Rationale and Objectives
To evaluate the bone mineral density (BMD) of the lumbar spine derived from dual-energy
CT (DECT)-based volumetric material decomposition and its association with acute insufficiency
fractures of the thoracolumbar spine.
Materials and Methods
L1 of 160 patients (77 men, 83 women; mean age 64.3 years, range, 22-94 years) who
underwent third-generation dual-source DECT between January 2016 and December 2021
due to suspected insufficiency fractures was retrospectively analyzed. All depicted
vertebrae were examined for signs of recent fractures. A dedicated DECT postprocessing
software using material decomposition was applied for phantomless BMD assessment.
Receiver-operating characteristic (ROC) analysis identified optimal BMD thresholds.
Associations of BMD, sex, and age with the occurrence of insufficiency fractures were
examined with logistic regression models.
Results
A DECT-derived BMD threshold of 120.40 mg/cm³ yielded 90.1% specificity and 59.32%
sensitivity to differentiate patients with at least one insufficiency fracture from
patients without fracture. No patient without fracture had a DECT-derived BMD below
85 mg/cm3. Lower DECT-derived bone mineral density was associated with an increased risk of
insufficiency fractures (Odds ratio of 0.93, 95% CI, 0.91-0.96, p < 0.001). Overall ROC-derived AUC was 0.82 (p < 0.0001) for the differentiation of patients that sustained an insufficiency fracture
from the control group.
Conclusion
Dual-Energy CT-based BMD assessment can accurately differentiate patients with acute
insufficiency fractures of the thoracolumbar spine from patients without fracture.
This algorithm can be used for phantomless risk stratification of patients undergoing
routine CT to sustain insufficiency fractures of the thoracolumbar spine The identified
cut-off value of 120.4 mg/cm³ is in line with current American College of Radiology
(ACR) recommendations to differentiate healthy individuals from those with reduced
bone mineral density.
Key Words
Abbreviations:
ACR (American College of Radiology), AUC (Area under the curve), BMD (Bone mineral density), DECT (Dual-energy computed tomography), DXA (Dual x-ray absorptiometry), HU (Hounsfield unit), PACS (Picture Archiving and Communication System), QCT (Quantitative computed tomography), ROC (Receiver-operating characteristic), ROI (Region of interest), VOI (Volume of interest)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 26, 2022
Accepted:
November 15,
2022
Received in revised form:
November 1,
2022
Received:
August 3,
2022
Publication stage
In Press Corrected ProofFootnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
