Computed tomography-based opportunistic osteoporosis assessment: a comparison of two software applications for lumbar vertebral volumetric bone mineral density measurements

Abstract

Background: We aimed to compare two volumetric bone mineral density (vBMD) analysis programs, regarding (I) agreement of vBMD values based on mono-and dual-energy computed tomography (MECT and DECT) scans and (II) suitability for analyzing DECT data obtained at different energies. Methods:We retrospectively analyzed two abdominal CT datasets: one performed in a MECT scan (vertebrae L1-L3) and one in a DECT scan (vertebrae L1-L4). Each dataset included different individuals [MECT 15 patients (45 vertebrae) and DECT 12 patients (48 vertebrae), respectively]. vBMD analysis was conducted using Philips IntelliSpace (IP) and Mindways qCT Pro (MW). Regarding the DECT scans, vBMD analysis was done at three different energies: 80, 150 and synthetic 120 kVp and for MECT scan at 120 kVp. For comparison of vBMD results between different software (aim 1) MECT 120 kVp and DECT synthetic 120 kVp data was used. For analyzing suitability of using different DECT energies for vBMD assessment (aim 2) all three DECT energies were used and results from each software was analyzed separately.Results: vBMD assessed with MW and IP, respectively correlated significantly for both the MECT (r=0.876; P<0.001) and DECT (r=0.837; P<0.001) scans, but the vBMD values were lower in using IP for vBMD assessment (8% and 14% lower for MECT and DECT, respectively; P=0.001). Regarding the different DECT energies, using MW for vBMD assessment showed significant correlations in vBMD results between 120 kVp and the two other energies (r=0.988 and r=0.939) and no significant differences in absolute vBMD values (P>0.05). The IP analysis as well showed significant correlation between 120 kVp and the other energies (r=0.769 and r=0.713, respectively), but differences in absolute vBMD values between the energies (P≤0.001). Conclusions:We show that the correlations between the vBMD derived from the two investigated software solutions were generally good but that absolute vBMD value did differ and might impact the clinical diagnosis of osteoporosis. Though small, our study data indicate that vBMD might be assessed in energies other than 120 kVp when using MW but not when using IP.

Osteoporosis and Endplate Damage Correlation Using a Combined Approach of Hounsfield Unit Values and Total Endplate Scores: A Retrospective Cross-Sectional Study

“…However, we could not obtain satisfactory results utilizing DXA while treating patients with degenerative diseases, which was confirmed by many previous studies. 13 , 14 , 32 , 33 Quantitative CT (QCT) was introduced as a reliable method of assessing the bone quality with trabecular BMD instead of areal BMD measured by DXA. 34 However, it cannot be performed routinely in most hospitals due to patients’ unwillingness to undergo additional examinations.…”

The impact of imaging time and contrast agent dose on screening for osteoporosis with contrast-enhanced CT

“…Another important aspect when considering vBMD measurement is to be aware of the kVp used in the CT examination. A lower kVp yields exponentially higher HU values [ 29 , 30 ], and furthermore impact of kVp varies between different tissues [ 28 , 29 ]. For this reason, vBMD analysis with software methods based on internal tissue references, i.e.…”

“…For the vBMD analysis, Mindways qCT PRO software, version 2 (Mindways, Austin, TX, USA) was used as described in detail earlier [ 28 ]. In brief, preceding the study, calibration scans with Mindways dedicated phantom were performed, repeated monthly during the study period.…”

“…In addition, most of the above-mentioned studies were single-centre studies with CT protocols using kVp values fixed at 120. As an increasing number of contrast-enhanced abdominal CT scans are made with lower kVps in order to save radiation dose and contrast agents, screening methods relying on software solutions using solely internal tissue references might be problematic to use [ 28 ]. The reason for this is that the Hounsfield Units (HU) units of different tissues behave differently after contrast administration at varying kVp [ 29 , 30 ].…”

Effect of abdominal adipose content on spine phantom bone mineral density measured by rapid kilovoltage-switching dual-energy CT and quantitative CT

“…However, some studies have shown that abdominal and spinal bone marrow adipose content influences the QCT measurements of vertebral BMD (8)(9)(10)(11)(12)(13). Dual-energy computed tomography (DECT) employs a high-and low-energy switching scanning method with a material decomposition (MD) technique that also allows the accurate measurement of vertebral BMD, which has shown preliminary advantages (14)(15)(16)(17). However, it is possible that the DECT measurements of BMD were influenced, to some extent, by abdominal adipose content.…”