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

• DOI: 10.1007/s00330-021-08323-9
• Publication Date: 2021-10-29T00:02:41Z
• Authors: Leon D. Gruenewald; Vitali Koch; Simon S. Martin; Ibrahim Yel; Katrin Eichler; Tatjana Gruber-Rouh; Lukas Lenga; Julian L. Wichmann; Leona S. Alizadeh; Moritz H. Albrecht; Christoph Mader; Nicole A. Huizinga; Tommaso D’Angelo; Silvio Mazziotti; Stefan Wesarg; Thomas J. Vogl; Christian Booz
• Keywords: Adult; Male; 0301 basic medicine; 610; CT dual-energy computed tomography; Osteoporotic fractures; 12. Responsible consumption; Young Adult; 03 medical and health sciences; Absorptiometry, Photon; Bone Density; 616; Humans; ddc:610; Aged; Retrospective Studies; Aged, 80 and over; ddc:610; Lumbar Vertebrae; Middle Aged; Musculoskeletal; Osteoporosis; Female; Metabolic; Bone density, Bone diseases, Metabolic, CT dual-energy computed tomography, Osteoporosis, Osteoporotic fractures, Absorptiometry, Photon, Adult, Aged, Aged, 80 and over, Bone Density, Female, Humans, Lumbar Vertebrae, Male, Middle Aged, Retrospective Studies, Tomography, X-Ray Computed, Young Adult, Osteoporosis, Osteoporotic Fractures; Bone diseases, Metabolic ; Musculoskeletal ; Bone Density [MeSH] ; Female [MeSH] ; Aged, 80 and over [MeSH] ; Osteoporotic fractures ; Aged [MeSH] ; Adult [MeSH] ; Humans [MeSH] ; Retrospective Studies [MeSH] ; Middle Aged [MeSH] ; CT dual-energy computed tomography ; Osteoporosis ; Tomography, X-Ray Computed [MeSH] ; Osteoporosis/diagnostic imaging [MeSH] ; Osteoporosis/epidemiology [MeSH] ; Male [MeSH] ; Absorptiometry, Photon [MeSH] ; Young Adult [MeSH] ; Bone density ; Osteoporotic Fractures/epidemiology [MeSH] ; Lumbar Vertebrae/diagnostic imaging [MeSH] ; Osteoporotic Fractures/diagnostic imaging [MeSH] ; Osteoporosis/complications [MeSH]; Bone density; Tomography, X-Ray Computed; Bone diseases; Osteoporotic Fractures

Abstract Objectives To evaluate the predictive value of volumetric bone mineral density (BMD) assessment of the lumbar spine derived from phantomless dual-energy CT (DECT)-based volumetric material decomposition as an indicator for the 2-year occurrence risk of osteoporosis-associated fractures.

Methods L1 of 92 patients (46 men, 46 women; mean age, 64 years, range, 19–103 years) who had undergone third-generation dual-source DECT between 01/2016 and 12/2018 was retrospectively analyzed. For phantomless BMD assessment, dedicated DECT postprocessing software using material decomposition was applied. Digital files of all patients were sighted for 2 years following DECT to obtain the incidence of osteoporotic fractures. Receiver operating characteristic (ROC) analysis was used to calculate cut-off values and logistic regression models were used to determine associations of BMD, sex, and age with the occurrence of osteoporotic fractures.

Results A DECT-derived BMD cut-off of 93.70 mg/cm3 yielded 85.45% sensitivity and 89.19% specificity for the prediction to sustain one or more osteoporosis-associated fractures within 2 years after BMD measurement. DECT-derived BMD was significantly associated with the occurrence of new fractures (odds ratio of 0.8710, 95% CI, 0.091–0.9375, p < .001), indicating a protective effect of increased DECT-derived BMD values. Overall AUC was 0.9373 (CI, 0.867–0.977, p < .001) for the differentiation of patients who sustained osteoporosis-associated fractures within 2 years of BMD assessment.

Conclusions Retrospective DECT-based volumetric BMD assessment can accurately predict the 2-year risk to sustain an osteoporosis-associated fracture in at-risk patients without requiring a calibration phantom. Lower DECT-based BMD values are strongly associated with an increased risk to sustain fragility fractures.

Key Points •Dual-energy CT–derived assessment of bone mineral density can identify patients at risk to sustain osteoporosis-associated fractures with a sensitivity of 85.45% and a specificity of 89.19%. •The DECT-derived BMD threshold for identification of at-risk patients lies above the American College of Radiology (ACR) QCT guidelines for the identification of osteoporosis (93.70 mg/cm3 vs 80 mg/cm3).