Purpose To evaluate the utility of lumbar spine attenuation measurement for bone mineral density (BMD) assessment at screening CT colonography (CTC), using central dual-energy x-ray absorptiometry (DXA) as the reference standard. Material and Methods 252 adults (240 women, 12 men; mean age, 58.9 years) underwent CTC screening and central DXA BMD measurement within 2 months (mean interval, 25.0 days). The lowest DXA T-score between the spine and hip served as the reference standard, with low BMD defined per WHO as osteoporosis (DXA T-score ≤-2.5) or osteopenia (DXA T-score between −1.0 and −2.4). Both phantomless QCT and simple non-angled ROI MDCT attenuation measurements were applied to T12-L5 levels. Ability to predict osteoporosis and low BMD (osteoporosis or osteopenia) by DXA was assessed. Results A BMD cut-off of 90 mg/cc at phantomless QCT yielded 100% sensitivity for osteoporosis (29/29) and specificity of 63.8% (143/224); 87.2% (96/110) below this threshold had low BMD and 49.6% (69/139) above this threshold had normal BMD at DXA. At L1, a trabecular ROI attenuation cut-off of 160 HU was 100% sensitive for osteoporosis (29/29), with a specificity of 46.4% (104/224); 83.9% (125/149) below this threshold had low BMD and 57.5% (59/103) above had normal BMD at DXA. ROI performance was similar at all individual T12-L5 levels. At ROC analysis, AUC for osteoporosis was 0.888 for phantomless QCT (95% CI: 0.780–0.946) and ranged from 0.825–0.853 using trabecular ROIs at single lumbar levels (0.864 [0.752–0.930] at multivariate analysis). Supine-prone reproducibility was better with simple ROI method compared with QCT. Conclusion Both phantomless QCT and simple ROI attenuation measurements of the lumbar spine are effective for BMD screening at CTC, with high sensitivity for osteoporosis as defined by the DXA T-score.
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