Local Bone Mineral Density, Subcutaneous and Visceral Adipose Tissue Measurements in Routine Multi Detector Computed Tomography—Which Parameter Predicts Incident Vertebral Fractures Best?

Abstract

In this case-control study the value of bone mineral density (BMD) at different vertebral levels, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) to identify patients with incident osteoporotic vertebral fractures in routine multi-detector computed tomography (MDCT) exams was assessed. Material and methods: Seventeen patients who underwent baseline and follow-up routine contrast-enhanced MDCT and had an incident osteoporotic vertebral fracture at follow-up were included. Seventeen age-, sex- and follow-up duration-matched controls were identified. Trabecular BMD (from Th5 to L5) as well as cross-sectional area of SAT and VAT were extracted. Results: BMD performed best to differentiate patients with an incident fracture from controls at the levels of Th5 (area under the curve [AUC] = 0.781, p = 0.014), Th7 (AUC = 0.877, p = 0.001), and Th9 (AUC = 0.818, p = 0.005). Applying multivariate logistic regression BMD at Th7 level remained the only significant predictor of incident vertebral fractures (Th5-L5) with an odds ratio of 1.07 per BMD SD decrease. VAT and SAT did not show significant differences between the fracture and control group (p > 0.05). Conclusion: The local BMD measurement appears to be more suitable than standard mean BMD from L1–L3 for fracture risk assessment.

Automated Opportunistic Trabecular Volumetric Bone Mineral Density Extraction Outperforms Manual Measurements for the Prediction of Vertebral Fractures in Routine CT

“…Various study results have led to an increasing acceptance of opportunistic osteoporosis assessment using clinical routine CT data over recent years [ 15 , 16 , 17 , 20 , 22 , 30 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. QCT and opportunistically used CT data showed no significant difference in vBMD measurements, underlining the fact that opportunistic bone densitometry is feasible for both non-contrast as well as contrast-enhanced CT-scans [ 46 ].…”

Editorial on Special Issue “Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools”

“…Other articles in this Special Issue have set a focus on the opportunistic use of MDCT data for osteoporosis diagnostics or prediction of incidental osteoporotic VFs (i.e., use of existing imaging data originally acquired for other purposes than osteoporosis screening, such as oncologic staging in cancer patients) [ 19 , 20 , 21 ]. In detail, Burian et al studied the contribution of bone mineral density (BMD) at different vertebral levels, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) regarding the identification of VFs using baseline and follow-up image data from a 64-row MDCT scanner in patients (osteoporotic incidental VFs) and controls (no VFs) [ 20 ]. The trabecular vertebral BMD (T5-L5), SAT, and VAT volumes were extracted from the imaging data [ 20 ].…”

“…In detail, Burian et al studied the contribution of bone mineral density (BMD) at different vertebral levels, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) regarding the identification of VFs using baseline and follow-up image data from a 64-row MDCT scanner in patients (osteoporotic incidental VFs) and controls (no VFs) [ 20 ]. The trabecular vertebral BMD (T5-L5), SAT, and VAT volumes were extracted from the imaging data [ 20 ]. It was revealed that the BMD performed best to differentiate patients with VFs from controls at the levels T5 (AUC = 0.781), T7 (AUC = 0.877), and T9 (AUC = 0.818), while, according to multivariate logistic regression (stepwise approach with baseline fracture status, BMD, SAT, VAT, and VAT/SAT ratio), only BMD at level T7 was a statistically significant predictor of VFs (T5-L5), with an odds ratio of 1.07 per BMD standard deviation decrease [ 20 ].…”

“…The trabecular vertebral BMD (T5-L5), SAT, and VAT volumes were extracted from the imaging data [ 20 ]. It was revealed that the BMD performed best to differentiate patients with VFs from controls at the levels T5 (AUC = 0.781), T7 (AUC = 0.877), and T9 (AUC = 0.818), while, according to multivariate logistic regression (stepwise approach with baseline fracture status, BMD, SAT, VAT, and VAT/SAT ratio), only BMD at level T7 was a statistically significant predictor of VFs (T5-L5), with an odds ratio of 1.07 per BMD standard deviation decrease [ 20 ]. However, there was no statistically significant difference between patients and controls for VAT or SAT [ 20 ].…”

“…It was revealed that the BMD performed best to differentiate patients with VFs from controls at the levels T5 (AUC = 0.781), T7 (AUC = 0.877), and T9 (AUC = 0.818), while, according to multivariate logistic regression (stepwise approach with baseline fracture status, BMD, SAT, VAT, and VAT/SAT ratio), only BMD at level T7 was a statistically significant predictor of VFs (T5-L5), with an odds ratio of 1.07 per BMD standard deviation decrease [ 20 ]. However, there was no statistically significant difference between patients and controls for VAT or SAT [ 20 ]. Furthermore, finite element analysis (FEA) as an advanced image analysis technique can be applied to MDCT data, which can relate morphological and material variations and properties to functional characteristics, thus providing 3D models of bone reconstructed from image data for the investigation of material properties within an FEA-meshed model [ 2 ].…”