Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

Buckens, Constantinus F.; Dijkhuis, Gawein R.; Keizer, Bart de; Verhaar, Harald J. J.; Jong, Pim A. de

doi:10.1007/s00330-014-3584-0

Cited by 121 publications

(74 citation statements)

References 13 publications

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“…However, QCT is subject to higher radiation exposure and typically requires an in-scan calibration phantom, eliminating the option for routine BMD measurements in CT acquired for any indication. Recent studies proposed the use of CT numbers on regular clinically obtained conventional CT scans for the use of BMD assessment with varying sensitivity and specificity of 62–93% and 79–97%, respectively, when compared to DXA [ 7 – 10 ]. In addition, asynchronous BMD calibration using a separate phantom calibration scan, and internal BMD calibration using the paraspinal muscle and subcutaneous fat as reference materials, have been proposed [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study

et al. 2017

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Objectives To investigate the accuracy of bone mineral density (BMD) quantification using dual-layer spectral detector CT (SDCT) at various scan protocols. Methods Two validated anthropomorphic phantoms containing inserts of 50-200 mg/cm 3 calcium hydroxyapatite (HA) were scanned using a 64-slice SDCT scanner at various acquisition protocols (120 and 140 kVp, and 50, 100 and 200 mAs). Regions of interest (ROIs) were placed in each insert and mean attenuation profiles at monochromatic energy levels (90-200 keV) were constructed. These profiles were fitted to attenuation profiles of pure HA and water to calculate HA concentrations. For comparison, one phantom was scanned using dual energy X-ray absorptiometry (DXA). Results At both 120 and 140 kVp, excellent correlations (R = 0.97, P < 0.001) were found between true and measured HA concentrations. Mean error for all measurements at 120 kVp was -5.6 ± 5.7 mg/cm 3 (-3.6 ± 3.2%) and at 140 kVp -2.4 ± 3.7 mg/cm 3 (-0.8 ± 2.8%). Mean measurement errors were smaller than 6% for all acquisition protocols. Strong linear correlations (R 2 ≥ 0.970, P < 0.001) with DXA were found.Conclusions SDCT allows for accurate BMD quantification and potentially opens up the possibility for osteoporosis evaluation and opportunistic screening in patients undergoing SDCT for other clinical indications. However, patient studies are needed to extend and translate our findings. Key points• Dual-layer spectral detector CT allows for accurate bone mineral density quantification.• BMD measurements on SDCT are strongly linearly correlated to DXA.• SDCT, acquired for several indications, may allow for evaluation of osteoporosis.• This potentially opens up the possibility for opportunistic osteoporosis screening.

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Section: Introductionmentioning

confidence: 99%

Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study

et al. 2017

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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%

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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“…A study conducted by Bansal S C et al found QCT is more sensitive for diagnosing osteoporosis than DXA (12) . Several studies have shown a positive correlation between DXA and QCT or DXA with HU (8,(12)(13)(14)(15)(16)(17) . However, we have correlated bone mineral density by QCT with HU and found a strong positive correlation (r = 0.94).…”

Section: Discussionmentioning

confidence: 99%

Correlation Of Bone Mineral Density Measured In Quantitative Computed Tomography With Hounsfield Unit

Lalruatfela¹,

Kotian²,

Panakkal³

2020

Preprint

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Background: Bone mineral density scan (BMD) is a simple, non-invasive procedure used to assess the strength of the bones by measuring the composition of minerals mainly calcium in the bones. In this study, BMD was measured using Quantitative Computed Tomography (QCT) and Hounsfield unit (HU) in the lumbar spine and the values were correlated.Methods: 240 participants referred for CT Abdomen and CT Lumbar spine were scanned using 64 slice Brilliance CT. Using BMD software, three different vertebral bodies from L1-L3 were taken and ROI was placed at the central portion of the trabecular bone. Two references ROI one in retro spinal muscle and one in fat tissue was also placed. To measure CT attenuation value an ROI graphic tool was drawn at the trabecular bone. The average of BMD in QCT and HU value was taken from L1-L3. Pearson Correlation Coefficient was used to correlate QCT and HU values.Results: The mean BMD for the 21-40 age group was found to be 156.3 and 228.0 for QCT and HU respectively. Similarly, the mean BMD for 41-60 and 61-80 age groups was found to be 125.5, 173.6 and 109.1, 140.4 for QCT and HU respectively. The results showed a strong positive correlation between QCT and HU BMD (r = 0.94) with a p-value less than 0.001.Discussion: In our present study, 64.53% (n=155) were found to have normal BMD based on the WHO diagnostic category for spine BMD in QCT. Whereas 24.58% were found to have a low bone mass (osteopenia) and 10.83% were found to have osteoporosis. The equivalent mean HU was found to be 211.98 ±31.06, 139.64 ±18.58, 87.22 ±15.92 for normal, osteopenia and osteoporosis respectively.Conclusion: The study shows a strong correlation between QCT BMD with HU. Therefore, the CT attenuation technique can also be used to derive bone mineral density values from routine abdomen and lumbar spine MDCT for osteoporosis screening with no additional cost to the patient

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Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

Cited by 121 publications

References 13 publications

Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study

Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Correlation Of Bone Mineral Density Measured In Quantitative Computed Tomography With Hounsfield Unit

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