Abstract
To compare the osteoporosis-predicting ability of computed tomography (CT) indexes in abdomen-pelvic CT using the proximal femur and the reliability of measurements in two- and three-dimensional analyses. Four hundred thirty female patients (age range, 50-96 years) who underwent dual-energy X-ray absorptiometry and abdominal-pelvic CT within 1 month were retrospectively selected. The volumes of interest (VOIs) from the femoral head to the lesser trochanter and the femoral neck were expressed as 3DFemur. Round regions of interest (ROIs) of image plane drawn over the femoral neck touching the outer cortex were determined as 2Dcoronal. In HU histogram analysis (HUHA), the percentages of HU histogram ranges related to the ROI or VOI were classified as HUHAFat (<0 HU) and HUHABone (126 HU≤). Diagnostic performance, correlation analysis and measurement reliability were analyzed by receiver operating characteristic curves, correlation coefficient and interobserver correlation coefficient (ICC), respectively. AUCs of each HUHA and mean-HU measurement on 2D-ROI and 3D-VOI were 0.94 or higher (P < 0.001). Both 3DFemur-Mean-HU and 3DFemur-HUHABone showed the highest AUC (0.96). The cut-off value of 3DFemur-Mean-HU was 231HU or less, (sensitivity: 94.8%; specificity: 85.0%; correlation coefficient: -0.65; P <0.001) for diagnosis of osteoporosis. There was no superiority between AUCs in 2D-ROI and 3D-VOI measurements (P > 0.05). Reliability of the 3D-VOI measurement showed perfect agreement (ICC ≥ 0.94), and 2D-ROI showed moderate to good agreement (ICC range: 0.63~0.84). CT indexes on 3D-VOI for predicting femoral osteoporosis showed similar diagnostic accuracy with better reproducibility of measurement, compared with 2D-ROI.
Highlights
With the rapid increase in the elderly population worldwide, osteoporosis has become a serious public health concern [1]
There was no superiority between AUCs in 2D-region of interest (ROI) and 3D-volume of interest (VOI) measurements (P > 0.05)
Reliability of the 3D-VOI measurement showed perfect agreement (ICC 0.94), and 2DROI showed moderate to good agreement (ICC range: 0.63~0.84)
Summary
With the rapid increase in the elderly population worldwide, osteoporosis has become a serious public health concern [1]. The prevalence of osteoporosis is very high, it can be diagnosed using techniques such as dual-energy X-ray absorptiometry (DXA), and effective treatment and preventive methods are available for this condition [1, 4]. Dual-energy X-ray absorptiometry (DXA) is recognized as the reference method to measure bone mineral density (BMD) for osteoporosis diagnosis. Several studies have shown that DXA screening are performed less frequently in high-risk populations including women aged 65 years, and more commonly in women at low fracture risk without osteoporosis risk [8,9,10]. DXA is a two-dimensional (2D) technique, clinically relevant diagnostic errors can be made: the presence of degenerative disc disease, compression fracture, or aortic calcification may increase the bone density without improving the actual skeletal strength and can be sources of errors in the diagnosis of osteoporosis [11]. There is a growing appreciation of the need for alternative screening methods
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
