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Entropy and uniformity as additional parameters to optimize the effectiveness of bone CT in the evaluation of acromegalic patients

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Abstract

Purpose

Acromegaly is considered an important cause of secondary osteoporosis. However, studies on bone mineral density (BMD) have yielded conflicting results and there are few studies that evaluate an accurate imaging method for early diagnosis of osteoporosis in these patients. The objective of this study was to assess whether entropy and uniformity on computed tomography (CT) scans are useful parameters for optimization of assessment of bone fragility in patients with acromegaly.

Methods

We included 34 patients and 36 controls matched for age and sex in a cross-sectional study. Patients and controls underwent CT scan of the lumbosacral spine, dual-energy x-ray absorptiometry (DXA) and blood tests. A software was developed to calculate the entropy and uniformity by a region of interest (ROI) of the trabecular bone of the first lumbar vertebra (L1).

Results

The acromegalic group presented higher mean bone entropy (6.87 ± 0.98 vs. 6.03 ± 1.68, p = 0.013) and lower mean bone uniformity (0.035 ± 0.704 vs. 0.113 ± 0.205, p = 0.035) than control group. Analyzing only acromegalics, mean bone entropy was higher and bone uniformity was lower in patients with hypogonadism than patients without hypogonadism (7.28 ± 0.36 vs. 6.74 ± 1.08, p = 0.038 and 0.008 ± 0.002 vs. 0.043 ± 0.079, p = 0.031) respectively. Patients with acromegaly presented higher BMD and Z-score in the femoral neck than control group (1.156 ± 0.108 vs. 0.925 ± 0.326 g/cm2, p = 0.043 and 0.6 ± 0.6 vs. −0.05 ± 0.8, p = 0.041, respectively). Entropy was negatively correlated with T-score of the lumbar spine (rp = −0.357, p = 0.033) in control group and uniformity was positively correlated with T-score of the lumbar spine, neck, and total hip, respectively (rp = 0.371, p = 0.031; rp = 0.348, p = 0.043 and rp = 0.341, p = 0.049) in acromegalic group.

Conclusions

The study identified that entropy and uniformity are a relevant parameters data in bone fragility assessment in acromegalic patients.

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References

  1. I.M. Holdaway, C. Rajasoorya, Epidemiology of acromegaly. Pituitary 2, 29–34 (1999)

    Article  CAS  Google Scholar 

  2. A. Giustina, G. Mazziotti, E. Canalis, Growth hormone, insulin-like growth factors, and the skeleton. Endocr. Rev. 29, 535–559 (2008)

    Article  CAS  Google Scholar 

  3. S. Ezzat, S. Melmed, D. Endres, D.R. Eyre, F.R. Singer, Biochemical assessment of bone formation and resorption in acromegaly. J. Clin. Endocrinol. Metab. 76, 1452–1457 (1993)

    CAS  PubMed  Google Scholar 

  4. P.G. Lacativa, M.L. de Farias, Office practice of osteoporosis evaluation. Arq. Bras. Endocrinol. Metab. 50, 674–684 (2006)

    Article  Google Scholar 

  5. E.M. Lewiecki, A.J. Laster, Clinical review: clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J. Clin. Endocrinol. Metab. 91, 4215–4222 (2006)

    Article  CAS  Google Scholar 

  6. M. Bolanowski, J. Daroszewski, M. Medras, B. Zadrozna-Sliwka, Bone mineral density and turnover in patients with acromegaly in relation to sex, disease activity, and gonadal function. J. Bone Miner. Metab. 24, 72–78 (2006)

    Article  Google Scholar 

  7. M.J. Wassenaar, N.R. Biermasz, N.A. Hamdy, M.C. Zillikens, J.B. van Meurs, F. Rivadeneira, A. Hofman, A.G. Uitterlinden, M.P. Stokkel, F. Roelfsema, M. Kloppenburg, H.M. Kroon, J.A. Romijn, A.M. Pereira, High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur. J. Endocrinol. 164, 475–83 (2011)

    Article  CAS  Google Scholar 

  8. J.T. Schousboe, T. Vokes, S.B. Broy, L. Ferrar, F. McKiernan, C. Roux, N. Binkley, Vertebral fracture assessment: the 2007 ISCD official positions. J. Clin. Densitom. Off. J. Int. Soc. Clin. Densitom. 11, 92–108 (2008)

    Article  Google Scholar 

  9. P.J. Pickhardt, B.D. Pooler, T. Lauder, A.M. del Rio, R.J. Bruce, N. Binkley, Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann. Intern. Med. 158, 588–595 (2013)

    Article  Google Scholar 

  10. C. Eller-Vainicher, A. Falchetti, L. Gennari, E. Cairoli, F. Bertoldo, F. Vescini, A. Scillitani, L. Chiodini, Evaluation of bone fragility in endocrine disorders. Imaging Endocr. Osteoporos. 180, 213–232 (2019)

    Google Scholar 

  11. E.T. Jaynes, Information theory and statistical mechanics. Phys. Rev. J. Arch. 106, 620–630 (1957)

    Article  Google Scholar 

  12. S. Melmed, F.F. Casanueva, A. Klibanski, M.D. Bronstein, P. Chanson, S.W. Lamberts, C.J. Strasburger, J.A. Wass, A. Giustina, A consensus on the diagnosis and treatment of acromegaly complications. Pituitary 16, 294–302 (2013)

    Article  CAS  Google Scholar 

  13. J. Halupczok-Żyła, A. Jawiarczyk-Przybyłowska, M. Bolanowski, Patients with active acromegaly are at high risk of 25(OH) D deficiency. Front. Endocrinol. 2, 89–95 (2015)

    Google Scholar 

  14. J.T. Schousboe, J.A. Shepherd, J.P. Bilezikian, S. Baim, Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J. Clin. Densitom. 16, 455–466 (2013)

    Article  Google Scholar 

  15. B. Ganeshan, K.A. Miles, R.C. Young, C.R. Chatwin, Hepatic entropy and uniformity: additional parameters that can potentially increase the effectiveness of contrast enhancement during abdominal CT. Clin. Radiol. 62, 761–768 (2007)

    Article  CAS  Google Scholar 

  16. R. M. Gray, Entropy and Information Theory. (Springer, 2011)

  17. J. E. Shore, R. M. Gray, Minimum cross-entropy pattern classification and cluster analysis. IEEE Trans. Pattern Anal. Mach. Intell. 1, 11–17 (1982)

    Article  Google Scholar 

  18. T. Jalava, S. Sarna, L. Pylkkanen, B. Mawer, J.A. Kanis, P. Selby, M. Davies, J. Adams, R.M. Francis, J. Robinson, E. McCloskey, Association between vertebral fracture and increased mortality in osteoporotic patients. J. Bone Miner. Res. 18, 1254–1260 (2003)

    Article  Google Scholar 

  19. K. Fujimoto, T. Tonan, S. Azuma, M. Kage, T. Nakashima, J. Naofumi, H. Koji, K. Takumi, M. Sata, A. Qayyum, Evaluation of the mean and entropy of apparent diffusion coefficient values in chronic hepatitis C: correlation with pathologic fibrosis stage and inflammatory activity grade. Radiology 258, 739–748 (2011)

    Article  Google Scholar 

  20. M. Kolancinski, M. Kozakiewicz, A. Materka, Textual entropy as a potential feature for quantitative assessment of a jaw bone healing process. Arch. Med. Sci. 11, 78–84 (2015)

    Article  Google Scholar 

  21. L. Dercle, S. Ammari, M. Bateson, Limits of radiomic-based entropy as a surrogate of tumor heterogeneity: ROI-area, acquisition protocol and tissue site exert substantial influence. Sci. Rep. 7, 1–10 (2017)

    Article  CAS  Google Scholar 

  22. G.P. Lesse, W.D. Fraser, R. Farquharson, L. Hipkin, J.P. Vora, Gonadal status is an important determinant of bone density in acromegaly. Clin. Endocrinol. 48, 59–65 (1998)

    Article  CAS  Google Scholar 

  23. S. Bonadonna, G. Mazziotti, M. Nuzzo, A. Bianchi, A. Fusco, L. De Marinis, A. Giustina, Increased prevalence of radiological spinal deformities in active acromegaly: a cross-sectional study in postmenopausal women. J. Bone Miner. Res. 20, 1837–1844 (2005)

    Article  Google Scholar 

  24. G. Mazziotti, A. Bianchi, S. Bonadonna, V. Cimino, I. Patelli, A. Fusco, A. Pontecorvi, L. De Marinis, A. Giustina, Prevalence of vertebral fractures in men with acromegaly. J. Clin. Endocrinol. Metab. 93, 4649–4655 (2008)

    Article  CAS  Google Scholar 

  25. A. Scillitani, C. Battista, I. Chiodini, V. Carnevale, S. Fusilli, E. Ciccarelli, M. Terzolo, G. Oppizzi, M. Arosio, M. Gasperi, G. Arnaldi, A. Colao, R. Baldelli, M.R. Ghiggi, D. Gaia, C. Di Somma, V. Trischitta, A. Liuzzi, Bone mineral density in acromegaly: the effect of gender, disease activity and gonadal status. Clin. Endocrinol. 58, 725–731 (2003)

    Article  CAS  Google Scholar 

  26. W. Zgliczynski, M. Kochman, W. Misiorowski, P. Zdunowski, In acromegaly, increased bone mineral density (BMD) is determined by GH-excess, gonadal function and gender. Neuro Endocrinol. Lett. 28, 621–628 (2007)

    CAS  PubMed  Google Scholar 

  27. M. Madeira, V.L. Neto, F.P.P. Neto, I.C.B.L. Lima, L.M.C.M. Mendonça, M.R. Gadelha, M.L.F. Farias, Acromegaly has a negative influence on trabecular bone, but not on cortical bone, as assessed by high-resolution peripheral quantitative computed tomography. J. Clin. Endocrinol. Metab. 98, 1734–1741 (2013)

    Article  CAS  Google Scholar 

  28. G. Mazziotti, M. Gola, M. Bianchi, T. Porcelli, A. Giampietro, V. Cimino, M. Doga, C. Gazzaruso, L. Marinis, A. Giustina, Influence of diabetes mellitus on vertebral fractures in men with acromegaly. Endocrine 40, 102–108 (2011)

    Article  CAS  Google Scholar 

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Acknowledgements

The authors are grateful for the help of Dra. Jane Lynn Garrison Dytz and Edison Dytz who contributed significantly to this project.

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Authors and Affiliations

  1. Department of Endocrinology, University Hospital of Brasilia, University of Brasilia, Brasilia, Brazil

    Olga de Castro Dytz, Márcio Garrison Dytz, Bernardo Alves Barbosa, Armindo Jreige Júnior, Arthur Disegna, Luiz Augusto Casulari & Luciana Ansaneli Naves

  2. Faculty of Medicine, University of Brasilia, Brasilia, Brazil

    Pedro de Azevedo Berger, Armindo Jreige Júnior, Arthur Disegna, Luiz Augusto Casulari & Luciana Ansaneli Naves

  3. Department of Computer Science, University of Brasilia, Brasilia, Brazil

    Pedro de Azevedo Berger

  4. Department of Radiology, University Hospital of Brasilia, University of Brasilia, Brasilia, Brazil

    Neysa Aparecida Tinoco Reggatieri & Wagner Diniz de Paula

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  1. Olga de Castro Dytz
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Correspondence to Olga de Castro Dytz.

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Informed consent was obtained from all individual participants included in the study.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of Ethics Committee of the Faculty of Health Sciences of the University of Brasilia (approval number 1.178.769) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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de Castro Dytz, O., de Azevedo Berger, P., Dytz, M.G. et al. Entropy and uniformity as additional parameters to optimize the effectiveness of bone CT in the evaluation of acromegalic patients. Endocrine 69, 368–376 (2020). https://doi.org/10.1007/s12020-020-02358-6

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