Abstract
BackgroundScreening for osteoporosis with contrast-enhanced computed tomography (CT) is promising for identifying high-risk osteoporotic patients. Our aims were (1) to investigate the estimated volume bone mineral density (vBMD) change over time after contrast injection (CT perfusion imaging, CTPI); and (2) to examine the influence of contrast dose on vBMD.MethodsFifteen patients, aged 71 ± 9 years (mean ± standard deviation, range 55–86) underwent a CTPI examination (28 scans within 63 s) of the upper body followed (after a waiting time of 10 min) by a full 4-phase CT examination (4 scans within 4 min). The contrast dose for CTPI was 0.38–0.83 mL/kg, and for 4-phase CT was 0.87–1.29 mL/kg. Vertebrae L1–L3 were analysed totalling 43 vertebrae, using Mindways qCT Pro.ResultsAfter contrast injection, vBMD showed a near-horizontal line until 17.5 s (non-contrast phase), followed by a steep increase 17.5–41.5 s after contrast injection, i.e., in the arterial phase, which plateaued 41.5 s after, i.e., in the early venous phase. A higher contrast dose per kg yielded significantly higher vBMD increase in both the arterial and venous phase (p < 0.003).ConclusionsBoth time from contrast administration and contrast dose per kg affected vBMD results. In arterial phase, the steepness of the curve makes vBMD estimation unsure. However, as values plateaued in the venous phase it might be possible to predict the correct vBMD values. Furthermore, contrast dose is a factor that needs to be adjusted for when using such a formula.
Highlights
Screening for osteoporosis with contrast-enhanced computed tomography (CT) is promising for identifying high-risk osteoporotic patients
(2022) 6:8 market [7], osteoporosis is still heavily underdiagnosed and undertreated [3, 8]. The reason for this is multifactorial including the risk of loss to follow-up regarding osteoporosis after fractures have been treated in the emergency setting
CT perfusion imaging (CTPI) As shown in Fig. 2, vertebral volume bone mineral density (vBMD) showed a nearhorizontal line until 17.5 s after contrast injection, where after a steep increase in estimated vBMD, a plateau after around 41.5 s was seen
Summary
Screening for osteoporosis with contrast-enhanced computed tomography (CT) is promising for identifying high-risk osteoporotic patients. Despite several cost effective treatment options on the Woisetschläger et al European Radiology Experimental (2022) 6:8 market [7], osteoporosis is still heavily underdiagnosed and undertreated [3, 8] The reason for this is multifactorial including the risk of loss to follow-up regarding osteoporosis after fractures have been treated in the emergency setting. An organisational reason for this might be the fact that that an additional examination, i.e., dual-energy x-ray absorptiometry, must be obtained before the decision of further handling of the patient regarding osteoporosis This dual-energy x-ray absorptiometry scan requires an extra visit for the patient, and might in some settings (e.g., some organisations in Sweden) include several months waiting times which further increase the risk of losing patients, and delaying treatment. There is often a lack of clarity regarding who is clinically responsible for this patient group, which was earlier referred by Harrington [9] as the Bermuda Triangle in osteoporosis care which is made up by the orthopaedist, primary care physician, and the osteoporosis expert into which the fracture patient disappears
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