The Association between opportunistic DECT-derived bone values and vertebral fracture status

IF 3.2 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-05-06 DOI:10.1016/j.ejrad.2025.112159

Philipp Reschke , Vitali Koch , Christof M Sommer , Jennifer Gotta , Elena Höhne , Christian Booz , Tommaso D’Angelo , Katrin Eichler , Thomas J. Vogl , Leon D. Gruenewald

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引用次数: 0

Abstract

Introduction

Osteoporosis is a major cause of spinal insufficiency fractures but often remains underdiagnosed. Dual-energy CT (DECT) enables reliable assessment of bone mineral density (BMD), but its limited accessibility highlights the need for alternative metrics. This study investigates the association between vertebral fracture status, DECT-derived BMD and alternative bone quality assessments, including Hounsfield Unit (HU)-based assessment and cortical thickness ratio.

Methods

A total of 180 patients who underwent non-contrast DECT of the spine between January 2016 and December 2021 were retrospectively analyzed. All imaged vertebrae were assessed for acute insufficiency fractures. DECT-based BMD was assessed using a dedicated postprocessing software that applies material decomposition and compared with HU-based assessment and cortical thickness ratio. Statistical analysis included correlation analysis, logistic regression adjusted for age and sex, ROC and PR curve analyses.

Results

Among 180 patients (97 females, median age of 65 years), 126 subjects (70 %) were confirmed to have insufficiency fractures. Patients with fractures had significantly lower values for DECT-based BMD (98.3 vs. 123.7 mg/cm³, p < 0.001), trabecular HU (93.5 vs. 159.5 HU, p < 0.001), and cortical thickness ratio (1.065 vs. 1.05, p < 0.001). Cortical HU showed no significant difference between patients with and without fractures (p = 0.35). DECT-based BMD provided the highest diagnostic accuracy for detecting insufficiency fractures, yielding an AUC of 0.8 for the ROC curve and an AUC of 0.9 for the PR curve. HU-based measurements (trabecular HU: Spearman ρ = 0.17; cortical HU: ρ = 0.2) and the cortical thickness ratio (ρ = -0.01) demonstrated only weak correlations with the reference standard, DECT-derived BMD.

Conclusion

DECT-based BMD demonstrated the highest diagnostic accuracy for insufficiency fractures. HU-based assessments and cortical thickness ratio showed only weak correlations with DECT-based BMD, limiting their reliability as alternatives.

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机会性ect衍生的骨值与椎体骨折状态之间的关系

骨质疏松症是脊柱不全性骨折的主要原因，但通常仍未得到充分诊断。双能CT （DECT）能够可靠地评估骨矿物质密度（BMD），但其有限的可及性突出了对替代指标的需求。本研究探讨了椎体骨折状态、ect衍生骨密度和其他骨质量评估（包括基于Hounsfield Unit （HU）的评估和皮质厚度比）之间的关系。方法回顾性分析2016年1月至2021年12月180例脊柱非对比DECT患者。所有椎骨成像评估急性不全骨折。使用专用的后处理软件评估基于ect的BMD，该软件应用材料分解，并将基于hu的评估和皮质厚度比进行比较。统计分析包括相关性分析、经年龄、性别校正的logistic回归分析、ROC和PR曲线分析。结果180例患者（女性97例，中位年龄65岁）中有126例（70%）确诊为不完全性骨折。骨折患者的ct骨密度值明显较低(98.3 vs 123.7 mg/cm3, p <；0.001)，小梁HU (93.5 vs 159.5 HU, p <；0.001)，皮质厚度比(1.065 vs. 1.05, p <；0.001)。骨折患者与非骨折患者的皮质HU差异无统计学意义（p = 0.35）。基于ct的BMD在检测不全骨折方面提供了最高的诊断准确性，ROC曲线的AUC为0.8，PR曲线的AUC为0.9。基于HU的测量(小梁HU: Spearman ρ = 0.17；皮质HU: ρ = 0.2)和皮质厚度比（ρ = -0.01）与参考标准（dect衍生BMD）仅呈弱相关性。结论基于ct的骨密度对不完全性骨折的诊断准确率最高。基于hu的评估和皮质厚度比与基于ect的BMD仅显示弱相关性，限制了它们作为替代方案的可靠性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.