Diagnostic accuracy of quantitative dual-energy CT-based volumetric bone mineral density assessment for the prediction of osteoporosis-associated fractures

  • Objectives: To evaluate the predictive value of volumetric bone mineral density (BMD) assessment of the lumbar spine derived from phantomless dual-energy CT (DECT)-based volumetric material decomposition as an indicator for the 2-year occurrence risk of osteoporosis-associated fractures. Methods: L1 of 92 patients (46 men, 46 women; mean age, 64 years, range, 19–103 years) who had undergone third-generation dual-source DECT between 01/2016 and 12/2018 was retrospectively analyzed. For phantomless BMD assessment, dedicated DECT postprocessing software using material decomposition was applied. Digital files of all patients were sighted for 2 years following DECT to obtain the incidence of osteoporotic fractures. Receiver operating characteristic (ROC) analysis was used to calculate cut-off values and logistic regression models were used to determine associations of BMD, sex, and age with the occurrence of osteoporotic fractures. Results: A DECT-derived BMD cut-off of 93.70 mg/cm3 yielded 85.45% sensitivity and 89.19% specificity for the prediction to sustain one or more osteoporosis-associated fractures within 2 years after BMD measurement. DECT-derived BMD was significantly associated with the occurrence of new fractures (odds ratio of 0.8710, 95% CI, 0.091–0.9375, p < .001), indicating a protective effect of increased DECT-derived BMD values. Overall AUC was 0.9373 (CI, 0.867–0.977, p < .001) for the differentiation of patients who sustained osteoporosis-associated fractures within 2 years of BMD assessment. Conclusions: Retrospective DECT-based volumetric BMD assessment can accurately predict the 2-year risk to sustain an osteoporosis-associated fracture in at-risk patients without requiring a calibration phantom. Lower DECT-based BMD values are strongly associated with an increased risk to sustain fragility fractures. Key Points: Dual-energy CT–derived assessment of bone mineral density can identify patients at risk to sustain osteoporosis-associated fractures with a sensitivity of 85.45% and a specificity of 89.19%. The DECT-derived BMD threshold for identification of at-risk patients lies above the American College of Radiology (ACR) QCT guidelines for the identification of osteoporosis (93.70 mg/cm 3 vs 80 mg/cm 3 ).
Author:Leon David GrünewaldORCiDGND, Vitali KochORCiDGND, Simon MartinORCiDGND, Ibrahim YelORCiDGND, Katrin EichlerGND, Tatjana Gruber-RouhORCiDGND, Lukas Fabian LengaORCiDGND, Julian WichmannORCiDGND, Leona Soraja AlizadehORCiDGND, Moritz Hans Ernst AlbrechtORCiDGND, Christoph MaderORCiDGND, Nicole A. Huizinga, Tommaso D’AngeloORCiD, Silvio MazziottiORCiD, Stefan Wesarg, Thomas J. VoglORCiDGND, Christian BoozORCiDGND
Parent Title (English):European radiology
Place of publication:Berlin ; Heidelberg
Document Type:Article
Date of Publication (online):2021/10/29
Date of first Publication:2021/10/29
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/02/09
Tag:Bone density; Bone diseases, Metabolic; CT dual-energy computed tomography; Osteoporosis; Osteoporotic fractures
Page Number:9
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0