Distal Radius in Adolescent Girls with Anorexia Nervosa: Trabecular Structure Analysis with High-Resolution Flat-Panel Volume CT

doi:10.1148/radiol.2492080173

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Musculoskeletal Imaging

Distal Radius in Adolescent Girls with Anorexia Nervosa: Trabecular Structure Analysis with High-Resolution Flat-Panel Volume CT¹

Miriam A. Bredella, MD, Madhusmita Misra, MD, MPH, Karen K. Miller, MD, Ijad Madisch, MD, Ammar Sarwar, MD, Arnold Cheung, MD, Anne Klibanski, MD, and Rajiv Gupta, MD, PhD

¹ From the Department of Radiology (M.A.B., I.M., A.S., A.C., R.G.), and Neuroendocrine Unit, Department of Medicine (M.M., K.K.M., A.K.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Boston, Mass (M.M.). Received January 26, 2008; revision requested March 19; revision received April 3; accepted April 28; final version accepted May 13. Supported by National Institutes of Health grants ROI DK062249, K23 RR018851, and MO1 RR01066. Address correspondence to M.A.B. (e-mail: mbredella{at}partners.org).

Purpose: To examine trabecular microarchitecture with high-resolutionflat-panel volume computed tomography (CT) and bone mineral density(BMD) with dual-energy x-ray absorptiometry (DXA) in adolescent girlswith anorexia nervosa (AN) and to compare these results with thosein normal-weight control subjects.

Materials and Methods: The study was approved by the institutionalreview board and complied with HIPAA guidelines. Informed consentwas obtained. Twenty adolescent girls, 10 with mild AN (mean age,15.9 years; range, 13–18 years) and 10 age- and sex-matchednormal-weight control subjects (mean age, 15.9 years; range, 12–18years) underwent flat-panel volume CT of distal radius to determineapparent trabecular bone volume fraction (BV/TV), apparent trabecularnumber (TbN), apparent trabecular thickness (TbTh), and apparenttrabecular separation (TbSp). All subjects underwent DXA of spine,hip, and whole body to determine BMD and body composition. The meansand standard deviations (SDs) of structure parameters were calculatedfor AN and control groups. Groups were compared (Student t test).Linear regression analysis was performed.

Results: AN subjects compared with control subjects, respectively,showed significantly lower mean values for BV/TV (0.37% ±0.05 [SD] vs 0.46% ± 0.03, P = .0002) and TbTh (0.31 mm ±0.03 vs 0.39 mm ± 0.03, P < .0001) and higher mean valuesfor TbSp (0.54 mm ± 0.13 vs 0.44 mm ± 0.04, P = .02).TbN was lower in AN subjects than in control subjects, but the differencewas not significant (1.17 mm^–3 ± 0.15 vs 1.22 mm^–3± 0.07, P = .43). There was no significant difference in BMDbetween AN and control subjects. BMD parameters showed positive correlationwith BV/TV and TbTh in the control group (r = 0.55–0.84, P= .05–.01) but not in AN patients.

Conclusion: Flat-panel volume CT is effective in evaluation of trabecularstructure in adolescent girls with AN and demonstrates that bonestructure is abnormal in these patients compared with that in normal-weightcontrol subjects despite normal BMD.