Diagnostic ability of spectral CT-based vertebral hydroxyapatite concentration for bone mineral density assessment in patients with liver cirrhosis: evaluating in unenhanced, arterial, and portal venous phase after intravenous contrast administration.

Abstract

Objectives: To access the impact of intravenous contrast on the diagnostic efficacy of abdominal spectral CT-based vertebral hydroxyapatite (HAP) concentration measurement for bone mineral density (BMD) assessment in menopausal women, women undergoing menopausal transition, and men older than 50 years with liver cirrhosis.

Methods: 172 patients (mean age, 63.78 ± 7.20 years; range, 51-82 years) with liver cirrhosis enrolled in the study. These individuals underwent comprehensive abdominal spectral abdominal spectral CT scans, which included both unenhanced and contrast-enhanced arterial phase (AP) and portal venous phase (VP). Vertebral HAP concentration was quantified in the medullary compartment of vertebral body (L1-L3) using HAP-based material decomposition images. The receiver operating characteristic (ROC) curves were adapted to investigate the diagnostic efficacy of using unenhanced, AP and VP HAP concentrations for evaluating BMD validated by T-scores on dual-energy x-ray absorptiometry.

Results: HAP values were significantly different among the three scan phases (all P < 0.05). By adjusting thresholds, high accuracies were obtained for detecting low bone mass (osteoporosis or osteopenia) with HAP measurements in all scan phases (all areas-under-ROC > 0.9). The data did not reveal a statistically significant disparity between the unenhanced and AP (P = 0.055) to detect low bone mass. The efficacies for detecting low bone mass had statistically significant reduction with HAP concentrations in VP (P = 0.012).

Conclusions: Vertebral HAP concentrations increased in AP and VP compared to unenhanced phase.

Advances in knowledge: Adjusting thresholds higher in contrast-enhanced phases may maintain high detection efficacies for low bone mass.