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This study aimed to evaluate the impact of contrast media application on CT attenuation of the bone using a novel calcium-only imaging technique (VCa) from dual-layer spectral detector CT (DLCT), which enables CT-based bone mineral density measurement unimpeded by soft tissue components. For this, true non-contrast (TNC) and venous phase images (VP) of n = 97 patients were acquired. CT attenuation of the first lumbar vertebra (L1) was measured in TNC-VCa, VP-VCa, and in virtual non-contrast images (VNC). CT attenuation was significantly higher in VP-VCa than in TNC-VCa (p < 0.001), although regression analyses revealed a strong linear association between these measures (R2 = 0.84). A statistical model for the prediction of TNC-VCa CT attenuation was established (TNC-VCa[HU] = − 6.81 + 0.87 × VP-VCa[HU]-0.55 × body weight[kg]) and yielded good agreement between observed and predicted values. Furthermore, a L1 CT attenuation threshold of 293 HU in VP-VCa showed a sensitivity of 90% and a specificity of 96% for detecting osteoporosis. The application of contrast media leads to an overestimation of L1 CT attenuation in VCa. However, CT attenuation values from VP-VCa can be used within CT-based opportunistic osteoporosis screening eighter by applying a separate threshold of 293 HU or by converting measured data to TNC-VCa CT attenuation with the given regression equation. [ABSTRACT FROM AUTHOR]

Background: The evidence regarding effects of statins on exacerbation risk in COPD remains controversial. Previous studies often excluded patients with cardiovascular comorbidities despite their high prevalence in COPD and role for exacerbations. Based on the cardioprotective properties of statins, we hypothesised that statins may reduce the risk of exacerbations especially in patients with cardiovascular comorbidities. Methods: One thousand eight hundred eighty seven patients of the German COPD cohort COSYCONET (COPD and Systemic Consequences Comorbidities Network) of GOLD grades 1–4 (37.8% female, mean age 64.78 ± 8.3) were examined at baseline and over a period of 4.5 years for the occurrence of at least one exacerbation or severe exacerbation per year in cross-sectional and longitudinal analyses adjusted for age, gender, BMI, GOLD grade and pack-years. Due to their collinearity, various cardiovascular diseases were tested in separate analyses, whereby the potential effect of statins in the presence of a specific comorbidity was tested as interaction between statins and comorbidity. We also identified patients who never took statins, always took statins, or initiated statin intake during the follow-up. Results: One thousand three hundred six patients never took statins, 31.6% were statin user, and 12.9% initiated statins during the follow-up. Most cardiovascular diseases were significantly (p < 0.05)may associated with an increased risk of COPD exacerbations, but in none of them the intake of statins was a significant attenuating factor, neither overall nor in modulating the increased risk linked to the specific comorbidities. The results of the cross-sectional and longitudinal analyses were consistent with each other, also those regarding at least 1 exacerbation or at least 1 severe exacerbation per year. Conclusion: These findings complement the existing literature and may suggest that even in patients with COPD, cardiovascular comorbidities and a statin therapy that targets these comorbidities, the effects of statins on exacerbation risk are either negligible or more subtle than a reduction in exacerbation frequency. Trial registration: Trial registration ClinicalTrials.gov, Identifier: NCT01245933. Other Study ID (BMBF grant): 01GI0881, registered 18 November 2010, study start 2010–11, primary completion 2013–12, study completion 2023–09. https://clinicaltrials.gov/study/NCT01245933?cond=COPD&term=COSYCONET&rank=3 [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a novel calcium-only imaging technique (VCa) with subtracted bone marrow in osteoporosis in dual-layer CT (DLCT) compared to conventional CT images (CI) and dual-energy X-ray absorptiometry (DXA)., Material and Methods: Images of a multi-energy CT phantom with calcium inserts, quantitative CT calibration phantom, and of 55 patients (mean age: 64.6 ± 11.5 years) were acquired on a DLCT to evaluate bone mineral density (BMD). CI, calcium-suppressed images, and VCa were calculated. For investigating the association of VCa and CI with DXA a subsample of 30 patients (<90 days between DXA and CT) was used. Multiple regression analysis was performed to identify further factors improving the prediction of DXA BMD., Results: The calcium concentrations of the CT phantom inserts were significantly associated with CT numbers from VCa (R 2  = 0.94) and from CI (R 2  = 0.89-0.92). VCa showed significantly higher CT numbers than CI in the phantom (p ≤ 0.001) and clinical setting (p < 0.001). CT numbers from VCa were significantly associated with CI (R 2  = 0.95, p < 0.001) and with DXA (R 2  = 0.31, p = 0.007), whereas no significant association between DXA and CI was found. Prediction of DXA BMD based on CT numbers derived from VCa yielded R 2  = 0.76 in multiple regression analysis. ROC for the differentiation of normal from pathologic BMD in VCa yielded an AUC of 0.7, and a cut-off value of 126HU (sensitivity: 0.90; specificity: 0.47)., Conclusion: VCa images showed better agreement with DXA and known calcium concentrations than CI, and could be used to estimate BMD. A VCa cut-off of 126HU could be used to identify abnormal bone mineral density., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Stephan Skornitzke has ownership interests in investment funds containing stock of healthcare companies. Dr. Stephan Skornitzke has become an employee of Philips Healthcare after his work on this study. Dr. Wolfram Stiller is a member of the CT Advisory Board of Philips Medical Systems. Dr. Thuy Duong Do was supported by the Olympia-Morata research grant by the Medical Faculty of the University of Heidelberg. Prof. Hans-Ulrich Kauczor receives grant support by Philips Medical Systems (paid to the institution) and honoraria from the speaker’s bureau. Otherwise, the authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: MRproANP and COPAVP are prognostic markers for mortality in chronic obstructive pulmonary disease (COPD). Furthermore, these biomarkers predict mortality due to cardiovascular diseases, which are important prognostically determining comorbidities in patients with COPD. However, less is known about these biomarkers in recently diagnosed mild to moderate COPD. Therefore, we analyzed these biomarkers as potential predictors of mortality in recently diagnosed mild to moderate COPD., Methods: The blood biomarkers considered were copeptin (COPAVP), midregional adrenomedullin (MRproADM), midregional proatrial naturetic peptide (MRproANP), and fibrinogen. Analyses were performed in patients with stable "recently diagnosed mild to moderate COPD" defined by GOLD grades 0-2 and diagnosis of COPD ≤ 5 years prior to inclusion into the COSYCONET cohort (COPD and Systemic Consequences-Comorbidities Network), using Cox regression analysis with stepwise adjustment for multiple COPD characteristics, comorbidities, troponin and NT-proBNP., Results: 655 patients with recently diagnosed mild to moderate COPD were included. In the initial regression model, 43 of 655 patients died during the 6-year follow-up, in the final model 27 of 487. Regression analyses with adjustment for confounders identified COPAVP and MRproANP as statistically robust biomarkers (p < 0.05 each) of all-cause mortality, while MRproADM and fibrinogen were not. The fourth quartile of MRproANP (97 pmol/L) was associated with a hazard ratio of 4.5 (95%CI: 1.6; 12.8), and the fourth quartile of COPAVP (9.2 pmol/L) with 3.0 (1.1; 8.0). The results for MRproANP were confirmed in the total cohort of grade 0-4 (n = 1470 finally)., Conclusion: In patients with recently diagnosed mild to moderate COPD, elevated values of COPVP and in particular MRproANP were robust, independent biomarkers for all-cause mortality risk after adjustment for multiple other factors. This suggests that these markers might be considered in the risk assessment of early COPD., (© 2024. The Author(s).)