorithm to TAVR planning CT scans can reveal a high rate of 43% patients having osteoporosis. Osteoporosis may represent a marker related to frailty and worsened outcome in TAVR patients.

Graphical Abstract