Purpose This study aimed to examine the discrepancy in osteoporosis diagnoses between central quantitative computed tomography(cQCT) and dual-energy X-ray absorptiometry(DXA) and evaluated correlations among volumetric bone mineral density(vBMD), areal BMD(aBMD), and trabecular bone score(TBS) in postmenopausal women who were undergoing thyrotropin(TSH) suppressive therapy. Methods We enrolled a total of 81 postmenopausal patients(median age:58 years; interquartile range[IQR]:57–60 years) undergoing TSH suppressive therapy with levothyroxine after receiving total thyroidectomy for papillary thyroid cancer. The aBMD and TBS of the lumbar spine were generated using DXA and the vBMD was generated using cQCT. Patients were diagnosed based on their BMD T-score and categorized according to a vBMD threshold of 120 mg/cm³ for osteopenia and one of 80 mg/cm³ for osteoporosis. Results Comparing DXA and cQCT, the BMD evaluation results differed in 76% of patients(n=62;p<0.001) and the detection rate of osteoporosis was 30.9% for cQCT and 21.0% for DXA. Among 62 patients with discordant results, the diagnosis of 74% patients(n=46) whose DXA T-scores were normal shifted to osteopenia(n=35) and osteoporosis(n=11) according to the vBMD on cQCT(p<0.001), and their vBMD values were significantly correlated with TBS(r=0.293,p=0.008). However, aBMD was not significantly correlated with TBS(r=0.080,p=0.480). TBS was significantly lower in patients with osteopenia(median:1.35;IQR:1.18–1.47) and osteoporosis(median:1.28;IQR:1.07–1.47) than in those with a normal BMD value(median:1.37;IQR:1.25–1.49, p=0.041) on cQCT. There was no significant difference in TBS according to DXA BMD status(p=0.200). Conclusions DXA and cQCT yielded inconsistent results, and detection of osteopenia and osteoporosis was higher using cQCT. TBS showed a more significant correlation with vBMD than with aBMD.

Objective: This study compared the diagnostic performance of three different imaging modalities for preoperative lymph node (LN) staging in thyroid cancer patients, using a network meta-analysis (NMA). Methods: PubMed and Embase were searched to identify studies evaluating the performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET or PET/CT), computed tomography (CT), and ultrasonography (US) for preoperative LN staging in thyroid cancer patients. The NMA included both patient- and lesion-based analyses. The surface under the cumulative ranking curve (SUCRA) values was used to decide on the most effective diagnostic method. Results: A total of 3,571 patients from 19 direct comparison studies using three different imaging modalities for preoperative LN staging in thyroid cancer patients were included. US showed the highest SUCRA values for positive predictive values (PPV), negative predictive values (NPV), and accuracy in detection of all cervical LN metastasis. F-18 FDG PET or PET/CT and US showed the highest SUCRA values for PPV and sensitivity, respectively, for central LN, and the highest SUCRA value of specificity and sensitivity, respectively, for lateral LN. Conclusion: The results from this NMA indicate that F-18 FDG PET or PET/CT, CT, and US have complementary diagnostic roles for preoperative staging in thyroid cancer patients. Advances in knowledge: Using NMA, we comprehensively compared the different diagnostic values and limitations of F-18 FDG PET or PET/CT, CT, and US for the preoperative LN staging in thyroid cancer patients.

We evaluated the associations between metabolic parameters with visceral adipose tissue (VAT) volume in women with prediabetes or type 2 diabetes (T2DM), and we compared the VAT volume with the VAT area. We enrolled women aged > 20 years with prediabetes or T2DM, who underwent oral glucose tolerance test and whose VAT was evaluated using computed tomography (CT) at our institution between 2017 and 2019. All participants underwent unenhanced spiral CT with a 3-mm slice thickness from the level of the diaphragm to the level of the mid-thigh. The two VAT areas were defined as the free drawn area on the levels of the umbilicus and L2 vertebra. The VAT areas were also manually drawn from the level of the diaphragm to the level of the pelvic floor and were used to calculate the VAT volumes by summing all areas with a slice thickness of 3 mm after setting the attenuation values from −45 to −195 Hounsfield Unit. All metabolic characteristics, except blood pressure, were significantly correlated with the VAT volume. The VAT areas measured at the level of the L2 vertebra and umbilicus were correlated with serum triglyceride, high-density lipoprotein cholesterol, and Framingham steatosis index alone. Multivariable regression analyses revealed that the VAT volume was significantly associated with several metabolic parameters. In conclusion, in women with prediabetes and T2DM, the VAT volume acquired from CT-based calculation has more significant correlations with metabolic risk factors compared with the VAT area.

Visceral adipose tissue (VAT) is a well-established risk factor for the development of diabetes in individuals with prediabetes. We aimed to evaluate various adiposity and metabolic indices, including visceral adipose tissue (VAT) volume measured by CT, in individuals with prediabetes, based on their different subtypes. This retrospective study included 78 prediabetes individuals aged ≥ 20 years whose VAT volumes were evaluated by CT. Individuals were classified into prediabetes subtypes: impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG and IGT (C-IFG/IGT). We conducted a comparison of the patients’ adiposity indices and their associations with one other, as well as with insulin resistance, based on the different prediabetes subtypes. Individuals with C-IFG/IGT had higher levels of visceral obesity than those with IFG or IGT. VAT volume was more strongly associated with insulin resistance than other adiposity indices, regardless of prediabetes subtypes. Additionally, VAT volume and liver attenuation index showed a significant correlation with the other indices studied across the prediabetes subtypes. CT-based measurement of VAT volume may be a valuable tool for evaluating metabolic risk factors among individuals with prediabetes.

The diagnostic criteria proposed by the World Health Organization did not consider the discrepancy in diagnosis between lumbar spine (LS) and femoral neck (FN) and the clinical implications is unclear. Therefore, this retrospective study evaluated the probability of fracture risk in postmenopausal women with lumbar spine (LS)-femoral neck (FN) bone mineral density (BMD) discordance or not Patients included 1066 healthy postmenopausal women (median age 55.5 years) who visited our hospital for a health check-up between May 2013 and April 2017. Discordance was defined as a difference of one or two degrees between LS BMD and FN BMD. TBS was calculated from dual energy absorptiometry (DXA) images. Fracture risk was assessed using the Fracture Risk Assessment Tool (FRAX), including TBS-adjusted FRAX Seven hundred and two patients (65.9%) showed concordant LS and FN results, whereas 364 patients (34.1%) exhibited discordance. Normal BMD was found in 519 concordant patients (73.9%). Concordant patients showed significantly higher FRAX scores, including TBS-adjusted FRAX results, than discordant patients with low LS or FN. Furthermore, FRAX results in concordant osteopenia patients were similar to that of osteoporosis patients with osteopenia or a normal result at one site. FRAX and TBS-adjusted FRAX results in concordant osteopenia patients were comparable to that of discordant osteoporosis patients We concluded that patients with colncordant osteopenia in both the FN and LS should be managed in a similar way to patients with discordant osteoporosis.