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Reschke P, Gotta J, Stahl A, Koch V, Mader C, Martin SS, Scholtz JE, Booz C, Yel I, Hescheler DA, Gruber-Rouh T, Eichler K, Vogl TJ, Gruenewald LD. Value of Dual-Energy CT-Derived Metrics for the Prediction of Bone Non-union in Distal Radius Fractures. Acad Radiol 2024:S1076-6332(24)00063-1. [PMID: 38461052 DOI: 10.1016/j.acra.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
RATIONALE AND OBJECTIVES Bone non-union is a serious complication of distal radius fractures (DRF) that can result in functional limitations and persistent pain. However, no accepted method has been established to identify patients at risk of developing bone non-union yet. This study aimed to compare various CT-derived metrics for bone mineral density (BMD) assessment to identify predictive values for the development of bone non-union. MATERIALS AND METHODS CT images of 192 patients with DRFs who underwent unenhanced dual-energy CT (DECT) of the distal radius between 03/2016 and 12/2020 were retrospectively identified. Available follow-up imaging and medical health records were evaluated to determine the occurrence of bone non-union. DECT-based BMD, trabecular Hounsfield unit (HU), cortical HU and cortical thickness ratio were measured in normalized non-fractured segments of the distal radius. RESULTS Patients who developed bone non-union were significantly older (median age 72 years vs. 54 years) and had a significantly lower DECT-based BMD (median 68.1 mg/cm3 vs. 94.6 mg/cm3, p < 0.001). Other metrics (cortical thickness ratio, cortical HU, trabecular HU) showed no significant differences. ROC and PR curve analyses confirmed the highest diagnostic accuracy for DECT-based BMD with an area under the curve (AUC) of 0.83 for the ROC curve and an AUC of 0.46 for the PR curve. In logistic regression models, DECT-based BMD was the sole metric significantly associated with bone non-union. CONCLUSION DECT-derived metrics can accurately predict bone non-union in patients who sustained DRF. The diagnostic performance of DECT-based BMD is superior to that of HU-based metrics and cortical thickness ratio.
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Affiliation(s)
- Philipp Reschke
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adrian Stahl
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christoph Mader
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel A Hescheler
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
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Moser LJ, Pitteloud J, Mergen V, Frey D, Nowak T, Distler O, Eberhard M, Alkadhi H. Bone Mineral Density Assessment Using Spectral Topograms From a Clinical Photon-Counting Detector CT System: A Phantom Evaluation. AJR Am J Roentgenol 2024; 222:e2330347. [PMID: 37937835 DOI: 10.2214/ajr.23.30347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
| | | | | | - Diana Frey
- University Hospital Zurich, Zurich, Switzerland
| | | | | | - Matthias Eberhard
- University Hospital Zurich, Zurich, Switzerland
- Spitäler Frutigen Meiringen Interlaken AG, Unterseen, Switzerland
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Tong X, Fang X, Wang S, Fan Y, Wei W, Xiao Q, Chen A, Liu Y, Liu L. Opportunistic screening for osteoporosis using enhanced images based on dual-energy computed tomography material decomposition: a comparison with quantitative computed tomography. Quant Imaging Med Surg 2024; 14:352-364. [PMID: 38223059 PMCID: PMC10784008 DOI: 10.21037/qims-23-855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/07/2023] [Indexed: 01/16/2024]
Abstract
Background Many patients with malignant tumors require chemotherapy and radiation therapy, which can result in a decline in physical function and potentially influence bone mineral density (BMD). Furthermore, these treatments necessitate enhanced computed tomography (CT) scans for determining disease staging or treatment outcomes, and opportunistic screening with available imaging data is beneficial for patients at high risk for osteoporosis if existing imaging data can be used. The study aimed to investigate the feasibility of opportunistic screening for osteoporosis using enhanced CT based on a dual-energy CT (DECT) material decomposition technique. Methods We prospectively enrolled 346 consecutive patients who underwent abdominal unenhanced and triphasic contrast-enhanced CT (arterial, portal venous, and delayed phases) between June 2021 and June 2022. The BMD, and the density of hydroxyapatite (HAP) on HAP-iodine images and calcium (Ca) on Ca-iodine images were measured on the L1-L3 vertebral bodies. The iodine intake was recorded. Pearson analysis was conducted to assess the correlation between iodine intake and the density values in three phases and the correlation between BMD and the densities of HAP and Ca. Furthermore, linear regression was employed for quantitative evaluation. Bland-Altman analysis was used to evaluate the agreement between calculated BMD derived from DECT (BMD-DECT) and reference BMD derived from quantitative CT (BMD-QCT). Receiver operating characteristic (ROC) analysis was applied to assess the diagnostic efficacy. Results The HAP and Ca density of the L1-L3 vertebral bodies did not differ significantly among the three phases of contrast-enhanced CT (F=0.001-0.049; P>0.05). Significant positive correlations were found between HAP, Ca densities, and BMD (HAP-BMD: r=0.9472, R2=0.8973; Ca-BMD: r=0.9470, R2=0.8968; all P<0.001). Bland-Altman plots showed high agreement between BMD-DECT and BMD-QCT. The area under the curve (AUC) using HAP and Ca measurements was 0.963 [95% confidence interval (CI): 0.937-0.980] and 0.964 (95% CI: 0.939-0.981), respectively, for diagnosing osteoporosis and was 0.951 (95% CI: 0.917-0.973) and 0.950 (95% CI: 0.916-0.973), respectively, for diagnosing osteopenia. Conclusions The HAP and Ca density measurements generated through the material decomposition technique in DECT have good diagnostic performances in assessing BMD, which offers a new perspective for opportunistic screening of osteoporosis on contrast-enhanced CT.
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Affiliation(s)
- Xiaoyu Tong
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xin Fang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shigeng Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yong Fan
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Wei
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingzhu Xiao
- School of Investment and Project Management, Dongbei University of Finance and Economics, Dalian, China
| | - Anliang Chen
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yijun Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lei Liu
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Ong W, Liu RW, Makmur A, Low XZ, Sng WJ, Tan JH, Kumar N, Hallinan JTPD. Artificial Intelligence Applications for Osteoporosis Classification Using Computed Tomography. Bioengineering (Basel) 2023; 10:1364. [PMID: 38135954 PMCID: PMC10741220 DOI: 10.3390/bioengineering10121364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Osteoporosis, marked by low bone mineral density (BMD) and a high fracture risk, is a major health issue. Recent progress in medical imaging, especially CT scans, offers new ways of diagnosing and assessing osteoporosis. This review examines the use of AI analysis of CT scans to stratify BMD and diagnose osteoporosis. By summarizing the relevant studies, we aimed to assess the effectiveness, constraints, and potential impact of AI-based osteoporosis classification (severity) via CT. A systematic search of electronic databases (PubMed, MEDLINE, Web of Science, ClinicalTrials.gov) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 39 articles were retrieved from the databases, and the key findings were compiled and summarized, including the regions analyzed, the type of CT imaging, and their efficacy in predicting BMD compared with conventional DXA studies. Important considerations and limitations are also discussed. The overall reported accuracy, sensitivity, and specificity of AI in classifying osteoporosis using CT images ranged from 61.8% to 99.4%, 41.0% to 100.0%, and 31.0% to 100.0% respectively, with areas under the curve (AUCs) ranging from 0.582 to 0.994. While additional research is necessary to validate the clinical efficacy and reproducibility of these AI tools before incorporating them into routine clinical practice, these studies demonstrate the promising potential of using CT to opportunistically predict and classify osteoporosis without the need for DEXA.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
| | - Ren Wei Liu
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Weizhong Jonathan Sng
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Bartenschlager S, Cavallaro A, Pogarell T, Chaudry O, Uder M, Khosla S, Schett G, Engelke K. Opportunistic Screening With CT: Comparison of Phantomless BMD Calibration Methods. J Bone Miner Res 2023; 38:1689-1699. [PMID: 37732678 DOI: 10.1002/jbmr.4917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
Opportunistic screening is a new promising technique to identify individuals at high risk for osteoporotic fracture using computed tomography (CT) scans originally acquired for an clinical purpose unrelated to osteoporosis. In these CT scans, a calibration phantom traditionally required to convert measured CT values to bone mineral density (BMD) is missing. As an alternative, phantomless calibration has been developed. This study aimed to review the principles of four existing phantomless calibration methods and to compare their performance against the gold standard of simultaneous calibration (ΔBMD). All methods were applied to a dataset of 350 females scanned with a highly standardized CT protocol (DS1) and to a second dataset of 114 patients (38 female) from clinical routine covering a large range of CT acquisition and reconstruction parameters (DS2). Three of the phantomless calibration methods must be precalibrated with a reference dataset containing a calibration phantom. Sixty scans from DS1 and 57 from DS2 were randomly selected for this precalibration. For each phantomless calibration method first the best combination of internal reference materials (IMs) was selected. These were either air and blood or subcutaneous adipose tissue, blood, and cortical bone. In addition, for phantomless calibration a fifth method based on average calibration parameters derived from the reference dataset was applied. For DS1, ΔBMD results (mean ± standard deviation) for the phantomless calibration methods requiring a precalibration ranged from 0.1 ± 2.7 mg/cm3 to 2.4 ± 3.5 mg/cm3 with similar means but significantly higher standard deviations for DS2. Performance of the phantomless calibration method, which does not require a precalibration was worse (ΔBMD DS1: 12.6 ± 13.2 mg/cm3 , DS2: 0.5 ± 8.8 mg/cm3 ). In conclusion, phantomless BMD calibration performs well if precalibrated with a reference dataset. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Stefan Bartenschlager
- Department of Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Cavallaro
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tobias Pogarell
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Oliver Chaudry
- Department of Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sundeep Khosla
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Georg Schett
- Department of Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Engelke
- Department of Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Gruenewald LD, Koch V, Yel I, Eichler K, Gruber-Rouh T, Alizadeh LS, Mahmoudi S, D'Angelo T, Wichmann JL, Wesarg S, Vogl TJ, Booz C. Association of Phantomless Dual-Energy CT-based Volumetric Bone Mineral Density with the Prevalence of Acute Insufficiency Fractures of the Spine. Acad Radiol 2023; 30:2110-2117. [PMID: 36577605 DOI: 10.1016/j.acra.2022.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the bone mineral density (BMD) of the lumbar spine derived from dual-energy CT (DECT)-based volumetric material decomposition and its association with acute insufficiency fractures of the thoracolumbar spine. MATERIALS AND METHODS L1 of 160 patients (77 men, 83 women; mean age 64.3 years, range, 22-94 years) who underwent third-generation dual-source DECT between January 2016 and December 2021 due to suspected insufficiency fractures was retrospectively analyzed. All depicted vertebrae were examined for signs of recent fractures. A dedicated DECT postprocessing software using material decomposition was applied for phantomless BMD assessment. Receiver-operating characteristic (ROC) analysis identified optimal BMD thresholds. Associations of BMD, sex, and age with the occurrence of insufficiency fractures were examined with logistic regression models. RESULTS A DECT-derived BMD threshold of 120.40 mg/cm³ yielded 90.1% specificity and 59.32% sensitivity to differentiate patients with at least one insufficiency fracture from patients without fracture. No patient without fracture had a DECT-derived BMD below 85 mg/cm3. Lower DECT-derived bone mineral density was associated with an increased risk of insufficiency fractures (Odds ratio of 0.93, 95% CI, 0.91-0.96, p < 0.001). Overall ROC-derived AUC was 0.82 (p < 0.0001) for the differentiation of patients that sustained an insufficiency fracture from the control group. CONCLUSION Dual-Energy CT-based BMD assessment can accurately differentiate patients with acute insufficiency fractures of the thoracolumbar spine from patients without fracture. This algorithm can be used for phantomless risk stratification of patients undergoing routine CT to sustain insufficiency fractures of the thoracolumbar spine The identified cut-off value of 120.4 mg/cm³ is in line with current American College of Radiology (ACR) recommendations to differentiate healthy individuals from those with reduced bone mineral density.
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Affiliation(s)
- Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Leona S Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, ME, Italy
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | | | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany.
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Yu Q, Yang J, Zhou C, Xu Z, Liu C, Luo Q, Zhang L. Quantification of bone quality and distribution of the proximal humerus with dual-energy computed tomography. Quant Imaging Med Surg 2023; 13:5676-5687. [PMID: 37711831 PMCID: PMC10498250 DOI: 10.21037/qims-22-927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/07/2023] [Indexed: 09/16/2023]
Abstract
Background The proximal humerus is a common site of osteoporotic fractures, and bone quality is a predictor of surgical reduction quality. Dual-energy computed tomography (DECT) is assuming an increasingly important role in the quantification of bone mineral density (BMD) due it is ability to perform three-material decomposition. We aimed to analyze the bone quality and distribution of the proximal humerus with DECT quantitatively. Methods Sixty-five consecutive patients (average age 49.5±15.2 years; male: female ratio 32:33) without proximal humerus fractures who had undergone DECT were retrospectively selected. The humeral head was divided into 4 regions on a cross section in the medial plane between the greater tuberosity and the surgical neck. The quantitative parameters, including virtual noncalcium (VNCa) value, computed tomography value of calcium (CaCT), computed tomography value of mixed-energy images (regular CT value) (rCT), and relative calcium density (rCaD), were measured. The correlations between the quantitative parameters and age and body mass index (BMI) were analyzed, and the correlations of age, sex, BMI, region of the humeral head, and VNCa value on CaCT were evaluated. Results The differences in CaCT, rCT, and rCaD between the 4 regions of proximal humerus were statistically significant (P<0.001), while the difference in VNCa values was not (P=0.688). The calcium concentration (CaCT and rCaD) was the densest in the posteromedial zone. The differences of CaCT, rCT, and rCaD between males and females in the 4 regions of proximal humerus were statistically significant (P<0.05), while those of the posterolateral zone were not (rCT; P>0.05). The differences in VNCa values between males and females were also not significant (P>0.05). Multivariable linear regression analysis indicated that sex, age, BMI, regions, and VNCa were significant (P<0.05) predictors of the CaCT value. Conclusions The concentration of calcium was the densest in the posteromedial region of proximal humerus, and the VNCa value of DECT may be used for quantifying the BMD of the proximal humerus.
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Affiliation(s)
- Qinqin Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Yang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenwei Zhou
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihan Xu
- Siemens Healthineers, Shanghai, China
| | - Chao Liu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Luo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hammel J, Birnbacher L, Campbell G, Coulon P, Ushakov L, Pfeiffer F, Makowski MR, Kirschke J, Pfeiffer D. Comparison of volumetric and areal bone mineral density in CT and scout scans using spectral detector technology. Eur Radiol Exp 2023; 7:37. [PMID: 37525062 PMCID: PMC10390397 DOI: 10.1186/s41747-023-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/26/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND To determine whether denoised areal bone mineral density (BMD) measurements from scout scans in spectral detector computed tomography (CT) correlate with volumetric trabecular BMD for opportunistic osteoporosis screening. METHODS A 64-slice single-source dual-layer spectral CT scanner was used to acquire scout scan data of 228 lumbar vertebral bodies within 57 patients. Scout scans in anterior-posterior (AP) view were performed with a dose of < 0.06 mSv and spectrally decomposed into areal BMD (aBMD) values. A spectral dictionary denoising algorithm was applied to increase the signal-to-noise ratio (SNR). Volumetric trabecular bone mineral density (vBMD) was determined via material decomposition. A 3D convolutional network for image segmentation and labeling was applied for automated vBMD quantification. Projected maps were used to compare the classification accuracy of AP and lateral scout scans. RESULTS The denoising algorithm led to the minimization of anticorrelated noise in spectral maps and an SNR increase from 5.23 to 13.4 (p < 0.002). Correlation analysis between vBMD and measured AP aBMD, projected AP, and lateral aBMD showed a Pearson correlation coefficient of 0.68, 0.81, and 0.90, respectively. The sensitivity and specificity for the osteoporosis classification task were higher in lateral projection images than in AP crystallizing in an increased area under the curve value of 0.99 versus 0.90. CONCLUSION Denoised material-specific aBMD maps show a positive correlation to vBMD, enabling spectral scout scans as an opportunistic predictor for osteoporotic patients. This could be applied routinely as a screening tool in patients undergoing a CT examination. RELEVANCE STATEMENT Scout-based DEXA could be applied routinely as a screening tool in patients undergoing a CT examination. KEY POINTS • Spectral scout scans can be used as a dual-energy x-ray absorptiometry-like screening tool. • Spectral dictionary denoising on projection images increases the signal-to-noise ratio. • Positive correlation between volumetric and areal bone mineral density is observed. • Lateral projections increase osteoporosis classification accuracy compared to anterior-posterior projections.
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Affiliation(s)
- Johannes Hammel
- Department of Diagnostic and Interventional Radiology, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, Garching, Germany.
| | - Lorenz Birnbacher
- Department of Diagnostic and Interventional Radiology, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, Garching, Germany
| | | | | | - Lev Ushakov
- Department of Diagnostic and Interventional Radiology, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
- TUM Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Jan Kirschke
- Department of Diagnostic and Interventional Neuroradiology, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
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Gruenewald LD, Koch V, Martin SS, Yel I, Mahmoudi S, Bernatz S, Eichler K, Gruber-Rouh T, Pinto Dos Santos D, D'Angelo T, Wesarg S, Herrmann E, Golbach R, Handon M, Vogl TJ, Booz C. Dual-Energy CT-based Opportunistic Volumetric Bone Mineral Density Assessment of the Distal Radius. Radiology 2023; 308:e223150. [PMID: 37552067 DOI: 10.1148/radiol.223150] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background In patients with distal radius fractures (DRFs), low bone mineral density (BMD) is associated with bone substitute use during surgery and bone nonunion, but BMD information is not regularly available. Purpose To evaluate the feasibility of dual-energy CT (DECT)-based BMD assessment from routine examinations in the distal radius and the relationship between the obtained BMD values, the occurrence of DRFs, bone nonunion, and use of surgical bone substitute. Materials and Methods Scans in patients who underwent routine dual-source DECT in the distal radius between January 2016 and December 2021 were retrospectively acquired. Phantomless BMD assessment was performed using the delineated trabecular bone of a nonfractured segment of the distal radius and both DECT image series. CT images and health records were examined to determine fracture severity, surgical management, and the occurrence of bone nonunion. Associations of BMD with the occurrence of DRFs, bone nonunion, and bone substitute use at surgical treatment were examined with generalized additive models and receiver operating characteristic analysis. Results This study included 263 patients (median age, 52 years; IQR, 36-64 years; 132 female patients), of whom 192 were diagnosed with fractures. Mean volumetric BMD was lower in patients who sustained a DRF (93.9 mg/cm3 vs 135.4 mg/cm3; P < .001), required bone substitutes (79.6 mg/cm3 vs 95.5 mg/cm3; P < .001), and developed bone nonunion (71.1 mg/cm3 vs 96.5 mg/cm3; P < .001). Receiver operating characteristic curve analysis identified these patients with an area under the curve of 0.71-0.91 (P < .001). Lower BMD increased the risk to sustain DRFs, develop bone nonunion, and receive bone substitutes at surgery (P < .001). Conclusion DECT-based BMD assessment at routine examinations is feasible and could help predict surgical bone substitute use and the occurrence of bone nonunion in patients with DRFs. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Carrino in this issue.
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Affiliation(s)
- Leon D Gruenewald
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Vitali Koch
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Simon S Martin
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Ibrahim Yel
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Scherwin Mahmoudi
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Simon Bernatz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Katrin Eichler
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Tatjana Gruber-Rouh
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Daniel Pinto Dos Santos
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Tommaso D'Angelo
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Stefan Wesarg
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Eva Herrmann
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Rejane Golbach
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Marlin Handon
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Thomas J Vogl
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Christian Booz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
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Chen YC, Li YT, Kuo PC, Cheng SJ, Chung YH, Kuo DP, Chen CY. Automatic segmentation and radiomic texture analysis for osteoporosis screening using chest low-dose computed tomography. Eur Radiol 2023; 33:5097-5106. [PMID: 36719495 DOI: 10.1007/s00330-023-09421-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 12/24/2022] [Accepted: 01/01/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study developed a diagnostic tool combining machine learning (ML) segmentation and radiomic texture analysis (RTA) for bone density screening using chest low-dose computed tomography (LDCT). METHODS A total of 197 patients who underwent LDCT followed by dual-energy X-ray absorptiometry were analyzed. First, an autosegmentation model was trained using LDCT to delineate the thoracic vertebral body (VB). Second, a two-level classifier was developed using radiomic features extracted from VBs for the hierarchical pairwise classification of each patient's bone status. All the patients were initially classified as either normal or abnormal, and all patients with abnormal bone density were then subdivided into an osteopenia group and an osteoporosis group. The performance of the classifier was evaluated through fivefold cross-validation. RESULTS The model for automated VB segmentation achieved a Sorenson-Dice coefficient of 0.87 ± 0.01. Furthermore, the area under the receiver operating characteristic curve scores for the two-level classifier were 0.96 ± 0.01 for detecting abnormal bone density (accuracy = 0.91 ± 0.02; sensitivity = 0.93 ± 0.03; specificity = 0.89 ± 0.03) and 0.98 ± 0.01 for distinguishing osteoporosis (accuracy = 0.94 ± 0.02; sensitivity = 0.95 ± 0.03; specificity = 0.93 ± 0.03). The testing prediction accuracy levels for the first- and second-level classifiers were 0.92 ± 0.04 and 0.94 ± 0.05, respectively. The overall testing prediction accuracy of our method was 0.90 ± 0.05. CONCLUSION The combination of ML segmentation and RTA for automated bone density prediction based on LDCT scans is a feasible approach that could be valuable for osteoporosis screening during lung cancer screening. KEY POINTS • This study developed an automatic diagnostic tool combining machine learning-based segmentation and radiomic texture analysis for bone density screening using chest low-dose computed tomography. • The developed method enables opportunistic screening without quantitative computed tomography or a dedicated phantom. • The developed method could be integrated into the current clinical workflow and used as an adjunct for opportunistic screening or for patients who are ineligible for screening with dual-energy X-ray absorptiometry.
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Affiliation(s)
- Yung-Chieh Chen
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Tien Li
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Po-Chih Kuo
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Sho-Jen Cheng
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Hsiang Chung
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Duen-Pang Kuo
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Cheng-Yu Chen
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
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11
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Alizadeh LS, Vogl TJ, Waldeck SS, Overhoff D, D'Angelo T, Martin SS, Yel I, Gruenewald LD, Koch V, Fulisch F, Booz C. Dual-Energy CT in Cardiothoracic Imaging: Current Developments. Diagnostics (Basel) 2023; 13:2116. [PMID: 37371011 DOI: 10.3390/diagnostics13122116] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This article describes the technical principles and clinical applications of dual-energy computed tomography (DECT) in the context of cardiothoracic imaging with a focus on current developments and techniques. Since the introduction of DECT, different vendors developed distinct hard and software approaches for generating multi-energy datasets and multiple DECT applications that were developed and clinically investigated for different fields of interest. Benefits for various clinical settings, such as oncology, trauma and emergency radiology, as well as musculoskeletal and cardiovascular imaging, were recently reported in the literature. State-of-the-art applications, such as virtual monoenergetic imaging (VMI), material decomposition, perfused blood volume imaging, virtual non-contrast imaging (VNC), plaque removal, and virtual non-calcium (VNCa) imaging, can significantly improve cardiothoracic CT image workflows and have a high potential for improvement of diagnostic accuracy and patient safety.
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Affiliation(s)
- Leona S Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Stephan S Waldeck
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Daniel Overhoff
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Mannheim, 68167 Mannheim, Germany
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, 98124 Messina, Italy
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Florian Fulisch
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
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Abstract
PURPOSE OF REVIEW Opportunistic screening is a combination of techniques to identify subjects of high risk for osteoporotic fracture using routine clinical CT scans prescribed for diagnoses unrelated to osteoporosis. The two main components are automated detection of vertebral fractures and measurement of bone mineral density (BMD) in CT scans, in which a phantom for calibration of CT to BMD values is not used. This review describes the particular challenges of opportunistic screening and provides an overview and comparison of current techniques used for opportunistic screening. The review further outlines the performance of opportunistic screening. RECENT FINDINGS A wide range of technologies for the automatic detection of vertebral fractures have been developed and successfully validated. Most of them are based on artificial intelligence algorithms. The automated differentiation of osteoporotic from traumatic fractures and vertebral deformities unrelated to osteoporosis, the grading of vertebral fracture severity, and the detection of mild vertebral fractures is still problematic. The accuracy of automated fracture detection compared to classical radiological semi-quantitative Genant scoring is about 80%. Accuracy errors of alternative BMD calibration methods compared to simultaneous phantom-based calibration used in standard quantitative CT (QCT) range from below 5% to about 10%. The impact of contrast agents, frequently administered in clinical CT on the determination of BMD and on fracture risk determination is still controversial. Opportunistic screening, the identification of vertebral fracture and the measurement of BMD using clinical routine CT scans, is feasible but corresponding techniques still need to be integrated into the clinical workflow and further validated with respect to the prediction of fracture risk.
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Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany.
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
| | - Stefan Bartenschlager
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
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Wang M, Wu Y, Zhou Y, Dong J, Hou P, Gao J. The new fast kilovoltage-switching dual-energy computed tomography for measuring bone mineral density. Quant Imaging Med Surg 2023; 13:801-811. [PMID: 36819284 PMCID: PMC9929404 DOI: 10.21037/qims-22-701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/27/2022] [Indexed: 01/09/2023]
Abstract
Background The update in technology may impact the accuracy in measuring bone mineral density (BMD). However, the application of the new fast kilovoltage (kV)-switching dual-energy computed tomography (DECT) for BMD measurement has not yet been reported. This study aimed to examine the accuracy and precision of the new fast kV-switching DECT in measuring BMD and to evaluate its applicability in clinical BMD measurement. Methods Forty sets of the new fast kV-switching DECT scans and one quantitative computed tomography (QCT) scan were performed on the European Spine Phantom. Their relative errors and relative standard deviations were compared. A retrospective analysis was performed on patients who underwent chest plain DECT and abdominal monoenergetic plain CT at the same time. The relationship between hydroxyapatite-water and hydroxyapatite-fat measured using DECT and BMD measured using QCT was analyzed by multivariate regression analysis. Results The relative errors of the new fast kV-switching DECT with low tube speeds (0.8 and 1.0 s/r) were all less than 6% and were less than those of QCT, except for those at 515 mA. The relative standard deviation values with high tube rotation speeds (0.5 and 0.6 s/r) were higher than those with low tube speeds (0.8 and 1.0 s/r) under most tube current conditions. The new fast kV-switching DECT-derived BMD values corrected by multiple linear regression (predicted hydroxyapatite) were significantly positively correlated with the QCT-based BMD values (R2=0.912; P<0.001). The results of the Bland-Altman analysis demonstrated high consistency between the 2 measurement methods. Conclusions Results of the phantom measurements indicated that the new fast kV-switching DECT could measure BMD with relatively high accuracy and precision. The results of a subsequent clinical in vivo experiment demonstrated that vertebral BMD measurements derived from DECT and QCT were mostly consistent and highly accurate. Therefore, patients who undergo DECT for other clinical indications can simultaneously have their BMD determined.
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Affiliation(s)
- Mingyue Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Wu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Zhou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqiang Dong
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ping Hou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Sheppard AJ, Paravastu SS, Wojnowski NM, Osamor CC, Farhadi F, Collins MT, Saboury B. Emerging Role of 18F-NaF PET/Computed Tomographic Imaging in Osteoporosis: A Potential Upgrade to the Osteoporosis Toolbox. PET Clin 2023; 18:1-20. [PMID: 36442958 PMCID: PMC9773817 DOI: 10.1016/j.cpet.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Osteoporosis is a metabolic bone disorder that leads to a decline in bone microarchitecture, predisposing individuals to catastrophic fractures. The current standard of care relies on detecting bone structural change; however, these methods largely miss the complex biologic forces that drive these structural changes and response to treatment. This review introduces sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) as a powerful tool to quantify bone metabolism. Here, we discuss the methods of 18F-NaF PET/CT, with a special focus on dynamic scans to quantify parameters relevant to bone health, and how these markers are relevant to osteoporosis.
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Affiliation(s)
- Aaron J. Sheppard
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Sriram S. Paravastu
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Natalia M. Wojnowski
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA;,Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA
| | - Charles C. Osamor
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-4320, USA;,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Michael T. Collins
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-4320, USA;,Corresponding author. 10 Center Drive, Bethesda, MD 20892.
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Choi KY, Lee SW, In Y, Kim MS, Kim YD, Lee SY, Lee JW, Koh IJ. Dual-Energy CT-Based Bone Mineral Density Has Practical Value for Osteoporosis Screening around the Knee. Medicina (Kaunas) 2022; 58. [PMID: 36013552 DOI: 10.3390/medicina58081085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
Introduction: Adequate bone quality is essential for long term biologic fixation of cementless total knee arthroplasty (TKA). Recently, vertebral bone quality evaluation using dual-energy computed tomography (DECT) has been introduced. However, the DECT bone mineral density (BMD) in peripheral skeleton has not been correlated with Hounsfield units (HU) or central dual-energy X-ray absorptiometry (DXA), and the accuracy remains unclear. Materials and methods: Medical records of 117 patients who underwent TKA were reviewed. DXA was completed within three months before surgery. DECT was performed with third-generation dual source CT in dual-energy mode. Correlations between DXA, DECT BMD and HU for central and periarticular regions were analyzed. Receiver operating characteristic (ROC) curves were plotted and area under the curve (AUC), optimal threshold, and sensitivity and specificity of each region of interest (ROI) were calculated. Results: Central DXA BMD was correlated with DECT BMD and HU in ROIs both centrally and around the knee (all p < 0.01). The diagnostic accuracy of DECT BMD was higher than that of DECT HU and was also higher when the T-score for second lumbar vertebra (L2), rather than for the femur neck, was used as the reference standard (all AUC values: L2 > femur neck; DECT BMD > DECT HU, respectively). Using the DXA T-score at L2 as the reference standard, the optimal DECT BMD cut-off values for osteoporosis were 89.2 mg/cm3 in the distal femur and 78.3 mg/cm3 in the proximal tibia. Conclusion: Opportunistic volumetric BMD assessment using DECT is accurate and relatively simple, and does not require extra equipment. DECT BMD and HU are useful for osteoporosis screening before cementless TKA.
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