Radiofrequency Echographic Multi Spectrometry Research Articles

POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.

POS1111 DIAGNOSIS OF OSTEOPOROSIS USING RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) AT THE LUMBAR SPINE IN PATIENTS WITH DIFFERENT BODY MASS INDEX

Background:In recent years, the technology based on the analysis of raw ultrasound signals, Radiofrequency Echographic Multi Spectrometry (REMS), has been validated against Dual-energy X-ray Absorptiometry (DXA) for the diagnosis of osteoporosis and risk fracture prediction.Objectives:The aim of this multicenter observational study was to evaluate the diagnostic performance of REMS with respect to DXA in patients with different body mass index (BMI) categories.Methods:The inclusion criteria were: Caucasian women; age between 30 and 90 years; referral by their clinician for spinal DXA assessment; absence of significant walking impairment; signed informed consent.Patients underwent DXA and REMS scans at the lumbar spine, according to the procedures described in Di Paola et al. [1], including an a-posteriori quality check of the examinations in order to guarantee the maximum reliability of the diagnostic outputs.Three groups of patients were considered according to BMI:: underweight (BMI<18.5 kg/m2), normal weight (BMI≥18.5 kg/m2 and <25 kg/m2), and overweight/obese (BMI≥25 kg/m2). DXA and REMS BMD values were also stratified in 3 diagnostic categories: osteoporotic, osteopenic, or healthy.The degree of correlation between DXA and REMS BMD values was quantified by calculating Pearson’s correlation coefficient (r). The diagnostic concordance between REMS and DXA was assessed by Cohen’s K considering the 3 diagnostic categories. REMS´s sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for discriminating patients with and without osteoporosis were also calculated using DXA outcomes as reference. The same statistics were calculated accepting a 0.3 T-score tolerance on T-score values of borderline cases [1].Results:Overall, 4282 patients were enrolled and, after the quality check, 3501 couples of scans were included in the analyses. Of these patients, 122 (3.5%) were underweight, 1964 (56.1%) were normal weight, and 1415 (40.4%) were overweight. The results of the diagnostic performance in patients after BMI stratification are reported in Table 1.Conclusion:We observed an excellent correlation between REMS-based diagnosis with respect to the osteoporosis diagnosis performed by DXA in patients from each BMI category. These results indicate that lumbar spine REMS analysis is a suitable and accurate diagnostic tool for patients with different BMI.

Radiofrequency Multi Echographic Spectrometry (REMS) Technology in Patients With Bone Artifacts

Introduction: Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard examination for the evaluation of bone mineral density (BMD). However, it is known that some conditions, such as arthrosis, vertebral collapse, or vertebroplasty, result in an overestimation of the BMD measured by DXA. Conversely, Radiofrequency Echographic Multi-Spectrometry (REMS) technology is able to automatically discard signals related to bone artifacts, such as calcifications or osteophytes, thanks to the identification of unexpected spectral features (Diez-Perez et al. 2019). The aim of this work is to assess the performance of REMS technology in patients with bone alterations that could alter the densitometric examination. Materials: The bone densitometry exams, both REMS and DXA, of patients with evidences of bone alterations at lumbar vertebrae or femoral neck were analysed. Written patient informed consent was obtained before the scans. Results: Eighty-seven patients with spinal artifacts, including 22 patients with vertebroplasty, 26 patients with bone fracture and 38 patients with osteo-arthrosis were considered. At lumbar spine, the mean BMD and T-score values assessed by REMS was lower than the ones measured by DXA. Moreover, the results obtained by the two technologies were not correlated. On the contrary, the BMD and T-score values measured by REMS and DXA at the femoral site were highly correlated (p<0.01), as well as BMD and the T-score values measured by DXA at the femoral neck and by REMS at the lumbar spine (p<0.01). As concerning artifacts involving femoral site, a patient with an intramedullary gamma nail positioned following a displaced pertrochanteric fracture of the left femur underwent a DXA scan of the right femur and a REMS scan of both femurs. A diagnosis of osteoporosis at the right femur was posed by both technologies. At the left femur with intramedullary gamma nail, REMS only made a diagnosis of osteoporosis highly corresponding with the one performed at right femur. Conclusions: The results from the patient series with spinal artifacts and the clinical case with femoral intramedullary gamma nail show the ability of REMS to evaluate anatomical sites that would not be assessable by DXA, such as in case of implanted nails, or that would give unreliable higher BMD values, such as in case of vertebroplasty, osteo-arthrosis and bone fracture.

Detection of low bone mineral density using radiofrequency echographic multi-spectrometry (REMS) in a pregnant woman with progressive scleroderma

Detection of low bone mineral density using radiofrequency echographic multi-spectrometry (REMS) in a pregnant woman with progressive scleroderma

481 First assessment of maternal status during pregnancy by means of radiofrequency echographic multi spectrometry technology

The maternal bone structure is the largest calcium reserve for the fetus during pregnancy, and this is claimed to lead to a bone mineral density (BMD) reduction in pregnant women. The aim of this study was to assess the maternal bone status at the end of pregnancy. In this prospective study a non-consecutive group of Caucasian women with uncomplicated pregnancy at or > 35 weeks were enrolled at the Department of Obstetrics and Gynecology, University of Parma from February to April 2020. The study subjects were submitted to a sonographic examination of the proximal femur with REMS technology. REMS (Radiofrequency Echographic Multi-Spectrometry) technology is a novel radiation-free technology that allows to quantify the bone mineral status on the two axial reference sites for the diagnosis of osteoporosis, namely the femur or the spine. To evaluate the bone status variation induced by pregnancy, the REMS-BMD values obtained in the study group were compared with those of a control group of non-pregnant women matched for age and BMI. Overall 71 women at 38.45+1.66 wks were assessed. Among these, maternal age and BMI were respectively 33.82±4.65 y and 23.79±4.09 Kg/m2. Compared with non-pregnant women the femoral REMS-BMD values measured in pregnancy were significant lower (0.762±0.087 vs 0.825±0.082 g/cm2, respectively; p<0.0001) with a mean BMD reduction of 8.2%." For the first time a decrease of bone mineral density has been objectively demonstrated in pregnant compared with non-pregnant women by means of REMS technology.

Bone densitometry by radiofrequency echographic multi-spectrometry (REMS) in acromegaly patients.

Radiofrequency echographic multi-spectrometry (REMS) is a recently introduced non-ionising technology employed in the evaluation of osteoporosis. The aim of our study was to compare bone mineral density (BMD) in acromegaly patients and healthy controls by performing novel REMS densitometry. The second objective was to analyse the correlation between results of REMS and classical dual-energy X-ray absorptiometry (DXA) in acromegaly patients. We enrolled 33 patients with acromegaly (AG) and 24 controls (CG). The acromegaly patients were divided into two subgroups: well-controlled acromegaly (WCA) and surgery-cured acromegaly (SCA). REMS was performed in all participants, while DXA was performed only in the acromegaly group. IGF-I and GH levels were measured in acromegaly patients. Bone mineral density of the lumbar spine (LS) and the femoral neck (FN) obtained from REMS did not reveal significant differences between AG, CG, WCA, and SCA. Similarly, there were no significant differences in BMD measured by DXA at the LS and at the FN between WCA and SCA. Significant positive correlations between IGF-I concentrations and BMD obtained from both REMS and DXA were detected in the AG and WCA. In the AG and WCA, there were positive correlations between T-scores and LS BMD obtained from both methods. Radiofrequency echographic multi-spectrometry is a potential method in assessment of bone status in acromegaly. Further studies with participation of active disease patients are needed.

Radiofrequency Echographic Multi Spectrometry (REMS) for the diagnosis of osteoporosis in a European multicenter clinical context.

Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology for the densitometric assessment of osteoporosis. It has already been validated in Italian women with respect to the current clinical reference technology, Dual-energy X-ray Absorptiometry (DXA). Aim of the current study was to assess the diagnostic accuracy of REMS technology with respect to DXA in a wider European clinical context. A total of 4307 female Caucasian patients aged between 30 and 90years underwent DXA and REMS scans at femoral neck and/or lumbar spine (the site depending on the medical prescription). The acquired data underwent a rigorous quality check in order to exclude the erroneous DXA and REMS reports. The diagnostic agreement between the two technologies was assessed, also stratifying for patients' age groups. The ability to recognise previously fractured patients was also investigated. Overall, 4245 lumbar spine scans and 4271 femoral neck scans were performed. The ability to discriminate patients with and without osteoporosis by femoral neck investigation resulted in sensitivity and specificity of 90.4% and 95.5%, respectively. For lumbar spine scans, a sensitivity of 90.9% and a specificity of 95.1% were obtained. The areas under the curve (AUCs) of the Receiver Operating Characteristic (ROC) curve evaluating the ability to discriminate groups of patients with previous osteoporotic fracture using DXA and REMS T-score values were 0.631 and 0.683 (p<0.0001), respectively, for femoral neck scans, whereas 0.603 and 0.640 (p=0.0002), respectively, for lumbar spine scans. The diagnostic effectiveness of REMS technology at reference anatomical sites for the assessment of osteoporosis has been confirmed in a large series of female patients, spanning from younger and pre-menopausal to elderly women up to 90years, in a multicenter European clinical context.

Radiofrequency Echographic Multi Spectrometry (REMS) evaluation in patients with primary osteoporosis and primary hyperparathyroidism

Radiofrequency Echographic Multi Spectrometry (REMS) evaluation in patients with primary osteoporosis and primary hyperparathyroidism

Quantitative bone assessment by radiofrequency echographic multi-spectrometry (REMS) in patients with acromegaly – a preliminary study

Quantitative bone assessment by radiofrequency echographic multi-spectrometry (REMS) in patients with acromegaly – a preliminary study

SAT0461 SHORT-TERM MONITORING OF DENOSUMAB EFFECT IN BREAST CANCER PATIENTS RECEIVING AROMATASE INHIBITORS USING REMS TECHNOLOGY ON LUMBAR SPINE

Background:Aromatase inhibitor (AI) therapy in women with estrogen receptor-positive (ER+) breast cancer (BC) causes accelerated bone loss and increased risk of osteoporosis and fractures as side effects. Denosumab (i.e. 60 mg twice a year) is a viable therapy against bone resorption, but the short-term monitoring of bone mineral density (BMD) change with time is still an unmet clinical need, since the current techniques (including dual-energy X-ray absorptiometry, DXA) require 1-2 years between two consecutive measurements [1]. Radiofrequency Echographic Multi Spectrometry (REMS), with high performance in terms of precision and repeatability [2], might be used in this setting of patients for short-term monitoring of bone health-related parameters.Objectives:The objective is the short-term monitoring of the effect of AIs with/without denosumab on bone health in BC patients using REMS and DXA scans at lumbar spine.Methods:Post-menopausal ER+ BC patients treated with adjuvant AIs were recruited. Two subgroups were identified, whether receiving also 60 mg of denosumab therapy every 6 months or not (named Group A and Group B, respectively). All patients underwent baseline DXA and REMS lumbar spine scans at time T0, previous to the first AI therapy, and after 12 months (time T1). REMS scan only was repeated also at 18 months (T2), since a 6-month interval between two consecutive scans is not recommended for DXA. The bone mineral density (BMD) was measured with both techniques.Results:Overall, 254 ER+ BC patients were enrolled (127 per group). The effect of denosumab on BMD is reported in Table. The BMD values obtained by DXA and REMS were not significantly different at T0 and T1, whereas the difference between Group A and B at T1 was statistically significant (p&lt;0.001) both for REMS and DXA. At T2, REMS confirmed the increasing trend of BMD for Group A and the decreasing one for Group B, and the difference between groups was statistically significant (p&lt;0.001). For each time point and each group, there were not statistically significant differences between DXA and REMS.Conclusion:Several studies have shown the effect of denosumab on BMD over a period not less than 2 years from the start of treatment. This study showed the feasibility of short-term follow-up using REMS lumbar spine scans at 6-month time steps.

SUN-LB74 Radiofrequency Echographic Multi-Spectrometry (REMS) for the Assessment of Bone Strength and Fracture Risk Prediction

Introduction Fragility bone fractures impact patient’s quality of life and worldwide healthcare systems: accurate technologies and device are required in order to early diagnose and monitor the effect of osteoporosis on a mass-population basis. Several studied have analysed the pros and cons of the numerous technologies available nowadays for the diagnosis and monitoring of bone health, highlighting the need of further tools able to better define and estimate bone strength and to predict the risk of fracture [1]. Objectives The aim is to assess the state of the art about Radiofrequency Echographic Multi-Spectrometry (REMS). Methods A review of the available literature was performed, considering full papers, reviews and abstracts on REMS published before January 31th 2020. Results REMS has been recently presented by an ESCEO consensus paper as a valuable technology for osteoporosis diagnosis and fracture risk estimation [1]. It is based on the automatic processing of the raw unfiltered signals obtained with an ultrasound scan, thus overcoming the main drawback of dual-energy X-ray absorptiometry (DXA) and computed tomography (CT)-based technologies [2]. Moreover, REMS scans are performed at axial skeleton reference sites, i.e. lumbar spine [3] and femoral neck [4], differently from quantitative ultrasound (QUS) technology, which is usually applied to peripheral sites [3]. Clinical performance has been confirmed by a multicentre clinical trial enrolling over 1900 Caucasian women, demonstrating a high correlation between bone mineral density (BMD) estimated by REMS and DXA. In addition, high performance in terms of precision and intra- and inter-operator repeatability of REMS have been assessed [6]. Prospective studies have demonstrated the predictive ability of incident fragility fractures [7] and the high concordance with DXA in terms of measured BMD in patients with rheumatoid arthritis and pre/post-menopause [8, 9]. Conclusions REMS is an innovative approach for the early diagnosis, short-term monitoring of osteoporosis and risk fracture prediction. The available data envisaged for further applications in paediatric patients, pregnant women and patients at risk of secondary osteoporosis (e.g., diabetic, nephropathic, oncological patients). The EchoS system, a device implementing the REMS technology, has recently received the approval from the U.S. Food and Drug Administration (FDA).

Radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures: A 5-year follow-up study.

To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures. A population of Caucasian women (30-90years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F' and Group NF', respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA. 1516 patients were enrolled and 1370 completed the follow-up (mean±SD: 3.7±0.8years; range: 1.9-5.0years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0-73.3] and 67.3 [65.4-69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, -2.9 [-3.6 to -1.9] in Group F', -2.2 [-2.9 to -1.2] in Group NF') and DXA T-score (-2.8 [-3.3 to -1.9] in Group F', -2.2 [-2.9 to -1.4] in Group NF') were statistically significant (p-value <0.001). Analogous results were obtained for femoral neck. Considering the T-score cut-off of -2.5, REMS identified Group F' patients with a sensitivity of 65.1% and specificity of 57.7% of (OR=2.6, 95%CI: 1.77-3.76, p<0.001), whereas DXA showed a sensitivity of 57.1% and a specificity of 56.3% (OR=1.7, 95%CI: 1.20-2.51, p-value=0.0032). For femoral neck, REMS sensitivity and specificity were 40.2% and 79.9%, respectively, with an OR of 2.81 (95%CI: 1.80-4.39, p<0.001). DXA, instead, showed a sensitivity and specificity of 42.3% and 79.3%, respectively, with an OR of 2.68 (95%CI: 1.71-4.21, p<0.001). REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine.

Assessment of Fracture Risk through Radiofrequency Echographic Multi Spectrometry (REMS) based Bone Mineral Density

Assessment of Fracture Risk through Radiofrequency Echographic Multi Spectrometry (REMS) based Bone Mineral Density

Radiofrequency echographic multispectrometry (REMS): a new approach for osteoporosis diagnosis in adolescents

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Bone densitometry by radiofrequency echographic multi-spectrometry (REMS) in the diagnosis of osteoporosis

The paper summarises the present knowledge of the new bone densitometry method called radiofrequency echographic multi-spectrometry (REMS). This ultrasound-based approach enables the evaluation of bone mineral density (BMD) in the hip and the lumbar spine. During REMS densitometry, a fully automatic algorithm performs a series of spectral and statistical analyses involving both echographic images and corresponding “raw” (unfiltered) radiofrequency signals. This provides the identification of the region of interest (ROI) and the calculation of standard densitometric parameters: BMD, T-score and Z-score. Nondiagnostic scans and artifacts are automatically excluded by the algorithm, reducing the risk of false results. A recently published multi-center study has demonstrated high diagnostic sensitivity, specificity and accuracy of this innovative method in the diagnosis of osteoporosis. To the authors’ best knowledge, this is the first Polish paper on REMS densitometry. Forum Reumatol. 2019, tom 5, nr 2: 81–88

Does the pilocarpine phenylephrine provocative test help in the management of acute and subacute angle closure glaucoma?

The pilocarpine phenylephrine provocative test (PPPT) has been described as a highly sensitive method to identify eyes suffering from or at risk of angle closure glaucoma (ACG). This paper reports on average 10 years follow-up of the outcome of cases of primary acute ACG and subacute ACG in which the management was determined by the result of the PPPT--a positive result indicating the need for a peripheral iridectomy, a negative result conservative treatment. In spite of a negative PPPT the fellow eyes of cases of acute ACG treated conservatively had a high rate (40%) of development of ACG. Similarly, in eyes with a history of subacute ACG with a negative PPPT, ACG developed at some stage during the follow-up in 60%. Peripheral iridectomy alone resulted in normal intraocular pressure in 63% of eyes that had suffered an attack of acute ACG. In hypertensive eyes that presented with subacute ACG, however, only one eye became normotensive following peripheral iridectomy alone. In the subacute ACG group a positive PPPT was closely related to the presence of glaucomatous optic disc damage. These results indicate that the PPPT lacks sensitivity in detecting eyes at risk of angle closure glaucoma, and a positive result is likely in eyes with damaged outflow that will not respond to peripheral iridectomy.