Quantifying Bone Quality Using Computed Tomography Hounsfield Units in the Mid-sagittal View of the Lumbar Spine

Elarjani, Turki; Warner, Tyler; Nguyen, Kimanh; Nguyen, Stéphanie; Urakov, Timur

doi:10.1016/j.wneu.2021.04.051

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…[13][14][15] Previous authors have attempted similar analyses in the lumbar spine, finding that at certain levels, sagittal HU scores were more strongly correlated to DEXA than axial scores (though the differences in correlation were minimal). 3 For the purposes of measuring HU scores, whether one CT reformat is superior to another remains to be seen.…”

Section: Discussionmentioning

confidence: 99%

“…Given that the vertebral bodies in the cervical spine are smaller and shorter, we modified this protocol by obtaining HU scores from axial, coronal, and sagittal multiplanar reconstructions. 3 Furthermore, the assessment of trabeculae microstructure over three axes gives a more accurate picture of the overall bone density. [13][14][15] Hounsfield units were measured in 5 regions of each vertebral body (C2-T1; mid-axial, anterior-axial, posterioraxial, mid-coronal, and mid-sagittal).…”

Section: Data Collectionmentioning

confidence: 99%

“…[6][7][8] In the lumbar spine, HU have been shown to vary by vertebral level. 3 Similar studies have not been performed for the cervical spine. Understanding trends in bone density of the cervical spine (as measured by HU scores) may be of clinical importance given the associations between HU and mechanical complications.…”

Section: Introductionmentioning

confidence: 99%

“…1 Certain authors have advocated for the use of cervical or lumbar CT scans as an "opportunistic" manner of screening for osteoporosis. 2 However, while the relationship between osteoporosis (diagnosed with DEXA) and low HU values on CT scan is well-established, [1][2][3] the patient's general bone health may not correlate with the bone density in the surgical zone of interest. In accordance with Wolff's law, bone remodels under stress.…”

Section: Introductionmentioning

confidence: 99%

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Bone Density Distribution in the Cervical Spine

Lovecchio

Ang

Louie

et al. 2022

Global Spine Journal

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Study Design Retrospective cohort study Objective Given changes in bone density induced by degenerative disease, general measures of bone health (ie DEXA) are inadequate to evaluate bone density in surgical areas of interest. Regional differences in HU in the cervical spine may influence surgical strategies. The purposes of our study were to determine whether cervical Hounsfield units (HU) vary by level, examine their relationship with age, comorbidities, and alignment, and propose a technique to measure HU in the lateral masses. Methods Two hundred twenty-four patients with degenerative spine pathology with a cervical computed tomography were included (2015-2019). Measurements were performed in each vertebral body (C2-T1; mid-axial, anterior-axial, posterior-axial, mid-coronal, and mid-sagittal) and 2 regions of the lateral masses (C3-C6; mid-cor, mid-sag). To evaluate reliability, 6 observers each measured 355 HU values, inter-relater reliability assessed with intraclass correlation coefficients Correlations of HU with age, BMI, comorbidities, and cervical alignment were evaluated. Results Bone density differed by level, with the lowest HU scores in the lower cervical spine (C6-T1) ( P < .001). No correlations were found between LM HU and age, BMI, CCI, or alignment ( P > .05). Increased kyphosis was weakly correlated with VB HU, while age and CCI showed moderate correlations with VB HU at all levels (P<.001). ICC for HU measurements were good to excellent for the VBs, but poor to moderate for the LMs. Conclusion Bone is least dense in the lower cervical spine. HU scoring is not reliable in the lateral masses. We recommend that a level-specific approach to bone density is considered in surgical planning.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bone Density Distribution in the Cervical Spine

Lovecchio

Ang

Louie

et al. 2022

Global Spine Journal

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“…The emerging paradigm of applying HU in the setting of osteoporosis and fracture risk has been well described in the literature [19]. Moreover, their correlation with the gold-standard dual-energy X-ray absorptiometry (DEXA) scans has ranged from moderate to strong, supporting their sensitivity in capturing bone mass changes [20][21][22]. Because true bone mass cannot be directly measured in a living patient, an indirect assessment via HU changes was performed.…”

Section: Introductionmentioning

confidence: 99%

Bone Mass Changes Following Percutaneous Radiofrequency Ablation, Osteoplasty, Reinforcement, and Internal Fixation of Periacetabular Osteolytic Metastases

Jiang

Caruana

Dussik

et al. 2023

JCM

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Background: The success of orthopedic interventions for periacetabular osteolytic metastases depends on the progression or regression of cancer-induced bone loss. Purpose: To characterize relative bone mass changes following percutaneous radiofrequency ablation, osteoplasty, cement reinforcement, and internal screw fixation (AORIF). Methods: Of 70 patients who underwent AORIF at a single institution, 21 patients (22 periacetabular sites; average follow-up of 18.5 ± 12.3 months) had high-resolution pelvic bone CT scans, with at least one scan within 3 months following their operation (baseline) and a comparative scan at least 6 months post-operatively. In total, 73 CT scans were measured for bone mass changes using Hounsfield Units (HU). A region of interest was defined for the periacetabular area in the coronal, axial, and sagittal reformation planes for all CT scans. For 6-month and 1-year scans, the coronal and sagittal HU were combined to create a weight-bearing HU (wbHU). Three-dimensional volumetric analysis was performed on the baseline and longest available CT scans. Cohort survival was compared to predicted PathFx 3.0 survival. Results: HU increased from baseline post-operative (1.2 ± 1.1 months) to most recent follow-up (20.2 ± 12.1 months) on coronal (124.0 ± 112.3), axial (140.3 ± 153.0), and sagittal (151.9 ± 162.4), p < 0.05. Grayscale volumetric measurements increased by 173.4 ± 166.4 (p < 0.05). AORIF median survival was 27.7 months (6.0 months PathFx3.0 predicted; p < 0.05). At 12 months, patients with >10% increase in wbHU demonstrated superior median survival of 36.5 months (vs. 26.4 months, p < 0.05). Conclusion: Percutaneous stabilization leads to improvements in bone mass and may allow for delays in extensive open reconstruction procedures.

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Assessing bone quality in hounsfield units using computed tomography: what value should be used to classify bone as normal or osteoporotic?

Courtois,

Ohnmeiss

2024

Eur Spine J

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Quantifying Bone Quality Using Computed Tomography Hounsfield Units in the Mid-sagittal View of the Lumbar Spine

Cited by 8 publications

References 15 publications

Bone Density Distribution in the Cervical Spine

Bone Density Distribution in the Cervical Spine

Bone Mass Changes Following Percutaneous Radiofrequency Ablation, Osteoplasty, Reinforcement, and Internal Fixation of Periacetabular Osteolytic Metastases

Assessing bone quality in hounsfield units using computed tomography: what value should be used to classify bone as normal or osteoporotic?

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