Abstract
Background/aim This study aimed to evaluate the diagnostic efficacy of vertebral Hounsfield unit (HU) values on routine contrast-enhanced abdominal computed tomography (CT) scans for the assessment of osteoporosis using dual-energy X-ray absorptiometry (DXA) T-scores as a reference standard.Materials and methods A total of 111 consecutive patients who underwent contrast-enhanced abdominal CT examination for any indication and DXA within a 6-month period were retrospectively analyzed. The CT attenuation values of trabecular bone in HUs were measured in axial and sagittal planes from lumbar vertebrae 1–4 (L1–L4). The correlation between the DXA T-scores and HU values measured on the CT scans was evaluated by Pearson’s correlation test. Areas under the curves (AUCs) were calculated by receiver operating characteristic analysis for diagnostic proficiency, and threshold values were determined. Paired t-test and Bland–Altman plot test were used to evaluate the correlation between axial and sagittal HU values.Results There was a strong correlation between the DXA T-scores and HU values of all the lumbar vertebrae (P < 0.001). The highest correlation was for the L3 vertebra; L3 was thus chosen for additional analyses. The mean axial and sagittal L3 attenuations were 133.7 HU and 131.9 HU, respectively. The axial measurements were not significantly different from the sagittal measurements, with a mean difference of 1.8 HU (P > 0.05). The L3 axial CT attenuation threshold for 90% sensitivity was 170 HU and that for 90% specificity was 102 HU for distinguishing osteoporosis from osteopenia and normal bone mineral density (BMD). To distinguish the low BMD group from the normal group, the L3 axial CT attenuation threshold for approximately 90% sensitivity was 102 HU and for 90% specificity was 165 HU.Conclusion The HUs derived from routine contrast-enhanced abdominal CT scans can be used for the evaluation of osteoporosis, without additional radiation exposure and cost.
Highlights
Osteoporosis is a common systemic skeletal disorder characterized by reduced bone mineral density (BMD) and microarchitectural deterioration of the bone tissue, leading to an increase in bone fragility fractures [1]
There was a strong correlation between the dual-energy X-ray absorptiometry (DXA) T-scores and Hounsfield unit (HU) values of all the lumbar vertebrae (P < 0.001)
The highest correlation was for the L3 vertebra; L3 was chosen for additional analyses
Summary
Osteoporosis is a common systemic skeletal disorder characterized by reduced bone mineral density (BMD) and microarchitectural deterioration of the bone tissue, leading to an increase in bone fragility fractures [1]. Beyond the age of 50 years, half of all women and one quarter of men are known to suffer from an osteoporotic fracture in their lifetime, with most of the fractures occurring in patients not undergoing specific treatment for osteoporosis [5]. More than 80% of the patients with osteoporotic fractures do not undergo BMD assessment or treatment to reduce the risk [7]. This technique has some limitations such as false-negative results in patients with vertebral compression fractures, and limited use in people who have a spinal deformity or history of previous surgery [8].
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