Could Computed Tomography Hounsfield Unit Values of Lumbar Vertebrae Detect Osteoporosis?

Hocaoğlu, Elif; İnci, Ercan; Vural, Meltem

doi:10.2174/1573405617999210112193545

Cited by 13 publications

(6 citation statements)

References 26 publications

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“…12 Another study, which included 340 patients with normal BMD on DEXA scan and evidence of DLD on CT scan, demonstrated that 44.2% of patients had OP as determined by CT HU calculations. 10 Similarly, our study demonstrates that of our 74 patients who had non-OP bone determined by DEXA, 46% of these patients had OP as defined by CT-derived HU calculations. The present data support published evidence but suggests that the prevalence of undiagnosed OP in the spine is higher than previously described.…”

Section: Discussionsupporting

confidence: 64%

“…The same group later demonstrated that DEXA T -scores are unreliable in patients with DLD 12 . Another study, which included 340 patients with normal BMD on DEXA scan and evidence of DLD on CT scan, demonstrated that 44.2% of patients had OP as determined by CT HU calculations 10 . Similarly, our study demonstrates that of our 74 patients who had non-OP bone determined by DEXA, 46% of these patients had OP as defined by CT-derived HU calculations.…”

Section: Discussionmentioning

confidence: 97%

“…9 Recent studies suggest DEXA is not sensitive to the detection of OP, particularly in patients experiencing lumbar spinal degeneration. 10 The 3-dimensional nature of CT scans makes it effective at isolating trabecular bone without anatomic interference, such as aortic atherosclerosis, which can increase effective x-ray absorption and falsely elevate T-scores in a 2-dimensional DEXA scan. Prior studies have demonstrated that measuring the BMD with CT-derived HUs is an effective method in patients with degenerative spinal pathologies.…”

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confidence: 99%

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Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis

Aynaszyan¹,

Devia²,

Parry³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Objective: This study aims to identify the prevalence of osteoporosis (OP) by lumbar computed tomography (CT) Hounsfield units (HUs) in patients who have normal or osteopenic bone determined by dual-energy x-ray absorptiometry (DEXA).Summary of Background Data: OP is a critical issue in the postmenopausal and aging population. Bone mineral density assessment by DEXA has been described as insensitive for diagnosing OP in the lumbar spine. Improving the detection of OP can bring more patients to treatment and reduce the risks associated with low bone mineral density. Patients and Methods:We retrospectively reviewed all patients with DEXA scans and noncontrast CTs of the lumbar spine over a 15-year period. Patients were diagnosed as non-OP if they had a normal DEXA T-score ( ≥ −1) or osteopenic DEXA T-score (between −1.1 and −2.4). Patients in this cohort were considered osteoporotic by CT if L1-HU ≤ 110. Demographics and lumbar HUs were compared between these stratified groups.Results: A total of 74 patients were included for analysis. All patients were demographically, similar, and the average patient age was 70 years. The prevalence of OP determined by CT L1-HU ≤ 110 was 46% (normal DEXA: 9%, osteopenic DEXA: 63%). A significant number of males in our study were considered osteoporotic by L1-HU ≤ 110 (74%, P = 0.03). All individual axial and sagittal lumbar HU measurements including L1-L5 average lumbar HUs were statistically significant among non-OP and OP groups except for the lower lumbar levels (P > 0.05 for L4 axial HUs, and L4-L5 sagittal HUs). Conclusions:The prevalence of OP in patients with normal or osteopenic T-scores is high. Among those with osteopenia by DEXA, more than 50% may lack appropriate medical treatment. The DEXA scan may be particularly insensitive to male bone quality making the CT HU the diagnostic method of choice for detecting OP.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

See 1 more Smart Citation

Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis

Aynaszyan¹,

Devia²,

Parry³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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“…Interestingly, our results showed forearm and femoral neck T-scores were more significantly correlated with arm and calf circumference and volume than lumbar T-scores. This is likely explained by the well documented limitation of DEXA scans in degenerative spine, especially given the age of our patient population[ 24 ]. The overall low DEXA T-score values of our sample are likely due to nature of the patient population of patients being evaluated at the bone health clinic.…”

Section: Discussionmentioning

confidence: 99%

3D Topographical Scanning for the Detection of Osteoporosis

Maschhoff,

Oquendo,

Michaud

et al. 2024

JFSF

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Objectives: Osteoporosis is associated with greater risk of fracture, which can lead to increased morbidity and mortality. DEXA scans are often inaccessible for patients, leaving many cases of osteoporosis undetected. A portable 3D topographical scan offers an easily accessible and inexpensive potential adjunct screening tool. We hypothesized that 3D scanning of arm and calf circumference and volume would correlate with DEXA T-scores. Methods: 96 female patients were enrolled. Patients were consented and completed a topographical scan of bilateral arms and lower legs with a mobile 3D scanner for arm and calf circumference and volume in clinic. Patient charts were then retrospectively reviewed for DEXA T-scores. Results: Forearm DEXA T-score was positively correlated with arm circumference (r = 0.49, p<0.01), arm volume (r=0.62, p<0.01), and calf volume (r=0.47, p<0.01). Femoral neck DEXA T-score was positively correlated with calf circumference (r=0.36, p<0.01) and calf volume (r=0.36, p<0.01). Conclusions: Our results showed significant correlations between DEXA T-scores and topographical measurements from mobile device acquired 3D scans, although these were in the “moderate” range. Mobile device-based 3D scanning may hold promise as an adjunct screening tool for osteoporosis when DEXA scanning is not available or feasible for patients, although further studies are needed to elucidate the full potential of its clinical utility. At a minimum, identifying a patient as high risk may promote earlier diagnostic DEXA scanning.

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“…CT HU values strongly correlate with DXA BMD values and different CT HU thresholds for the diagnosis of osteoporosis in the lumbar spine have been proposed. [7][8][9][10][11][12][13][14][15][16] The measurement of CT HU values is reliable, with excellent intra-and interobserver reliability. 9 HU measurements correlate with future osteoporotic fracture risk, 17 adjacent segment fractures after spinal fusion, 18 cage subsidence after transforaminal lumbar interbody fusion (TLIF), 19 pedicle screw loosening, [20][21][22] symptomatic pseudarthrosis after posterolateral 23 and proximal junctional failure after posterior lumbar fusion.…”

Section: Introductionmentioning

confidence: 99%

The Use of Intraoperative CT Hounsfield Unit Values for the Assessment of Bone Quality in Patients Undergoing Lumbar Interbody Fusion

Mertens

Hecht

Bauknecht

et al. 2022

Global Spine Journal

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Study Design Retrospective Cohort Study Objective To evaluate the accuracy of intraoperatively measured computed tomography (CT) Hounsfield unit (HU) values by comparison with preoperative CT HU values and to compare the radiation exposure between preoperative and intraoperative CT scans. Methods HU values of lumbar vertebrae were measured and compared between preoperative and intraoperative CT scans in patients undergoing lumbar interbody fusion. In patient group one, Canon CT scanners were used preoperatively and the AIRO CT scanner was used intraoperatively. In patient group two, Canon CT scanners were used preoperatively and the O-arm Cone Beam CT (CBCT) scanner was used intraoperatively. In a subgroup analysis of patient group one, radiation by means of CT Dose Index (CTDI) was compared between Canon and AIRO CT scanners. Results In the first patient group, a total of 250 vertebrae were analysed in 74 patients showing a strong Pearson correlation of >.94 between pre- and intraoperative HU values. Bland-Altman analysis indicated consistency and equivalence with a bias of 3.9 and 95% limits of agreement from −27.17 to 34.97 when comparing all pre- and intraoperative HU values of L1–5. In the second patient group, a total of 27 vertebrae were analysed in 10 patients showing weak Pearson correlation and Bland-Altman analysis indicated no equivalence. CTDI did not differ between Canon and AIRO CT scanners. Conclusion Correct and reliable CT HU measurement as mandatory key factor for the intraoperative assessment of bone quality and robotic-assisted surgery is feasible with intraoperative AIRO CT imaging without increase of radiation exposure.

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Could Computed Tomography Hounsfield Unit Values of Lumbar Vertebrae Detect Osteoporosis?

Cited by 13 publications

References 26 publications

Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis

Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis

3D Topographical Scanning for the Detection of Osteoporosis

The Use of Intraoperative CT Hounsfield Unit Values for the Assessment of Bone Quality in Patients Undergoing Lumbar Interbody Fusion

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