Opportunistic osteoporosis screening via the measurement of frontal skull Hounsfield units derived from brain computed tomography images

Abstract

Background and purposeOsteoporosis is one of the most common chronic metabolic diseases, but detection and treatment rates are low. The aim of the current study was to evaluate the correlation between frontal skull Hounsfield unit (HU) values from brain computed tomography (CT) scans and T-scores of the lumbar spine and femoral neck from dual-energy X-ray absorptiometry (DXA) scans.MethodsPatients with < 1 year between brain CT and DXA scans were included in the study. The average frontal skull HU value used for analysis was defined as the average of four HU values of the frontal bone. A receiver operating characteristic curve was generated, and area under the curve (AUC) was used to determine the HU values of the frontal skull for predicting osteoporosis. The frontal skull HU value with the highest sensitivity and specificity was considered the optimal cutoff value.ResultsIn total, 899 patients who underwent both brain CT and DXA scans at a single institution were enrolled. Average skull HU values differed significantly among patients in different bone mineral density categories (p < 0.001). There was a positive correlation between skull HU value and T-score (β = 105.06, p < 0.001, R2 = 0.343). The mean HU value in subjects with osteoporosis was 515, and the optimal cutoff value for the prediction of osteoporosis was 610 HU (AUC = 0.775, 95% CI 0.744–0.806, p < 0.001).ConclusionsClinical brain CT scans can assist in the detection of osteoporosis, and patients with an HU value < 610 as determined via brain CT may be considered for further evaluation for possible osteoporosis.

Does the skull Hounsfield unit predict shunt dependent hydrocephalus after decompressive craniectomy for traumatic acute subdural hematoma?

“…Previous studies reported that specific regional cancellous bone HU values from CT scans showed strong correlation with T-score and may be useful for predicting osteoporotic conditions [16][17][18][19]. We previously demonstrated a strong correlation between T-score and frontal skull HU value [14,20]. As osteoporosis is a systemic disease, we propose that osteoporotic conditions may influence cancellous bone structures in the skull.…”

Effects of Possible Osteoporotic Conditions on the Recurrence of Chronic Subdural Hematoma

“…Previous studies have demonstrated that specific regional cancellous bone HU values from CT scans show a strong correlation with the T-score and may be useful for predicting osteoporotic conditions ( 13 – 15 ). We previously showed a strong correlation between the T-score and frontal skull HU values ( 7 , 16 ). Because osteoporosis is a systemic disease and is strongly related to genetic components of type 1 collagen ( COL1A1 and COL1A2) , we propose that osteoporotic conditions may influence cancellous bone of the skull ( 17 ).…”

Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

“…Osteoporosis is a systemic disease that affects systemic bone mass and microarchitecture throughout the body. We previously reported the close association between mean frontal skull HU and BMD [8,14]. We also demonstrated that systemic osteoporosis may negatively affect the integrity of arachnoid trabeculae and granulations because bone, arachnoid trabeculae, and granulations are all composed of type 1 collagen [8,9].…”

“…We previously demonstrated detailed methods for measuring HU values at each of four lines on the frontal cancellous bone. This was between the right and left coronal sutures on axial CT slices at the point where the lateral ventricles disappear [8,14]. The HU value of the frontal cancellous bone was measured using the "Linear histogram graph" function in the picture archiving and communication system (PACS) (PiViewSTAR version 5.0, INFINITT Healthcare, Seoul, Korea).…”