Nova tecnologia REMS (Radiofrequência ecográfica de espectrometria múltipla) comparada à DXA (absorciometria por duplo feixe de raios-X) na avaliação óssea de mulheres adultas: uma experiência de vida real
Data
2023-12-14
Orientadores
Castro, Marise Lazaretti 
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Radiofrequência ecográfica de espectrometria múltipla (REMS) é uma tecnologia de avaliação óssea densitométrica desenvolvida para ser um método alternativo ao padrão-ouro Absorciometria por duplo feixe de raios-X (DXA). Discute-se que sua análise poderia ser influenciada por propriedades da qualidade óssea. O objetivo desta tese foi avaliar a acurácia de REMS no diagnóstico de osteoporose por DXA, a precisão do método e sua correlação com outros parâmetros de fragilidade óssea como o Escore de osso trabecular (TBS) e o FRAX. Materiais e métodos: Uma população de mulheres de 30 a 80 anos e IMC <40kg/m2 foi recrutada no serviço de DXA do Hospital São Paulo para avaliação óssea de coluna lombar e fêmur por REMS e DXA. Após exclusão de exames com erros técnicos, foram calculadas a acurácia e precisão de REMS. Posteriormente, o TBS foi aplicado aos exames de DXA e pacientes com IMC>37kg/m2 e idade menor do que 40 anos foram excluídos a fim de evitar interferência na acurácia do TBS e para realizar o cálculo da estimativa do risco de fratura por FRAX, respectivamente. Revisão de prontuário e contato telefônico foram realizados para obtenção de dados clínicos. Resultados: Um total de 343 pacientes foram avaliados por REMS e DXA, entretanto 227 exames de coluna lombar e 238 exames de fêmur foram comparáveis, após exclusão de exames com erros técnicos por ambos os métodos. Encontradas fortes correlações entre DMO por REMS e DXA em coluna lombar (r=0,75, p<0,001) e colo femoral (r=0,78, p<0,001). A diferença média entre DMOs pelos métodos foi de −0,026±0,179 g/cm2 em coluna lombar e de −0,027±0,156 g/cm2 em colo femoral. Nenhum exame definido como osteoporose pela DXA foi classificado como normal por REMS, quando aplicada uma tolerância de 0,3 no T-score por REMS. A mínima variação significativa (MVS) considerando a avaliação por um único operador foi de 1,41% em coluna lombar e 2,99% em colo femoral. Quanto à variabilidade inter-operadores, a MVS foi de 3,96% em coluna lombar e 5,35% em colo femoral. Em um segundo momento, 213 participantes tiveram DMO em coluna lombar por REMS e DXA comparadas com o índice do TBS. A correlação entre DMO por REMS e TBS foi baixa (r=0,27, p<0,001), assim como entre DMO por DXA e TBS (r=0,39, p<0,001). Um total de 119 participantes respondeu às chamadas telefônicas e foram avaliados quanto aos limiares de intervenção dependentes da idade para risco de fratura: 92% apresentaram concordância para o risco de fratura osteoporótica maior (κ=0,71, p<0,001) e 87% para o risco de fratura de quadril (κ=0,58, p<0,001) por REMS e DXA. Conclusões: O método REMS teve elevada acurácia para o diagnóstico de osteoporose por DXA em mulheres adultas e sua precisão foi comparável aos valores de DXA descritos em literatura. Os resultados sugerem que REMS e DXA são comparáveis na avaliação óssea baseada em densidade mineral e que REMS é uma alternativa promissora em especial para populações sem acesso à DXA.
Introduction: Radiofrequency Echographic Multi Spectometry (REMS) is a technology for the densitometric assessment of osteoporosis. The method was developed to be an alternative to the standard method Dualenergy Xray absorptiometry (DXA). Additionally, its assessment may be influenced by bone quality properties. This thesis aimed to evaluate the REMS accuracy for the osteoporosis diagnosis based on DXA and the precision of the method. Also, to evaluate REMS correlation with other parameters of bone fragility such as Trabecular Bone Score (TBS) and FRAX. Materials and methods: A female population aged between 30 and 80 years and BMI<40kg/m2 was recruited from the DXA Unit at Hospital São Paulo to perform bone evaluation by REMS and DXA at the lumbar spine and femur sites. After the exclusion of exams with technical errors, the REMS accuracy and precision were calculated. Later, TBS was applied to DXA exams. Participants with BMI>37 kg/m2 and younger than 40 years old were excluded to avoid interference with TBS accuracy and to estimate the fracture risk by FRAX, respectively. Hospital charters review, and personal and parental previous fractures were informed by phone calls. Results: A total of 343 participants were assessed by REMS and DXA, but 227 lumbar spine exams and 238 hip exams were acceptable for comparison analysis, after excluding scans with technical errors by both methods. Strong correlations were found between BMD measured by REMS and DXA in the lumbar spine (r=0.75, p<0.001) and femoral neck (r=0.78, p<0.001). The average difference in BMD was −0.026±0.179g/cm2 for the spine and −0.027±0.156g/cm2 for the femoral neck. When accepted 0.3 tolerance on Tscore, there were no cases diagnosed as osteoporosis by DXA that were defined as normal by REMS. Regarding REMS precision, the Least Significant Change (LSC) considering singleoperator assessments was 1.41% for lumbar spine and 2.99% for femoral neck. The LSC for interoperator assessments was 3.96% for lumbar spine and 5.35% for femoral neck. The correlation between lumbar spine BMD assessed by REMS and TBS was weak (r=0.27, p<0.001), mirroring DXA and TBS (r=0.39, p<0.001). A total of 119 participants responded to phone calls and were assessed for agedependent intervention thresholds: 92% showed concordance for major osteoporotic fracture risk (κ=0.71, p<0.001) and 87% for hip fracture risk (κ= 0.58, p<0.001) by REMS and DXA. Conclusions: The REMS approach had high accuracy for the diagnosis of osteoporosis based on DXA in adult women, and its precision was
Introduction: Radiofrequency Echographic Multi Spectometry (REMS) is a technology for the densitometric assessment of osteoporosis. The method was developed to be an alternative to the standard method Dualenergy Xray absorptiometry (DXA). Additionally, its assessment may be influenced by bone quality properties. This thesis aimed to evaluate the REMS accuracy for the osteoporosis diagnosis based on DXA and the precision of the method. Also, to evaluate REMS correlation with other parameters of bone fragility such as Trabecular Bone Score (TBS) and FRAX. Materials and methods: A female population aged between 30 and 80 years and BMI<40kg/m2 was recruited from the DXA Unit at Hospital São Paulo to perform bone evaluation by REMS and DXA at the lumbar spine and femur sites. After the exclusion of exams with technical errors, the REMS accuracy and precision were calculated. Later, TBS was applied to DXA exams. Participants with BMI>37 kg/m2 and younger than 40 years old were excluded to avoid interference with TBS accuracy and to estimate the fracture risk by FRAX, respectively. Hospital charters review, and personal and parental previous fractures were informed by phone calls. Results: A total of 343 participants were assessed by REMS and DXA, but 227 lumbar spine exams and 238 hip exams were acceptable for comparison analysis, after excluding scans with technical errors by both methods. Strong correlations were found between BMD measured by REMS and DXA in the lumbar spine (r=0.75, p<0.001) and femoral neck (r=0.78, p<0.001). The average difference in BMD was −0.026±0.179g/cm2 for the spine and −0.027±0.156g/cm2 for the femoral neck. When accepted 0.3 tolerance on Tscore, there were no cases diagnosed as osteoporosis by DXA that were defined as normal by REMS. Regarding REMS precision, the Least Significant Change (LSC) considering singleoperator assessments was 1.41% for lumbar spine and 2.99% for femoral neck. The LSC for interoperator assessments was 3.96% for lumbar spine and 5.35% for femoral neck. The correlation between lumbar spine BMD assessed by REMS and TBS was weak (r=0.27, p<0.001), mirroring DXA and TBS (r=0.39, p<0.001). A total of 119 participants responded to phone calls and were assessed for agedependent intervention thresholds: 92% showed concordance for major osteoporotic fracture risk (κ=0.71, p<0.001) and 87% for hip fracture risk (κ= 0.58, p<0.001) by REMS and DXA. Conclusions: The REMS approach had high accuracy for the diagnosis of osteoporosis based on DXA in adult women, and its precision was
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Citação
AMORIM, D.M.R. Nova tecnologia REMS (Radiofrequência ecográfica de espectrometria múltipla) comparada à DXA (absorciometria por duplo feixe de raios-X) na avaliação óssea de mulheres adultas: uma experiência de vida real. 2023. 90 f. Tese (Doutorado em Endocrinologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2023.