Intravenous contrast injection significantly affects bone mineral density measured on CT

Pompe, Esther; Willemink, Martin J.; Dijkhuis, Gawein R.; Verhaar, Harald J. J.; Hoesein, Firdaus A. A. Mohamed; Jong, Pim A. de

doi:10.1007/s00330-014-3408-2

Cited by 76 publications

(44 citation statements)

References 25 publications

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“…We minimized that risk by providing both observers with an intensive training session before starting the study, thus helping to achieve a very low inter-and intraobserver variability. In contrast to other studies like those of Pompe et al or Pickhardt et al, our technique requires a specific software tool, which entails additional costs [10,15]. Another limitation of this study is that no additional DXA or QCT examinations were available as a reference or for comparison.…”

Section: Discussionmentioning

confidence: 95%

“…Previous studies have already investigated the possibility of BMD measurements on routinely performed MDCT scans and the influence of intravenous contrast agent on the measured BMD values [10,15,16,18,22,23]. These studies used different methods and showed somewhat divergent outcomes: Pompe et al measured attenuation values of L1 in different contrast agent phases and found a significant difference between all phases [15].…”

Section: Discussionmentioning

confidence: 99%

“…These studies used different methods and showed somewhat divergent outcomes: Pompe et al measured attenuation values of L1 in different contrast agent phases and found a significant difference between all phases [15]. In contrast, Pickhardt et al compared Hounsfield Unit (HU) values of L1 on pre-contrast CT scans with measurements on contrast-enhanced CT scans and did not find a significant difference [10,22].…”

Section: Discussionmentioning

confidence: 99%

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Influence of Contrast Media on Bone Mineral Density (BMD) Measurements from Routine Contrast-Enhanced MDCT Datasets using a Phantom-less BMD Measurement Tool

Toelly

Bardach

Weber

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Ziel der Studie war den Einfluss einer intravenösen Kontrastmittelgabe auf phantomlos gemessene volumetrische Knochendichtewerte im Routine-MDCT zu evaluieren. Zusätz-lich sollte eine Formel zur Berechnung der wahrheitsgetreuen Knochendichte aus arteriell und venös gemessenen Werten aufgestellt werden. Material und Methodik 112 postmenopausale Frauen imAlter von 40 bis 77 Jahren (mittleres Alter 57,31; SD 9,61), die ein triphasisches MDCT (nativ, arteriell und venös) ABSTR AC TAim To evaluate the differences in phantom-less bone mineral density (BMD) measurements in contrast-enhanced routine MDCT scans at different contrast phases, and to develop an algorithm for calculating a reliable BMD value.Materials and Methods 112 postmenopausal women from the age of 40 to 77 years (mean age: 57.31 years; SD 9.61) who underwent a clinically indicated MDCT scan, consisting of an unenhanced, an arterial, and a venous phase, were included. A retrospective analysis of the BMD values of the Th12 to L4 vertebrae in each phase was performed using a commercially available phantom-less measurement tool.Results The mean BMD value in the unenhanced MDCT scans was 79.76 mg/cm³ (SD 31.20), in the arterial phase it was 85.09 mg/cm³ (SD 31.61), and in the venous phase it was 86.18 mg/cm³ (SD 31.30). A significant difference (p < 0.001) was found between BMD values on unenhanced and contrastenhanced MDCT scans. There was no significant difference between BMD values in the arterial and venous phases (p = 0.228). The following conversion formulas were calculated using linear regression: unenhanced BMD = -2.287 + 0.964 * . The intrarater agreement of BMD measurements was calculated with an intraclass correlation (ICC) of 0.984 and the interobserver reliability was calculated with an ICC of 0.991.Conclusion Phantom-less BMD measurements in contrastenhanced MDCT scans result in increased mean BMD values, but, with the formulas applied in our study, a reliable BMD value can be calculated. However, the mean BMD values did not differ significantly between the arterial and venous phases. Key points▪ BMD can be assessed on routine CT scans using a phantom-less tool.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Influence of Contrast Media on Bone Mineral Density (BMD) Measurements from Routine Contrast-Enhanced MDCT Datasets using a Phantom-less BMD Measurement Tool

Toelly

Bardach

Weber

et al. 2017

Fortschr Röntgenstr

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“…A variation of 3 HU is substantially less than the variation in mg/cc or HU thresholds for osteopenia reported in the literature (American College of Radiology, 2014; Pickhardt, et al, 2013). The majority (97%) of the CIREN scans analyzed were contrast-enhanced which may lead to underestimation of osteopenia/osteoporosis compared to non-contrast CT (Pompe, et al, 2015). Calibration with fat and muscle measures collected from the same scan may adjust for the effect of contrast, but further investigation is warranted to evaluate this theory.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Bone Mineral Density Phantomless Computed Tomography Measurements and Correlation with Age and Fracture Incidence

Weaver

Beavers

Hightower

et al. 2015

Traffic Injury Prevention

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Objective Low bone quality is a contributing factor to motor vehicle crash (MVC) injury. Quantification of occupant bone mineral density (BMD) is important from an injury causation standpoint. The first aim of this study was to validate a technique for measuring lumbar volumetric BMD (vBMD) from phantom-less computed tomography (CT) scans. The second aim was to apply the validated phantom-less technique to quantify lumbar vBMD in Crash Injury Research and Engineering Network (CIREN) occupants for correlation with age, fracture incidence, and osteopenia/osteoporosis diagnoses. Methods Quantitative CT (qCT) and dual-energy X-ray absorptiometry (DXA) were collected prospectively for 50 subjects and used to validate a technique to measure vBMD from 281 phantom-less CT scans of CIREN occupants. Hounsfield Unit (HU) measurements were collected from the L1-L5 vertebrae, right psoas major muscle, and anterior subcutaneous fat for all subjects and from three phantom ports with known mg/cc calcium hydroxyapatite values for the validation group. qCT calibration was accomplished using regressions between the phantom HU and mg/cc values to convert L1-L5 HU values to mg/cc. A phantom-less calibration technique was developed where the fat and muscle HU values were linearly regressed against fat (−69 mg/cc) and muscle (77 mg/cc) to establish a conversion for L1-L5 HU measurements to mg/cc. vBMD calculated from qCT versus the phantom-less method was compared for the 50 subjects to assess agreement and a mg/cc osteopenia threshold was established using DXA T-scores. CIREN HU measurements were converted to mg/cc using the phantom-less technique and the mg/cc osteopenia threshold was used to compare vBMD to age, fracture incidence, and osteopenia comorbidity classifications in CIREN. Results Linear regression of lumbar vBMD derived from the qCT versus phantom-less calibrations showed excellent agreement (R2=0.87, p=<0.0001). A 145 mg/cc threshold for osteopenia was established (sensitivity=1, specificity=0.57) and 44 CIREN occupants had vBMD below this threshold. Of these 44 occupants, 64% were not classified as osteopenic in CIREN, but vBMD suggested undiagnosed osteopenia. Age was negatively correlated with vBMD in both sexes (p=<0.0001) and CIREN occupants with less than 145 mg/cc vBMD sustained an average 1.7 additional rib/sternum fractures (p=0.036). Conclusions As lumbar vBMD was estimated from phantom-less CT scans with accuracy similar to qCT, the phantom-less technique can be broadly applied to both prospectively and retrospectively assess patient bone quality for research and clinical studies related to MVCs, falls, and aging.

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“…In any of the CT examinations, the hip was not analyzed if metal artifacts from implants were present; the spine was not analyzed either if metastatic bone disease was observed in all scanned vertebral levels or if intravenous contrast medium was present. Intravenous contrast medium has been shown to substantially influence vertebral BMD measurements [43, 44] but not to appreciably influence hip measurements [22, 44]. …”

Section: Methodsmentioning

confidence: 99%

Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations

Schwaiger

Kopperdahl

Nardo

et al. 2017

Bone

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PURPOSE Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans—as validated in previous studies—as a reference standard. MATERIALS AND METHODS Men with prostate cancer (n=82, 71.6±8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤80mg/cm3, femoral neck or total hip T-score ≤−2.5, vertebral strength ≤6500N and femoral strength ≤3500N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. RESULTS All measurements from PET/CT versus MDCT were strongly correlated (R2= 0.93–0.97; P<0.0001 for all). Mean differences for total hip areal BMD (0.001g/cm2, 1.1%), femoral strength (−60N, 1.3%), vertebral trabecular BMD (2mg/cm3, 2.6%) and vertebral strength (150N; 1.7%) measurements were not statistically significant (P>0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (−0.018 g/cm2; −2.5%; P=0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). CONCLUSION Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.

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Intravenous contrast injection significantly affects bone mineral density measured on CT

Cited by 76 publications

References 25 publications

Influence of Contrast Media on Bone Mineral Density (BMD) Measurements from Routine Contrast-Enhanced MDCT Datasets using a Phantom-less BMD Measurement Tool

Influence of Contrast Media on Bone Mineral Density (BMD) Measurements from Routine Contrast-Enhanced MDCT Datasets using a Phantom-less BMD Measurement Tool

Lumbar Bone Mineral Density Phantomless Computed Tomography Measurements and Correlation with Age and Fracture Incidence

Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations

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