Diagnostic Accuracy of Dual-Energy CT Material Decomposition Technique for Assessing Bone Status Compared with Quantitative Computed Tomography

Abstract

Purpose: The purpose of this study was to evaluate the diagnostic accuracy when using various base material pairs (BMPs) in dual-energy computed tomography (DECT), and to establish corresponding diagnostic standards for assessing bone status through comparison with quantitative computed tomography (QCT). Methods: This prospective study enrolled a total of 469 patients who underwent both non-enhanced chest CT scans under conventional kVp and abdominal DECT. The bone densities of hydroxyapatite (water), hydroxyapatite (fat), hydroxyapatite (blood), calcium (water), and calcium (fat) (DHAP (water), DHAP (fat), DHAP (blood), DCa (water), and DCa (fat)) in the trabecular bone of vertebral bodies (T11–L1) were measured, along with bone mineral density (BMD) via QCT. Intraclass correlation coefficient (ICC) analysis was used to assess the agreement of the measurements. Spearman’s correlation test was performed to analyze the relationship between the DECT- and QCT-derived BMD. Receiver operator characteristic (ROC) curves were generated to determine the optimal diagnostic thresholds of various BMPs for diagnosing osteopenia and osteoporosis. Results: A total of 1371 vertebral bodies were measured, and QCT identified 393 with osteoporosis and 442 with osteopenia. Strong correlations were observed between DHAP (water), DHAP (fat), DHAP (blood), DCa (water), and DCa (fat) and the QCT-derived BMD. DHAP (water) showed the best predictive capability for osteopenia and osteoporosis. The area under the ROC curve, sensitivity, and specificity for identifying osteopenia were 0.956, 86.88%, and 88.91% with DHAP (water) ≤ 107.4 mg/cm3, respectively. The corresponding values for identifying osteoporosis were 0.999, 99.24%, and 99.53% with DHAP (water) ≤ 89.62 mg/cm3, respectively. Conclusions: Bone density measurement using various BMPs in DECT enables the quantification of vertebral BMD and the diagnosis of osteoporosis, with DHAP (water) having the highest diagnostic accuracy.

Correlation between vertebral bone mineral density and multi-level virtual non-calcium imaging parameters from dual-layer spectral detector computed tomography

“…For instance, the existence of bone marrow adipose tissue leads to an underestimation of spine BMD, and this error will amplify with higher fat content ( 25 ). A similar finding was also reported in another DECT study in which the utilization of substance decomposition method (fat vs. HAP) for diagnosing osteoporosis yielded unsatisfactory results, with an AUC of only 0.594 ( 26 ).…”

Vertebral and Femoral Bone Mineral Density (BMD) Assessment with Dual-Energy CT versus DXA Scan in Postmenopausal Females

“…Yue et al reported that using calcium and water as base materials could reflect the age-related changes in the lumbar spine of adult women and its correlation with BMD [19]. Wang et al proved that measurement using the hydroxyapatitewater base material pair provides high diagnostic accuracy [20].…”