Diagnostic accuracy of quantitative dual-energy CT-based bone mineral density assessment in comparison to Hounsfield unit measurements using dual x-ray absorptiometry as standard of reference

Booz, Christian; Noeske, Jochen; Albrecht, Moritz H.; Lenga, Lukas; Martin, Simon S.; Yel, Ibrahim; Huizinga, Nicole A.; Vogl, Thomas J.; Wichmann, Julian L.

doi:10.1016/j.ejrad.2020.109321

Cited by 41 publications

(32 citation statements)

References 37 publications

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“…In contrast to the established QCT value of 80 mg/cm 3 according to the ACR, our analysis yielded an optimal DECTbased BMD threshold of 93.7 mg/cm 3 to distinguish patients who sustained a fracture during a 2-year follow-up period from patients who did not [21,22]. This finding closely matches previous findings of our group that, contrary to ACR QCT guidelines, identified a DECT-based BMD value of 92 mg/cm 3 as an optimal cut-off to differentiate osteopenia from normal BMD [18]. This higher threshold can in part be attributed to the removal of aforementioned confounding variables as well as the elimination of technical shortcomings that underestimate conventional QCT-based BMD measurements, such as the fat error [6,24,31].…”

Section: Discussionsupporting

confidence: 86%

“…Material differentiation in DECT can provide novel relevant information for different musculoskeletal applications compared to conventional CT [16][17][18]. Recently, a DECTbased postprocessing algorithm, which permits phantomless volumetric BMD assessment of lumbar trabecular bone, has been evaluated, showing superior results for the detection of osteoporosis compared to HU measurements as well as strong correlation with bone strength in human cadaver vertebrae specimens [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of quantitative dual-energy CT-based volumetric bone mineral density assessment for the prediction of osteoporosis-associated fractures

et al. 2021

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Objectives To evaluate the predictive value of volumetric bone mineral density (BMD) assessment of the lumbar spine derived from phantomless dual-energy CT (DECT)-based volumetric material decomposition as an indicator for the 2-year occurrence risk of osteoporosis-associated fractures. Methods L1 of 92 patients (46 men, 46 women; mean age, 64 years, range, 19–103 years) who had undergone third-generation dual-source DECT between 01/2016 and 12/2018 was retrospectively analyzed. For phantomless BMD assessment, dedicated DECT postprocessing software using material decomposition was applied. Digital files of all patients were sighted for 2 years following DECT to obtain the incidence of osteoporotic fractures. Receiver operating characteristic (ROC) analysis was used to calculate cut-off values and logistic regression models were used to determine associations of BMD, sex, and age with the occurrence of osteoporotic fractures. Results A DECT-derived BMD cut-off of 93.70 mg/cm3 yielded 85.45% sensitivity and 89.19% specificity for the prediction to sustain one or more osteoporosis-associated fractures within 2 years after BMD measurement. DECT-derived BMD was significantly associated with the occurrence of new fractures (odds ratio of 0.8710, 95% CI, 0.091–0.9375, p < .001), indicating a protective effect of increased DECT-derived BMD values. Overall AUC was 0.9373 (CI, 0.867–0.977, p < .001) for the differentiation of patients who sustained osteoporosis-associated fractures within 2 years of BMD assessment. Conclusions Retrospective DECT-based volumetric BMD assessment can accurately predict the 2-year risk to sustain an osteoporosis-associated fracture in at-risk patients without requiring a calibration phantom. Lower DECT-based BMD values are strongly associated with an increased risk to sustain fragility fractures. Key Points •Dual-energy CT–derived assessment of bone mineral density can identify patients at risk to sustain osteoporosis-associated fractures with a sensitivity of 85.45% and a specificity of 89.19%. •The DECT-derived BMD threshold for identification of at-risk patients lies above the American College of Radiology (ACR) QCT guidelines for the identification of osteoporosis (93.70 mg/cm3 vs 80 mg/cm3).

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of quantitative dual-energy CT-based volumetric bone mineral density assessment for the prediction of osteoporosis-associated fractures

et al. 2021

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“…However, further quantitative analysis was not possible given that CT-based HU osteopenia-osteoporotic cutoffs are not yet standardized or well defined and the heterogeneous tumor characteristics of the vertebrae make interpretation difficult. [30][31][32] With more study, surrogate radiographic markers of bone density like HU or the recently published MRIbased vertebral bone quality score may help further associate the density of bone with fracture risk, instrumentation failure, and surgical outcomes. [33][34][35] The safety of using cement in the spine is established, but complications are not uncommon.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability

Massaad

Rolle

Hadzipasic

et al. 2021

Neurosurgical Focus

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OBJECTIVE Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such as osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws with cement is a strategy to overcome construct failure. This study aimed to assess the safety and efficacy of cement augmentation with fenestrated pedicle screws in patients undergoing posterior, open thoracolumbar surgery for spinal metastases. METHODS A retrospective review was performed for patients who underwent surgery for cancer-related spine instability from 2016 to 2019 at the Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns of cement extravasation, complications, and prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference and Pain Intensity scores were analyzed using descriptive statistics. Logistic regression was performed to determine factors associated with cement extravasation. RESULTS Sixty-nine patients underwent open posterior surgery with a total of 502 cement-augmented screws (mean 7.8 screws per construct). The median follow-up period for those who survived past 90 days was 25.3 months (IQR 10.8–34.6 months). Thirteen patients (18.8%) either died within 90 days or were lost to follow-up. Postoperative CT was performed to assess the instrumentation and patterns of cement extravasation. There was no screw loosening, pullout, or failure. The rate of cement extravasation was 28.9% (145/502), most commonly through the segmental veins (77/145, 53.1%). Screws breaching the lateral border of the pedicle but with fenestrations within the vertebral body were associated with a higher risk of leakage through the segmental veins compared with screws without any breach (OR 8.77, 95% CI 2.84–29.79; p < 0.001). Cement extravasation did not cause symptoms except in 1 patient who developed a symptomatic thoracic radiculopathy requiring decompression. There was 1 case of asymptomatic pulmonary cement embolism. Patients experienced significant pain improvement at the 3-month follow-up, with decreases in Pain Interference (mean change 15.8, 95% CI 14.5–17.1; p < 0.001) and Pain Intensity (mean change 28.5, 95% CI 26.7–30.4; p < 0.001). CONCLUSIONS Cement augmentation through fenestrated pedicle screws is a safe and effective option for spine stabilization in the cancer population. The risk of clinically significant adverse events from cement extravasation is very low.

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“…(4) (5) First, to determine the parameters of each parametrized model, anthropomorphic tissues defined by the International Commission on Radiation Units and Measurements (ICRU) Report 44 were described by elemental composition (H, C, N, O, Na, Mg, P, S, Cl, K, Ca, Fe, I), electron density, and physical density [24]. Using this information, attenuation at 70 keV and effective atomic number was calculated using well-accepted material properties, i.e.…”

Section: A Physical Density Model Developmentmentioning

confidence: 99%

Accurate Non-invasive Mass and Temperature Quantifications with Spectral CT

Liu

Hwang

Hung

et al. 2022

Preprint

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Spectral CT has been increasingly implemented clinically for its better characterization and quantification of materials through its multi-energy results. It also facilitates calculation of physical density utilizing the Alvarez-Macovski model without approximations. These spectral physical density quantifications allow for non-invasive mass measurements and temperature evaluations by manipulating the definition of physical density and thermal volumetric expansion, respectively. To develop the model, original and parametrized versions of the Alvarez-Macovski model and electron density-physical density model were validated with a phantom. The best physical density model was then implemented on clinical spectral CT scans of ex vivo bovine muscle to determine the accuracy and effect of acquisition parameters on mass measurements. In addition, the relationship between physical density and changes in temperature was evaluated by scanning and subjecting the tissue to a range of temperatures. A linear fit utilizing the thermal volumetric expansion was performed to assess the correlation. The parametrized Alvarez-Macovski model performed best in both model development and validation with errors within ±0.02 g/mL. As observed with muscle, physical density was not significantly affected by dose and acquisition mode but was slightly affected by collimation. These effects were also reflected in mass measurements, which demonstrated accuracy with a maximum percent error of 0.34%, further validating the physical density model. Furthermore, physical density was strongly correlated (R of 0.9781) to temperature changes through thermal volumetric expansion. Accurate and precise spectral physical density quantifications enable non-invasive mass measurements for pathological detection and temperature evaluation for thermal therapy monitoring in interventional oncology.

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Diagnostic accuracy of quantitative dual-energy CT-based bone mineral density assessment in comparison to Hounsfield unit measurements using dual x-ray absorptiometry as standard of reference

Cited by 41 publications

References 37 publications

Diagnostic accuracy of quantitative dual-energy CT-based volumetric bone mineral density assessment for the prediction of osteoporosis-associated fractures

Diagnostic accuracy of quantitative dual-energy CT-based volumetric bone mineral density assessment for the prediction of osteoporosis-associated fractures

Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability

Accurate Non-invasive Mass and Temperature Quantifications with Spectral CT

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