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Dual-energy CT-based phantomless in vivo three-dimensional bone mineral density assessment of the lumbar spine

: Wichmann, Julian L.; Booz, Christian; Wesarg, Stefan; Kafchitsas, Konstantinos; Bauer, Ralf W.; Kerl, J. Matthias; Lehnert, Thomas; Vogl, Thomas J.; Khan, M. Fawad


Radiology 271 (2014), No.3, pp.778-784
ISSN: 0033-8419
ISSN: 1527-1315
Journal Article
Fraunhofer IGD ()
computed tomography (CT); Computer Aided Diagnosis; medical image processing; medical visualization; medicine

To evaluate the feasibility of phantomless in vivo dual-energy computed tomography (CT)-based three-dimensional (3D) bone mineral density (BMD) assessment in comparison with dual x-ray absorptiometry (DXA).
Materials and Methods:
This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. Data from clinically indicated dual-energy CT and DXA examinations within 2 months, comprising the lumbar spine of 40 patients, were included. By using automated dedicated postprocessing dual-energy CT software, the trabecular bone of lumbar vertebrae L1-L4 were analyzed and segmented. A mixed-effects model was used to assess the correlations between BMD values derived from dual-energy CT and DXA.
One hundred sixty lumbar vertebrae were analyzed in 40 patients (mean age, 57.1 years; range, 24-85 years), 21 male (mean age, 54.3 years; range, 24-85 years) and 19 female (mean age, 58.5 years; range, 31-80 years). Mean BMD of L1-L4 determined with DXA was 0.995 g/ cm², and 18 patients (45%) showed an osteoporotic BMD (T score less than 22.5) of at least two vertebrae. Mean dual-energy CT-based BMD of L1-L4 was 0.254 g/cm³. Bland-Altman analysis with mixed effects demonstrated a lack of correlation between dual-energy CT-based and DXA-based BMD values, with a mean difference of 0.7441 and 95% limits of agreement of 0.7441 +/- 0.4080.
Dedicated postprocessing of dual-energy CT data allows for phantomless in vivo BMD assessment of the trabecular bone of lumbar vertebrae and enables freely rotatable color-coded 3D visualization of intravertebral BMD distribution.