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DXA-equivalent quantification of bone mineral density using dual-layer spectral CT scout scans

  • Computed Tomography
  • Published:
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Abstract

Objectives

To develop and evaluate a method for areal bone mineral density (aBMD) measurement based on dual-layer spectral CT scout scans.

Methods

A post-processing algorithm using a pair of 2D virtual mono-energetic scout images (VMSIs) was established in order to semi-automatically compute the aBMD at the spine similarly to DXA, using manual soft tissue segmentation, semi-automatic segmentation for the vertebrae, and automatic segmentation for the background. The method was assessed based on repetitive measurements of the standardized European Spine Phantom (ESP) using the standard scout scan tube current (30 mA) and other tube currents (10 to 200 mA), as well as using fat-equivalent extension rings simulating different patient habitus, and was compared to dual-energy X-ray absorptiometry (DXA). Moreover, the feasibility of the method was assessed in vivo in female patients.

Results

Derived from standard scout scans, aBMD values measured with the proposed method significantly correlated with DXA measurements (r = 0.9925, p < 0.001), and mean accuracy (DXA, 4.12%; scout, 1.60%) and precision (DXA, 2.64%; scout, 2.03%) were comparable between the two methods. Moreover, aBMD values assessed at different tube currents did not differ significantly (p ≥ 0.20 for all), suggesting that the presented method could be applied to scout scans with different settings. Finally, data derived from sample patients were concordant with BMD values from a reference age-matched population.

Conclusions

Based on dual-layer spectral scout scans, aBMD measurements were fast and reliable and significantly correlated with the according DXA measurements in phantoms. Considering the number of CT acquisitions performed worldwide, this method could allow truly opportunistic osteoporosis screening.

Key Points

• 2D scout scans (localizer radiographs) from a dual-layer spectral CT scanner, which are mandatory parts of a CT examination, can be used to automatically determine areal bone mineral density (aBMD) at the spine.

• The presented method allowed fast (< 25 s/patient), semi-automatic, and reliable DXA-equivalent aBMD measurements for state-of-the-art DXA phantoms at different tube settings and for various patient habitus, as well as for sample patients.

• Considering the number of CT scout scan acquisitions performed worldwide on a daily basis, the presented technique could enable truly opportunistic osteoporosis screening with DXA-equivalent metrics, without involving higher radiation exposure since it only processes existing data that is acquired during each CT scan.

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Abbreviations

ANCOVA:

Analysis of covariance (a statistical analysis technique)

AP:

Antero-posterior

BMC:

Bone mineral content (g)

BMD:

Bone mineral density (mg/mL), sometimes also used for areal bone mineral density (aBMD, g/cm2)

CV:

Coefficient of variation

DXA, DEXA:

Dual-energy X-ray absorptiometry

ESP:

European Spine Phantom

HA:

Calcium-hydroxyapatite, the main mineral component of bone

IV:

Intravenous (contrast agent)

QCT:

Quantitative computed tomography

VMSI:

Virtual mono-energetic scout image

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Funding

We acknowledge support through QRM for providing the ESP phantom, the German Department of Education and Research (BMBF) under grant IMEDO (13GW0072C), the German Research Foundation (DFG - Gottfried Wilhelm Leibniz program), and the DFG within the Research Training Group GRK 2274.

K.B, L.C.F., and R.P. are employees of Philips. The remaining authors have no financial disclosures and had complete, unrestricted access to the study data at all stages of the study.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany

    Alexis Laugerette, Benedikt J. Schwaiger, Felix K. Kopp, Kai Mei, Alexandra S. Gersing, Daniela Pfeiffer, Alexander A. Fingerle, Ernst J. Rummeny, Peter B. Noël & Franz Pfeiffer

  2. Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany

    Alexis Laugerette, Thorsten Sellerer & Franz Pfeiffer

  3. Philips Healthcare, Cleveland, OH, USA

    Kevin Brown

  4. Philips Research Laboratories, Hamburg, Germany

    Lena C. Frerking & Roland Proksa

  5. Section of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany

    Jan Kirschke & Thomas Baum

  6. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Peter B. Noël

Authors
  1. Alexis Laugerette
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  2. Benedikt J. Schwaiger
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Corresponding author

Correspondence to Peter B. Noël.

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The scientific guarantor of this publication is PD Dr. Peter B. Noël.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Summary statement

The presented method, based on spectral CT scout scans, allows to reliably determine areal BMD in state-of-the-art phantom and in sample patient data. The results suggest that the performance of the method is possibly similar to that of DXA for the phantom experiments performed in this work.

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Laugerette, A., Schwaiger, B.J., Brown, K. et al. DXA-equivalent quantification of bone mineral density using dual-layer spectral CT scout scans. Eur Radiol 29, 4624–4634 (2019). https://doi.org/10.1007/s00330-019-6005-6

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  • DOI: https://doi.org/10.1007/s00330-019-6005-6

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