Longitudinal Association between L1 Trabecular Attenuation from Chest
Computed Tomography (CT) and Bone Mineral Density from Dualenergy
X-ray Absorptiometry (DXA)

Lim, Jiyun; Oh, Eunsun; Park, Suyeon; Kim, Hyun‐Joo; Yoon, Young Cheol; Nam, Bo Da; Lee, Eun Ji; Hwang, Jiyoung; Jeong, Jewon; Chang, Yun Woo

doi:10.2174/1573405619666230213122733

Cited by 1 publication

(4 citation statements)

References 25 publications

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“…Our results were consistent with that of the former study ( 12 ). Previous studies have revealed a positive correlation between HU values obtained with different CT protocols and BMD form DXA ( 12 , 15 , 22 , 23 ). Park et al ( 12 ) showed that HU values from each protocol (abdomen/pelvis contrast-enhanced CT, lumbar spine CT, and chest LDCT) were correlated (r=0.676–0.735, P<0.005) with DXA BMD.…”

Section: Discussionmentioning

confidence: 90%

“…Chest LDCT had the highest diagnostic performance (AUC =0.701) for diagnosing osteoporosis ( 12 ). The association of L1 trabecular attenuation values and T-score appeared to be changed over time and the degree of correlation tended to decrease slightly over time, which was because osteophyte formation and degenerative scoliosis caused errors in DXA results with age ( 15 ). L1 and L2 are the current frequently-used vertebrae for QCT diagnosis ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…In most previous studies ( 12 , 14 , 15 ), trabecular attenuation was usually measured at the L1 level in chest CT and its performance evaluation commonly used DXA as reference standard. A CT-based reference standard of L1 trabecular attenuation for opportunistic osteoporosis screening was constructed in a largely White population ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…The number of vertebrae captured in chest CT depends on the field of view, which varies between patients ( 18 ). Some hospitals tend to narrow the scan range to reduce radiation exposure, resulting in some chest CT scans not including L1 on unenhanced image ( 15 ). To our knowledge, few studies have assessed HU measurement at lower thoracic vertebrae levels in opportunistic osteoporosis screening of a Chinese population.…”

Section: Introductionmentioning

confidence: 99%

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Opportunistic use of chest low-dose computed tomography (LDCT) imaging for low bone mineral density and osteoporosis screening: cutoff thresholds for the attenuation values of the lower thoracic and upper lumbar vertebrae

Pan,

Wu,

Wang

et al. 2024

Quant Imaging Med Surg

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Background Osteoporosis remains substantially underdiagnosed and undertreated worldwide. Chest low-dose computed tomography (LDCT) may provide a valuable and popular opportunity for osteoporosis screening. This study sought to evaluate the feasibility of the screening of low bone mineral density (BMD) and osteoporosis with mean attenuation values of the lower thoracic compared to upper lumbar vertebrae. The cutoff thresholds of the mean attenuation values in Hounsfield units (HU) were derived to facilitate implementation of opportunistic screening using chest LDCT. Methods The participants aged 30 years or older who underwent chest LDCT and quantitative computed tomography (QCT) examinations from August 2018 to October 2020 in our hospital were consecutively included in this retrospective study. A region of interest (ROI) was placed in the trabecular bone of each vertebral body to measure the HU values. The correlations of mean HU values of lower thoracic (T11–T12) and upper lumbar (L1–L2) vertebrae with age and lumbar BMD obtained with QCT were performed using the Pearson correlation coefficient, respectively. The area under the curve (AUC) of the receiver operator characteristic (ROC) curve was generated to determine the cutoff thresholds for distinguishing low BMD from normal and osteoporosis from non-osteoporosis. Results A total of 1,112 participants were included in the final study cohort (743 men and 369 women, mean age 58.2±8.9 years; range, 32–88 years). The mean HU values of T11–T12 and L1–L2 were significantly different among 3 QCT-defined BMD categories of osteoporosis, osteopenia, and normal (P<0.001). The differences in HU values between T11–T12 and L1–L2 in each category of bone status were statistically significant (P<0.001). The mean HU values of T11–T12 (r=−0.453, P<0.001) and L1–L2 (r=−0.498, P<0.001) had negative correlations with age. Positive correlations were observed between the mean HU values of T11–T12 (r=0.872, P<0.001) and L1–L2 (r=0.899, P<0.001) with BMD. The optimal cutoff thresholds for distinguishing low BMD from normal were average T11–T12 ≤157 HU [AUC =0.941, 95% confidence interval (CI): 0.925–0.954, P<0.001] and L1–L2 ≤138 HU (AUC =0.950, 95% CI: 0.935–0.962, P<0.001), as well as distinguishing osteoporosis from non-osteoporosis were average T11–T12 ≤125 HU (AUC =0.960, 95% CI: 0.947–0.971, P<0.001) and L1–L2 ≤107 HU (AUC =0.961, 95% CI: 0.948–0.972, P<0.001). There was no significant difference between the AUC values of T11–T12 and L1–L2 for low BMD (P=0.07) and osteoporosis (P=0.92) screening. Conclusions We have conducted a study on low BMD and osteoporosis screening using mean attenuation values of lower thoracic and upper lumbar vertebrae. Assessment of mean attenuation values of T11–T12 and L1–L2 can be used interchangeably for low BMD and osteoporosis screening using chest LDCT, and their cutoff thresholds were established.

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