Treatment Planning and Fracture Prediction in Patients with Skeletal Metastasis with CT-Based Rigidity Analysis

Area of Science:

• Orthopedics
• Oncology
• Radiology
• Medical Imaging

Background:

• Pathologic fractures from skeletal metastases pose a significant clinical challenge.
• Accurate fracture risk assessment is crucial for timely intervention and prevention.
• Current methods may lack the precision needed for optimal treatment planning.

Purpose of the Study:

• To evaluate the effectiveness of CT-based Rigidity Analysis (CTRA) in predicting fracture risk for skeletal metastases.
• To identify predictors influencing physicians' treatment plans for metastatic bone lesions.
• To compare CTRA's performance against the established Mirels method.

Main Methods:

• A multicenter prospective study involving 124 patients with 149 metastatic lesions.
• Physicians initially determined treatment plans using the Mirels method.
• Treatment plans were reassessed after CTRA results were provided, and changes were recorded.
• Patient follow-up assessed fracture incidence over 4 months.

Main Results:

• Pain, lesion type, and size predicted initial treatment plans.
• CTRA results led to treatment plan modifications in 36 patients.
• CTRA demonstrated 100% sensitivity and 90% specificity in predicting fractures, outperforming the Mirels method (71% sensitivity, 50% specificity).

Conclusions:

• CTRA significantly influences physicians' treatment decisions for skeletal metastases.
• CTRA shows high sensitivity and specificity, making it a promising tool for pathologic fracture screening.
• Integrating CTRA into clinical practice could enhance fracture risk assessment and patient management.