title: Comparison of mandibular cortical thickness and QCT-derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia: a retrospective study.
abstract: OBJECTIVE
  To examine whether panoramic radiograph-determined mandibular cortical thickness correlated with quantitative computed tomography-derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  We identified patients treated for ALL at St. Jude Children's Research Hospital, seen in the After Completion of Therapy (ACT) Clinic between January of 2006 and January of 2014 who had QCT-derived BMD and panoramic radiographs obtained within 1 month of each other. Panoramic radiographs were independently scored by a pediatric radiologist, two pediatric dentists, and a general dentist using the Klemetti technique. We used the Spearman's rank correlation test and the multivariate regression model to investigate the effect of evaluator experience on results.
  
  
  RESULTS
  The study cohort comprised 181 patients with 320 paired studies: 112 (62%) male, 112 (71%) were white. Median age at ALL diagnosis was 6.4 (range, 0-18.8) years. Median age at study was 11.9 (range, 3.3 to 29.4) years. The median average BMD was 154.6 (range, 0.73-256) mg/cc; median QCT Z-score (age and gender adjusted) was -0.875 (range, -5.04 to 3.2). We found very weak association between panoramic radiograph score and both QCT-BMD average (P = 0.53) and QCT Z-score (P = 0.39). Results were not influenced by level of reader experience.
  
  
  CONCLUSIONS
  The Klemetti technique of estimating BMD does not predict BMD deficits in children and young adult survivors of ALL, regardless of reviewer expertise. Alternative methods are needed whereby dental healthcare providers can identify and refer patients at risk for BMD deficits for detailed assessment and intervention.
authors.affiliation: Department of Pediatric Dentistry, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN, USA.
authors.forename: Brandice
authors.initials: B
authors.lastname: Allen
authors.affiliation: Department of Diagnostic Sciences and Oral Medicine, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Migliorati
authors.affiliation: Department of Surgery, Dental Clinic St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Rowland
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.affiliation: Department of Diagnostic Sciences and Oral Medicine, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN, USA.
authors.forename: Werner
authors.initials: W
authors.lastname: Shintaku
authors.affiliation: Department of Pediatric Dentistry, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Donaldson
authors.affiliation: Department of Pediatric Dentistry, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Wells
authors.affiliation: Departments of Radiological Sciences and Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.|Department of Radiology, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Kaste
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008334:Mandible / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D015999:Multivariate Analysis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D011862:Radiography, Panoramic; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D017741:Survivors / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult