Opportunistic Bone Density Measurement on Abdomen and Pelvis Computed Tomography to Predict Fracture Risk in Women Aged 50 to 64 Years Without Osteoporosis Risk Factors

Fang, Jieming; Franconeri, Andrea; Boos, Johannes; NiMhuircheartaigh, Jennifer; Zhang, Zheng; Brook, Alexander; Brook, Olga R.

doi:10.1097/rct.0000000000000744

Cited by 12 publications

(12 citation statements)

References 28 publications

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“…oCT data has been shown to accurately correlate to current and future VCFs with diagnostic accuracy as high as 97.4% and AUC ¼ 0.978. 30,[44][45][46][47] oCT has outperformed DXA in the prediction of VCFs. 23,24 oCT has even been used to screen for cervical spine and hip fractures among the elderly.…”

Section: Resultsmentioning

confidence: 98%

“…Different thresholds have been proposed using receiver operating characteristic (ROC) analysis to optimize sensitivity and specificity ( Table 1 ). 22 , 23 , 25 , 28 - 30 Pickhardt et al 22 found that optimum thresholds for prediction of osteoporosis were less than 100 HU, while normal bone could be considered greater than 150 HU. Among other studies, highly specific HU lower limit thresholds range between 73 and 100, while highly sensitive cutoffs range between 100 and 180 ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

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Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Shirley

Wanderman

Keaveny

et al. 2019

Global Spine Journal

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Study Design: Narrative review. Objective: This article seeks to provide a narrative review regarding the ability of opportunistic information available from computed tomography (CT) scans to guide decisions in spine surgery related to patient bone quality. Methods: A review of the literature (limited to human and English language) was performed via PubMed and Google Scholar using the search terms; “osteoporosis” AND “opportunistic” AND “computed tomography” AND “spine surgery.” The titles and then abstracts of all identified citations were reviewed for inclusion by 2 of the authors (MS, BAF). Relevant articles were then studied in full text. Results: A review of the literature found 25 articles that were selected for inclusion in this narrative review. These articles were broadly divided into 4 subcategories: (1) opportunistic CT (oCT) and osteoporosis detection, (2) oCT data and the quality of screw fixation, (3) utilization of Hounsfield units to assess clinical and/or radiographic outcomes following spine fusion, and (4) virtual stress testing in spine surgery. Conclusion: The literature on oCT, as well as associated virtual stress-testing techniques, demonstrate the potential to enhance spine surgery outcomes by preoperatively identifying at-risk patients in need of bone health optimization and informing best techniques for performing spinal fusion surgery on patients with diminished bone quality. While our narrative summary of the limited literature to date suggests a promising future for oCT data, significant additional research and/or radiographic workflow standardization is needed to validate these methods for clinical use.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Shirley

Wanderman

Keaveny

et al. 2019

Global Spine Journal

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“…The resulting masks can be used for the same purposes as those generated with AI-based algorithms Vertebral morphometry and shape analysis [ 32 , 33 ] Classical algorithms to automatically determine vertebral morphometry and shape. Grading of fracture severity [ 34 – 36 ] Morphological measures to classify vertebra fractures. …”

Section: Vertebral Fracture Assessmentmentioning

confidence: 99%

“…Iodine-containing contrast agents are frequently administered prior to a CT scan in order to increase the contrast of blood-containing vessels and tissues. These contrast agents increase CT values [ 34 , 43 , 44 , 74 , 75 ]. The impact on BMD depends on the amount of contrast agent, i.e., the concentration within the bone of interest at the time of the CT scan.…”

Section: Assessment Of Bmdmentioning

confidence: 99%

Opportunistic Screening Techniques for Analysis of CT Scans

Engelke

Chaudry

Bartenschlager

2022

Curr Osteoporos Rep

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Purpose of Review Opportunistic screening is a combination of techniques to identify subjects of high risk for osteoporotic fracture using routine clinical CT scans prescribed for diagnoses unrelated to osteoporosis. The two main components are automated detection of vertebral fractures and measurement of bone mineral density (BMD) in CT scans, in which a phantom for calibration of CT to BMD values is not used. This review describes the particular challenges of opportunistic screening and provides an overview and comparison of current techniques used for opportunistic screening. The review further outlines the performance of opportunistic screening. Recent Findings A wide range of technologies for the automatic detection of vertebral fractures have been developed and successfully validated. Most of them are based on artificial intelligence algorithms. The automated differentiation of osteoporotic from traumatic fractures and vertebral deformities unrelated to osteoporosis, the grading of vertebral fracture severity, and the detection of mild vertebral fractures is still problematic. The accuracy of automated fracture detection compared to classical radiological semi-quantitative Genant scoring is about 80%. Accuracy errors of alternative BMD calibration methods compared to simultaneous phantom-based calibration used in standard quantitative CT (QCT) range from below 5% to about 10%. The impact of contrast agents, frequently administered in clinical CT on the determination of BMD and on fracture risk determination is still controversial. Summary Opportunistic screening, the identification of vertebral fracture and the measurement of BMD using clinical routine CT scans, is feasible but corresponding techniques still need to be integrated into the clinical workflow and further validated with respect to the prediction of fracture risk.

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“…More recent studies on opportunistic CT have used fractures as outcomes [67][68][69][70][71][72][73][74]. In patients who had a hip fracture after an abdominopelvic CT examination performed for other reasons, Lee et al [73] reported significantly lower L1 trabecular attenuation values (98.5 ± 36.8 HU) in patients who fractured, compared to age-and sex-matched controls (129.7 ± 44.9 HU).…”

Section: The Presentmentioning

confidence: 99%

Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift

et al. 2018

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Purpose of Review-Osteoporosis is disproportionately common in rheumatology patients. For the past three decades, the diagnosis of osteoporosis has benefited from well-established practice guidelines that emphasized the use of dual x-ray absorptiometry (DXA). Despite these guidelines and the wide availability of DXA, approximately two thirds of eligible patients do not undergo testing. One strategy to improve osteoporosis testing is to employ computed tomography (CT) examinations obtained as part ofroutine patient care to "opportunistically" screen for osteoporosis, without additional cost or radiation exposure to patients. This review examines the role of opportunistic CT in the evaluation of osteoporosis. Recent Findings-Recent evidence suggests that opportunistic measurement of bone attenuation (radiodensity) using CT has sensitivity comparable to DXA. More importantly, such an approach has been shown to predict osteoporotic fractures. Summary-The paradigm shift of using CTs obtained for other reasons to opportunistically screen for osteoporosis promises to substantially improve patient care.

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Opportunistic Bone Density Measurement on Abdomen and Pelvis Computed Tomography to Predict Fracture Risk in Women Aged 50 to 64 Years Without Osteoporosis Risk Factors

Abstract: Opportunistic bone density screening can identify women at elevated risk of developing fractures within 10 years.

Cited by 12 publications

References 28 publications

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Opportunistic Screening Techniques for Analysis of CT Scans

Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift

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