Pitfalls in the Measurement of Bone Mineral Density by Dual Energy X-ray Absorptiometry

Antonacci,; Ds, Hanson; Mh, Heggeness

doi:10.1097/00007632-199601010-00020

Cited by 41 publications

(24 citation statements)

References 24 publications

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“…The advantages of DXA, such as cost efficiency, noninvasiveness, and low radiation exposure for patients, have led to a widespread availability of DXA and frequent usage by clinicians. However, several authors have demonstrated disadvantages of DXA, such as distortion of values in estimating actual bone mass and interference by body composition and patient age (4)(5)(6). While DXA can provide an accurate BMD measurement in vitro (eg, vertebrae in a homogeneous fluid) (7), in vivo analysis is impaired by overlying soft tissue, vascular calcifications, bowel contents, and degenerative spine changes (6,8).…”

Section: Patient Selection and Study Designmentioning

confidence: 99%

Dual-Energy CT–based Phantomless in Vivo Three-dimensional Bone Mineral Density Assessment of the Lumbar Spine

Wichmann¹,

Booz²,

Wesarg³

et al. 2014

Radiology

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Section: Patient Selection and Study Designmentioning

confidence: 99%

Dual-Energy CT–based Phantomless in Vivo Three-dimensional Bone Mineral Density Assessment of the Lumbar Spine

Wichmann¹,

Booz²,

Wesarg³

et al. 2014

Radiology

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“…We hypothesized that this technique may also be applied to targeted BMD assessment of the cancellous bone of the vertebral pedicle which is not assessed with dual-energy x-ray absorptiometry (DXA) routinely performed for evaluation of BMD and detection of osteoporosis [12]. Preoperative evaluation of pedicle BMD may be beneficial as the trabecular architecture of the lumbar pedicle is different from that of the vertebral body [13].…”

Section: Introductionmentioning

confidence: 99%

Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength

et al. 2014

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“…5–7 The modality inherits a variety of advantages compared with dual-energy X-ray absorptiometry (DXA), 8,9 the modality currently implemented in the World Health Organization definition of osteoporosis. 10 Because many patients undergo abdominal multidetector CT (MDCT) for clinical reasons, routine MDCT-derived measurements may lead to a redundancy of additional quantitative CT (QCT) scans and thus minimize radiation exposure and health care costs.…”

mentioning

confidence: 99%

Bone Mineral Density Estimations From Routine Multidetector Computed Tomography

Kaesmacher

Liebl

Baum

et al. 2017

Journal of Computer Assisted Tomography

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IntroductionPhantom-based (synchronous and asynchronous) and phantomless (internal tissue calibration based) assessment of bone mineral density (BMD) in routine MDCT (multidetector computed tomography) examinations potentially allows for diagnosis of osteoporosis. Although recent studies investigated the effects of contrast-medium application on phantom-calibrated BMD measurements, it remains uncertain to what extent internal tissue-calibrated BMD measurements are also susceptible to contrast-medium associated density variation. The present study is the first to systemically evaluate BMD variations related to contrast application comparing different calibration techniques.PurposeTo compare predicative performance of different calibration techniques for BMD measurements obtained from triphasic contrast-enhanced MDCT.Materials and MethodsBone mineral density was measured on nonenhanced (NE), arterial (AR) and portal-venous (PV) contrast phase MDCT images of 46 patients using synchronous (SYNC) and asynchronous (ASYNC) phantom calibration as well as internal calibration (IC). Quantitative computed tomography (QCT) served as criterion standard. Density variations were analyzed for each contrast phase and calibration technique, and respective linear fitting was performed.ResultsBoth asynchronous calibration-derived BMD values (NE-ASYNC) and values estimated using IC (NE-IC) on NE MDCT images did reasonably well in predicting QCT BMD (root-mean-square deviation, 8.0% and 7.8%, respectively). Average NE-IC BMD was 2.7% lower when compared with QCT (P = 0.017), whereas no difference could be found for NE-ASYNC (P = 0.957). All average BMD estimates derived from contrast-enhanced scans differed significantly from QCT BMD (all P < 0.005) and led to notable systemic BMD biases (mean difference at least > 6.0 mg/mL). All regression fits revealed a consistent linear dependency (R2 range, 0.861–0.963). Overall accuracy and goodness of fit tended to decrease from AR to PV contrast phase. Highest precision and best linear fit could be reached using a synchronously scanned phantom (root-mean-square deviation, 9.4% for AR and 14.4% for PV). Both ASYNC and IC estimations performed comparably accurate and precise.ConclusionsOur data suggest that internal calibration driven BMD measurements derived from contrast-enhanced MDCT need the same amount of post hoc contrast-effect adjustment as measurements using phantom calibration. Adjustment using linear correction equations can correct for systematic bias of bone density variations related to contrast application, irrespective of the calibration technique used.

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Pitfalls in the Measurement of Bone Mineral Density by Dual Energy X-ray Absorptiometry

Abstract: The effect of volume on bone mineral density data based on projectional areas can cause very significant perturbations of the data in biomechanical studies.

Cited by 41 publications

References 24 publications

Dual-Energy CT–based Phantomless in Vivo Three-dimensional Bone Mineral Density Assessment of the Lumbar Spine

Dual-Energy CT–based Phantomless in Vivo Three-dimensional Bone Mineral Density Assessment of the Lumbar Spine

Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength

Bone Mineral Density Estimations From Routine Multidetector Computed Tomography

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