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Wang XY, Pan S, Liu WF, Wang YK, Yun SM, Xu YJ. Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis. J Orthop Surg Res 2024; 19:335. [PMID: 38845012 PMCID: PMC11157924 DOI: 10.1186/s13018-024-04825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Existing studies have shown that computed tomography (CT) attenuation and skeletal muscle tissue are strongly associated with osteoporosis; however, few studies have examined whether vertebral HU values and the pectoral muscle index (PMI) measured at the level of the 4th thoracic vertebra (T4) are strongly associated with bone mineral density (BMD). In this study, we demonstrate that vertebral HU values and the PMI based on chest CT can be used to opportunistically screen for osteoporosis and reduce fracture risk through prompt treatment. METHODS We retrospectively evaluated 1000 patients who underwent chest CT and DXA scans from August 2020-2022. The T4 HU value and PMI were obtained using manual chest CT measurements. The participants were classified into normal, osteopenia, and osteoporosis groups based on the results of dual-energy X-ray (DXA) absorptiometry. We compared the clinical baseline data, T4 HU value, and PMI between the three groups of patients and analyzed the correlation between the T4 HU value, PMI, and BMD to further evaluate the diagnostic efficacy of the T4 HU value and PMI for patients with low BMD and osteoporosis. RESULTS The study ultimately enrolled 469 participants. The T4 HU value and PMI had a high screening capacity for both low BMD and osteoporosis. The combined diagnostic model-incorporating sex, age, BMI, T4 HU value, and PMI-demonstrated the best diagnostic efficacy, with areas under the receiver operating characteristic curve (AUC) of 0.887 and 0.892 for identifying low BMD and osteoporosis, respectively. CONCLUSIONS The measurement of T4 HU value and PMI on chest CT can be used as an opportunistic screening tool for osteoporosis with excellent diagnostic efficacy. This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation.
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Affiliation(s)
- Xiong-Yi Wang
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Sheng Pan
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Wei-Feng Liu
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yi-Ke Wang
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Si-Min Yun
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - You-Jia Xu
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Li D, Mao SS, Budoff MJ. Trabecular bone mineral density as measured by thoracic vertebrae predicts incident hip and vertebral fractures: the multi-ethnic study of atherosclerosis. Osteoporos Int 2024; 35:1061-1068. [PMID: 38519739 DOI: 10.1007/s00198-024-07040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024]
Abstract
We evaluated the relationship of bone mineral density (BMD) by computed tomography (CT), to predict fractures in a multi-ethnic population. We demonstrated that vertebral and hip fractures were more likely in those patients with low BMD. This is one of the first studies to demonstrate that CT BMD derived from thoracic vertebrae can predict future hip and vertebral fractures. PURPOSE/INTRODUCTION Osteoporosis affects an enormous number of patients, of all races and both sexes, and its prevalence increases as the population ages. Few studies have evaluated the association between the vertebral trabecular bone mineral density(vBMD) and osteoporosis-related hip fracture in a multiethnic population, and no studies have demonstrated the predictive value of vBMD for fractures. METHOD We sought to determine the predictive value of QCT-based trabecular vBMD of thoracic vertebrae derived from coronary artery calcium scan for hip fractures in the Multi-Ethnic Study of Atherosclerosis(MESA), a nationwide multicenter cohort included 6814 people from six medical centers across the USA and assess if low bone density by QCT can predict future fractures. Measures were done using trabecular bone measures, adjusted for individual patients, from three consecutive thoracic vertebrae (BDI Inc, Manhattan Beach CA, USA) from non-contrast cardiac CT scans. RESULTS Six thousand eight hundred fourteen MESA baseline participants were included with a mean age of 62.2 ± 10.2 years, and 52.8% were women. The mean thoracic BMD is 162.6 ± 46.8 mg/cm3 (95% CI 161.5, 163.7), and 27.6% of participants (n = 1883) had osteoporosis (T-score 2.5 or lower). Over a median follow-up of 17.4 years, Caucasians have a higher rate of vertebral fractures (6.9%), followed by Blacks (4.4%), Hispanics (3.7%), and Chinese (3.0%). Hip fracture patients had a lower baseline vBMD as measured by QCT than the non-hip fracture group by 13.6 mg/cm3 [P < 0.001]. The same pattern was seen in the vertebral fracture population, where the mean BMD was substantially lower 18.3 mg/cm3 [P < 0.001] than in the non-vertebral fracture population. Notably, the above substantial relationship was unaffected by age, gender, race, BMI, hypertension, current smoking, medication use, or activity. Patients with low trabecular BMD of thoracic vertebrae showed a 1.57-fold greater risk of first hip fracture (HR 1.57, 95% CI 1.38-1.95) and a nearly threefold increased risk of first vertebral fracture (HR 2.93, 95% CI 1.87-4.59) compared to normal BMD patients. CONCLUSION There is significant correlation between thoracic trabecular BMD and the incidence of future hip and vertebral fracture. This study demonstrates that thoracic vertebrae BMD, as measured on cardiac CT (QCT), can predict both hip and vertebral fractures without additional radiation, scanning, or patient burden. Osteopenia and osteoporosis are markedly underdiagnosed. Finding occult disease affords the opportunity to treat the millions of people undergoing CT scans every year for other indications.
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Affiliation(s)
- Dong Li
- Division of Hospital Medicine, Emory School of Medicine, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Song Shou Mao
- The Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Matthew J Budoff
- The Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA.
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Zambrano Chaves JM, Lenchik L, Gallegos IO, Blankemeier L, Rubin DL, Willis MH, Chaudhari AS, Boutin RD. Abdominal CT metrics in 17,646 patients reveal associations between myopenia, myosteatosis, and medical phenotypes: a phenome-wide association study. EBioMedicine 2024; 103:105116. [PMID: 38636199 PMCID: PMC11031722 DOI: 10.1016/j.ebiom.2024.105116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Deep learning facilitates large-scale automated imaging evaluation of body composition. However, associations of body composition biomarkers with medical phenotypes have been underexplored. Phenome-wide association study (PheWAS) techniques search for medical phenotypes associated with biomarkers. A PheWAS integrating large-scale analysis of imaging biomarkers and electronic health record (EHR) data could discover previously unreported associations and validate expected associations. Here we use PheWAS methodology to determine the association of abdominal CT-based skeletal muscle metrics with medical phenotypes in a large North American cohort. METHODS An automated deep learning pipeline was used to measure skeletal muscle index (SMI; biomarker of myopenia) and skeletal muscle density (SMD; biomarker of myosteatosis) from abdominal CT scans of adults between 2012 and 2018. A PheWAS was performed with logistic regression using patient sex and age as covariates to assess for associations between CT-derived muscle metrics and 611 common EHR-derived medical phenotypes. PheWAS P values were considered significant at a Bonferroni corrected threshold (α = 0.05/1222). FINDINGS 17,646 adults (mean age, 56 years ± 19 [SD]; 57.5% women) were included. CT-derived SMI was significantly associated with 268 medical phenotypes; SMD with 340 medical phenotypes. Previously unreported associations with the highest magnitude of significance included higher SMI with decreased cardiac dysrhythmias (OR [95% CI], 0.59 [0.55-0.64]; P < 0.0001), decreased epilepsy (OR, 0.59 [0.50-0.70]; P < 0.0001), and increased elevated prostate-specific antigen (OR, 1.84 [1.47-2.31]; P < 0.0001), and higher SMD with decreased decubitus ulcers (OR, 0.36 [0.31-0.42]; P < 0.0001), sleep disorders (OR, 0.39 [0.32-0.47]; P < 0.0001), and osteomyelitis (OR, 0.43 [0.36-0.52]; P < 0.0001). INTERPRETATION PheWAS methodology reveals previously unreported associations between CT-derived biomarkers of myopenia and myosteatosis and EHR medical phenotypes. The high-throughput PheWAS technique applied on a population scale can generate research hypotheses related to myopenia and myosteatosis and can be adapted to research possible associations of other imaging biomarkers with hundreds of EHR medical phenotypes. FUNDING National Institutes of Health, Stanford AIMI-HAI pilot grant, Stanford Precision Health and Integrated Diagnostics, Stanford Cardiovascular Institute, Stanford Center for Digital Health, and Stanford Knight-Hennessy Scholars.
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Affiliation(s)
- Juan M Zambrano Chaves
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Leon Lenchik
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Isabel O Gallegos
- Department of Computer Science, (IOG), Stanford University, Stanford, CA, USA
| | - Louis Blankemeier
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Marc H Willis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Akshay S Chaudhari
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Robert D Boutin
- Department of Radiology, Stanford University, Stanford, CA, USA.
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Levi R, Mollura M, Savini G, Garoli F, Battaglia M, Ammirabile A, Cappellini LA, Superbi S, Grimaldi M, Barbieri R, Politi LS. CT Cadaveric dataset for Radiomics features stability assessment in lumbar vertebrae. Sci Data 2024; 11:366. [PMID: 38605079 PMCID: PMC11009306 DOI: 10.1038/s41597-024-03191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Radiomics features (RFs) studies have showed limitations in the reproducibility of RFs in different acquisition settings. To date, reproducibility studies using CT images mainly rely on phantoms, due to the harness of patient exposure to X-rays. The provided CadAIver dataset has the aims of evaluating how CT scanner parameters effect radiomics features on cadaveric donor. The dataset comprises 112 unique CT acquisitions of a cadaveric truck acquired on 3 different CT scanners varying KV, mA, field-of-view, and reconstruction kernel settings. Technical validation of the CadAIver dataset comprises a comprehensive univariate and multivariate GLM approach to assess stability of each RFs extracted from lumbar vertebrae. The complete dataset is publicly available to be applied for future research in the RFs field, and could foster the creation of a collaborative open CT image database to increase the sample size, the range of available scanners, and the available body districts.
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Affiliation(s)
- Riccardo Levi
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Maximiliano Mollura
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Giovanni Savini
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
| | - Federico Garoli
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
| | - Massimiliano Battaglia
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
| | - Angela Ammirabile
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
| | - Luca A Cappellini
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
| | - Simona Superbi
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Marco Grimaldi
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Riccardo Barbieri
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Letterio S Politi
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
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Simion G, Eckardt N, Ullrich BW, Senft C, Schwarz F. Bone density of the cervical, thoracic and lumbar spine measured using Hounsfield units of computed tomography - results of 4350 vertebras. BMC Musculoskelet Disord 2024; 25:200. [PMID: 38443864 PMCID: PMC10916010 DOI: 10.1186/s12891-024-07324-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION The assessment of bone density has gained significance in recent years due to the aging population. Accurate assessment of bone density is crucial when deciding on the appropriate treatment plan for spinal stabilization surgery. The objective of this work was to determine the trabecular bone density values of the subaxial cervical, thoracic and lumbar spine using Hounsfield units. MATERIAL AND METHODS Data from 200 patients who underwent contrast-enhanced polytrauma computed tomography at a maximum care hospital over a two-year period were retrospectively analyzed. HUs were measured with an elliptical measurement field in three different locations within the vertebral body: below the upper plate, in the middle of the vertebral body, and above the base plate. The measured Hounsfield units were converted into bone density values using a validated formula. RESULTS The mean age of the patient collective was 47.05 years. Mean spinal bone density values decreased from cranial to caudal (C3: 231.79 mg/cm3; L5: 155.13 mg/cm3; p < 0.001), with the highest values in the upper cervical spine. Bone density values generally decreased with age in all spinal segments. There was a clear decrease in values after age 50 years (p < 0.001). CONCLUSIONS In our study, bone density decreased from cranial to caudal with higher values in the cervical spine. These data from the individual spinal segments may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation.
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Affiliation(s)
- George Simion
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
| | - Niklas Eckardt
- Department of Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Bernhard W Ullrich
- Department of Orthopedics and Traumatology, Friedrich Schiller University Jena, Jena, Germany
| | - Christian Senft
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Luo X, Zhang J, Dai Z, Gong X, Qu G, Li J, Zhang Z. Hounsfield units on abdominal computed tomography: a new tool for predicting osteoporosis. Acta Radiol 2023; 64:2841-2848. [PMID: 37644799 DOI: 10.1177/02841851231190795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Osteoporosis can cause bone fractures and disability, but early diagnosis faces challenges. Our proposed diagnostic indicators offer a new approach for early detection, which benefits early identification. PURPOSE To determine the most appropriate threshold for predicting osteoporosis in patients with each section of vertebral body. MATERIAL AND METHODS A retrospective analysis of 210 patients, including 646 vertebrae, who had both abdominal computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) within six months. The correlation between DXA T-score and CT Hounsfield units (HU) values was tested by Pearson. The area under the curve (AUC) was calculated using the threshold obtained from the regression equation. RESULTS The thresholds matching the T-score of -2.5 were 85, 95, 85, and 90 HU for the upper axial plane of the vertebral body (Lau), the middle axial plane of the vertebral body (Lam), the lower axial plane of the vertebral body (Lad), and the mid-sagittal plane of the vertebral body (Lsm), respectively. Defining osteoporosis using CT as Lau ≤ 85, Lam ≤ 95, Lad ≤ 85, or Lsm ≤ 90 HU had a specificity of 88.1% (116/134) and sensitivity of 90.8% (69/76) for distinguishing DXA osteoporosis of the lumbar spine in 210 patients. T-score ≤-2.5 defined as Lau ≤85 or Lam ≤95 or Lad ≤85 or Lsm ≤90 HU had a specificity of 85.9% (275/320) and sensitivity of 82.8% (270/326) for DXA T-score ≤-2.5 in 646 lumbar vertebrae. CONCLUSION CT HU values obtained based on different sections of the vertebral body in abdominal CT can be used as a supplementary measure to assess osteoporosis.
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Affiliation(s)
- Xiaohui Luo
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Jiongfeng Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Zhengzai Dai
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Xiang Gong
- Graduate School, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Gaoyang Qu
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Juncheng Li
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Zhiping Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
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Lee H, Park S, Kwack KS, Yun JS. CT and MR for bone mineral density and trabecular bone score assessment in osteoporosis evaluation. Sci Rep 2023; 13:16574. [PMID: 37789069 PMCID: PMC10547782 DOI: 10.1038/s41598-023-43850-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023] Open
Abstract
Dual energy X-ray absorptiometry (DXA) is widely used modality for measuring bone mineral density (BMD). DXA is used to measure the quantitative areal BMD of bone, but has the disadvantage of not reflecting the bone architecture. To compensate for this disadvantage, trabecular bone score (TBS), a qualitative parameter of trabecular microarchitecture, is used. Meanwhile, there have been recent attempts to diagnose osteoporosis using the Hounsfield unit (HU) from CT and MR-based proton density fat fraction (PDFF) measurements. In our study, we aimed to find out the correlation between HU/PDFF and BMD/TBS, and whether osteoporosis can be diagnosed through HU/PDFF. Our study revealed that the HU value showed a moderate to good positive correlation with BMD and TBS. PDFF showed a fair negative correlation with BMD and TBS. In diagnosing osteopenia and osteoporosis, the HU value showed good performance, whereas the PDFF showed fair performance. In conclusion, both HU values and PDFF can play a role in predicting BMD and TBS. Both HU values and PDFF can be used to predict osteoporosis; further, CT is expected to show better results.
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Affiliation(s)
- Haein Lee
- Department of Radiology, Ajou University School of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea
| | - Sunghoon Park
- Department of Radiology, Ajou University School of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea
| | - Kyu-Sung Kwack
- Department of Radiology, Ajou University School of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea
| | - Jae Sung Yun
- Department of Radiology, Ajou University School of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea.
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea.
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Yang Y, Kang Y, Yang Y, Ding M, Shan X, Cai Z. Feasibility analysis of bone density evaluation with Hounsfield unit value after fibula flap reconstruction of jaw defect. Maxillofac Plast Reconstr Surg 2023; 45:30. [PMID: 37644349 PMCID: PMC10465458 DOI: 10.1186/s40902-023-00397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Implant-supported dentures have become an essential means of restoring occlusal function after jaw reconstruction. Bone mineral density (BMD) may influence the success rate of implant denture restorations. This study aimed to explore whether the Hounsfield unit (HU) value can be used to monitor the changing trend of fibular BMD after jaw reconstruction. RESULTS A total of 54 patients who underwent maxillar/mandibular reconstruction with a fibula flap were included in this study. There was a significant correlation between the HU value and BMD at 1 week, 3 months, and 6 months after surgery, and both were significantly correlated with follow-up time. The difference between each pair of absorption rates (DAR) was less than 10% in 66.7% and 75.9% of patients at 3 and 6 months; however, the DAR was more than 20% in 12% and 13.8% of patients at 3 and 6 months, respectively. CONCLUSIONS There is a significant correlation between HU value and BMD. The HU value can be used to roughly reflect the fibular BMD changing trend in a group of patients as opposed to an individual, and the HU value is not equivalent to BMD. TRIAL REGISTRATION ChiCTR, ChiCTR2300069661, retrospectively registered on 22 March 2023. Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=188953 .
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Affiliation(s)
- Yihui Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yifan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yifan Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Mengkun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Xiaofeng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Zhigang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
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Vadera S, Osborne T, Shah V, Stephenson JA. Opportunistic screening for osteoporosis by abdominal CT in a British population. Insights Imaging 2023; 14:57. [PMID: 37005941 PMCID: PMC10067782 DOI: 10.1186/s13244-023-01400-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND It has previously been shown that CT scans performed for other indications can be used to identify patients with osteoporosis. This has not yet been tested in a British population. We sought to evaluate the use of vertebral CT attenuation measures for predicting osteoporosis in a British cohort, using dual-energy X-ray absorptiometry (DEXA) as a reference standard. METHODS Patients who underwent abdominal CT in 2018 and concomitantly underwent DEXA within a six-month interval were retrospectively included. CT attenuation values in Hounsfield units (HU) were measured by placement of a region-of-interest at the central portion of the L1 vertebral body and then compared to their corresponding DEXA score. Receiver operating characteristic (ROC) curves were generated to evaluate the performance of a logistic regression model and to determine sensitivity and specificity thresholds. RESULTS 536 patients (394 females, mean age 65.8) were included, of which 174 had DEXA-defined osteoporosis. L1 attenuation measures were significantly different (p < 0.01) between the three DEXA-defined groups of osteoporosis (118 HU), osteopenia (143 HU) and normal bone density (178 HU). The area under the ROC curve was 0.74 (95% CI 0.69-0.78). A threshold of 169 HU was 90% sensitive, and a threshold of 104 HU was 90% specific for diagnosing osteoporosis. CONCLUSIONS Routine abdominal CT can be used to opportunistically screen for osteoporosis without additional cost or radiation exposure. The thresholds identified in this study are comparable with previous studies in other populations. We recommend radiologists engage with primary care and rheumatology providers to determine appropriate cut-off values for further investigation.
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Affiliation(s)
- Sonam Vadera
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Timothy Osborne
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Vikas Shah
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - James A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
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10
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Simion G, Eckardt N, Senft C, Schwarz F. Bone density of the axis (C2) measured using Hounsfield units of computed tomography. J Orthop Surg Res 2023; 18:93. [PMID: 36765379 PMCID: PMC9921026 DOI: 10.1186/s13018-023-03560-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION The assessment of bone density is of great importance nowadays due to the increasing age of patients. Especially in regard to the surgical stabilization of the spine, the assessment of bone density is important for therapeutic decision making. The aim of this work was to record trabecular bone density values using Hounsfield units of the second cervical vertebra. MATERIAL AND METHODS The study is a monocentric retrospective data analysis of 198 patients who received contrast-enhanced polytrauma computed tomography in a period of two years at a maximum care hospital. Hounsfield units were measured in three different regions within the C2: dens, transition area between dens and vertebral body and vertebral body. The measured Hounsfield units were converted into bone density values using a validated formula. RESULTS A total of 198 patients were included. The median bone density varied in different regions of all measured C2 vertebrae: in the dens axis, C2 transition area between dens and vertebral body, and in the vertebral body bone densities were 302.79 mg/cm3, 160.08 mg/cm3, and 240.31 mg/cm3, respectively. The transition area from dens axis to corpus had statistically significant lower bone density values compared to the other regions (p < 0.001). There was a decrease in bone density values after age 50 years in both men and women (p < 0.001). CONCLUSIONS The transitional area from dens axis to corpus showed statistically significant lower bone density values compared to the adjacent regions (p < 0.001). This area seems to be a predilection site for fractures of the 2nd cervical vertebra, which is why special attention should be paid here in radiological diagnostics after a trauma.
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Affiliation(s)
- George Simion
- grid.9613.d0000 0001 1939 2794Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Niklas Eckardt
- grid.9613.d0000 0001 1939 2794Department for Radiology, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Christian Senft
- grid.9613.d0000 0001 1939 2794Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
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11
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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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12
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Anam C, Amilia R, Naufal A, Budi WS, Maya AT, Dougherty G. The automated measurement of CT number linearity using an ACR accreditation phantom. Biomed Phys Eng Express 2022; 9. [PMID: 36541467 DOI: 10.1088/2057-1976/aca9d5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
We developed a software to automatically measure the linearity between the CT numbers and densities of objects using an ACR 464 CT phantom, and investigated the CT number linearity of 16 different CT scanners. The software included a segmentation-rotation method. After segmenting five objects within the phantom image, the software computed the mean CT number of each object and plotted a graph between the CT numbers and densities of the objects. Linear regression and coefficients of regression, R2, were automatically calculated. The software was used to investigate the CT number linearity of 16 CT scanners from Toshiba, Siemens, Hitachi, and GE installed at 16 hospitals in Indonesia. The linearity of the CT number obtained on most of the scanners showed a strong linear correlation (R2> 0.99) between the CT numbers and densities of the five phantom materials. Two scanners (Siemens Emotion 16) had the strongest linear correlation withR2= 0.999, and two Hitachi Eclos scanners had the weakest linear correlation withR2< 0.99.
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Affiliation(s)
- Choirul Anam
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof Soedarto, SH Tembalang, Semarang 50275, Central Java, Indonesia
| | - Riska Amilia
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof Soedarto, SH Tembalang, Semarang 50275, Central Java, Indonesia
| | - Ariij Naufal
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof Soedarto, SH Tembalang, Semarang 50275, Central Java, Indonesia
| | - Wahyu S Budi
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof Soedarto, SH Tembalang, Semarang 50275, Central Java, Indonesia
| | - Anisa T Maya
- Loka Pengamanan Fasilitas Kesehatan (LPFK) Surakarta, Mojosongo, Jebres, Surakarta City 57127, Central Java, Indonesia
| | - Geoff Dougherty
- Department of Applied Physics and Medical Imaging, California State University Channel Islands, Camarillo, CA 93012, United States of America
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13
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Zhang J, Zhou R, Luo X, Dai Z, Qu G, Li J, Wu P, Yuan X, Li J, Jiang W, Zhang Z. Routine chest CT combined with the osteoporosis self-assessment tool for Asians (OSTA): a screening tool for patients with osteoporosis. Skeletal Radiol 2022; 52:1169-1178. [PMID: 36520217 DOI: 10.1007/s00256-022-04255-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The osteoporosis self-assessment tool for Asians (OSTA) is a common screening tool for osteoporosis. The seventh thoracic CT (CT-T7) Hounsfield unit (HU) measured by chest CT correlates with osteoporosis. This study aimed to investigate the diagnostic value of OSTA alone, CT-T7 alone, or the combination of OSTA and CT-T7 in osteoporosis. MATERIALS AND METHODS In this study, 1268 participants were grouped into 586 men and 682 women. We established multiple linear regression models by combining CT-T7 and OSTA. Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose osteoporosis. RESULTS In the male group, the mean age was 59.02 years, and 108 patients (18.4%) had osteoporosis. In the female group, the mean age was 63.23 years, and 308 patients (45.2%) had osteoporosis. By ROC curve comparison, the CT-T7 (male, AUC = 0.789, 95% CI 0.745-0.832; female, AUC = 0.835, 95% CI 0.805-0.864) in the diagnosis of osteoporosis was greater than the OSTA (male, AUC = 0.673, 95% CI 0.620-0.726; female, AUC = 0.775, 95% CI 0.741-0.810) in both the male and female groups (p < 0.001). When OSTA was combined with CT, the equation of multiple linear regression (MLR) was obtained as follows: female = 3.020-0.028*OSTA-0.004*CT-T7. In the female group, it was found that the AUC of MLR (AUC = 0.853, 95% CI 0.825-0.880) in the diagnosis of osteoporosis was larger than that of CT-T7 (p < 0.01). When the MLR was 2.65, the sensitivity and specificity were 53.9% and 90%, respectively. CONCLUSION For a patient who has completed chest CT, CT-T7 (HU) combined with OSTA is recommended to identify the high-risk population of osteoporosis, and it has a higher diagnostic value than OSTA alone or CT-T7 alone, especially among females. For a female with MLR greater than 2.65, further DXA examination is needed.
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Affiliation(s)
- Jiongfeng Zhang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Ruiling Zhou
- Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiaohui Luo
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhengzai Dai
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Gaoyang Qu
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Juncheng Li
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Pengyun Wu
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xuhui Yuan
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jiayu Li
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Wei Jiang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhiping Zhang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.
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14
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Boutin RD, Houston DK, Chaudhari AS, Willis MH, Fausett CL, Lenchik L. Imaging of Sarcopenia. Radiol Clin North Am 2022; 60:575-582. [PMID: 35672090 DOI: 10.1016/j.rcl.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sarcopenia is currently underdiagnosed and undertreated, but this is expected to change because sarcopenia is now recognized with a specific diagnosis code that can be used for billing in some countries, as well as an expanding body of research on prevention, diagnosis, and management. This article focuses on practical issues of increasing interest by highlighting 3 hot topics fundamental to understanding sarcopenia in older adults: definitions and terminology, current diagnostic imaging techniques, and the emerging role of opportunistic computed tomography.
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Affiliation(s)
- Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, 453 Quarry Road, MC 5659, Palo Alto, CA 94304-5659, USA.
| | - Denise K Houston
- Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305-5372, USA; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305-5372, USA
| | - Marc H Willis
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room H1330A, Stanford, CA 94305-5642, USA
| | - Cameron L Fausett
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway Street, Redwood City, CA 94063-6342, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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15
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Tse JJ, Smith ACJ, Kuczynski MT, Kaketsis DA, Manske SL. Advancements in Osteoporosis Imaging, Screening, and Study of Disease Etiology. Curr Osteoporos Rep 2021; 19:532-541. [PMID: 34292468 DOI: 10.1007/s11914-021-00699-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to inform researchers and clinicians with the most recent imaging techniques that are employed (1) to opportunistically screen for osteoporosis and (2) to provide a better understanding into the disease etiology of osteoporosis. RECENT FINDINGS Phantomless calibration techniques for computed tomography (CT) may pave the way for better opportunistic osteoporosis screening and the retroactive analysis of imaging data. Additionally, hardware advances are enabling new applications of dual-energy CT and cone-beam CT to the study of bone. Advances in MRI sequences are also improving imaging evaluation of bone properties. Finally, the application of image registration techniques is enabling new uses of imaging to investigate soft tissue-bone interactions as well as bone turnover. While DXA remains the most prominent imaging tool for osteoporosis diagnosis, new imaging techniques are becoming more widely available and providing additional information to inform clinical decision-making.
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Affiliation(s)
- Justin J Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ainsley C J Smith
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Michael T Kuczynski
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Daphne A Kaketsis
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.
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