Assessment of Bone Mineral Density by CT Hounsfield Units in Lumbosacral Spine
DOI:
https://doi.org/10.69980/ajpr.v27i2.141Keywords:
Quantitative Computed Tomography (QCT); Bone Mineral Densitometry (BMD); Osteopenia; OsteoporosisAbstract
Background: Osteoporosis, a condition leading to reduced bone mineral density (BMD) and increased fracture risk, remains a significant public health concern. While dual-energy X-ray absorptiometry (DXA) is the standard for BMD assessment, its limitations include limited accessibility and inability to provide localized bone quality data. Computed tomography (CT), through Hounsfield Unit (HU) analysis, has emerged as a viable alternative for evaluating BMD in the lumbosacral spine. This study investigates the utility of routine CT imaging in estimating BMD using HU values.
Methods: Conducted as a prospective, cross-sectional study on 193 subjects at Teerthanker Mahaveer Hospital, Moradabad, U.P., this research involved patients undergoing CT scans for clinical purposes, specifically of the abdomen and KUB region. Multiplanar reconstruction (MPR) was utilized to examine the lumbar spine in axial, sagittal, and coronal planes. HU measurements were obtained from the trabecular regions of T11, T12, L1, L2, L3, and L4 vertebrae. Correlations between HU values and DXA-derived BMD measurements were analyzed, alongside factors influencing HU variability, including age, sex, and spinal pathologies.
Result: The mean age of participants was 40.72 years (SD = 14.96), with 53.8% males and 46.2% females. Results demonstrated a decrease in HU values with increasing age for most vertebrae, except L1. The highest HU value was observed at T11 (156.80), while L3 exhibited the lowest (137.03). A statistically significant positive correlation (p < 0.05) was found between HU values across vertebrae.
Conclusion: This study highlights the potential of CT-derived HU values as a cost-effective, accessible tool for opportunistic osteoporosis screening. By incorporating HU analysis into routine CT protocols, clinicians can enhance early osteoporosis detection and management without additional patient burden. The findings emphasize CT's role in improving bone health outcomes and reducing fracture risks.
References
Buenger, F., Sakr, Y., Eckardt, N., Senft, C., Schwarz, F., 2022. Correlation of quantitative computed tomography derived bone density values with Hounsfield units of a contrast medium computed tomography in 98 thoraco-lumbar vertebral bodies. Arch. Orthop. Trauma Surg. 142, 3335–3340. https://doi.org/10.1007/s00402-021-04184-5
2. Buenger, F., Sakr, Y., Eckardt, N., Senft, C., Schwarz, F., 2021. Correlation of quantitative computed tomography derived bone density values with Hounsfield units of a contrast medium computed tomography in 98 thoraco ‑ lumbar vertebral bodies. Arch. Orthop. Trauma Surg. https://doi.org/10.1007/s00402-021-04184-5
3. Burke, C.J., Didolkar, M.M., Barnhart, H.X., Vinson, E.N., 2016. The use of routine non density calibrated clinical computed tomography data as a potentially useful screening tool for identifying patients with osteoporosis. Clin. Cases Miner. Bone Metab. Off. J. Ital. Soc. Osteoporos. Miner. Metab. Skelet. Dis. 13, 135–140. https://doi.org/10.11138/ccmbm/2016.13.2.135
4. Engelke, K., Adams, J.E., Armbrecht, G., Augat, P., Bogado, C.E., Bouxsein, M.L., Felsenberg, D., Ito, M., Prevrhal, S., Hans, D.B., Lewiecki, E.M., 2008a. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J. Clin. Densitom. Off. J. Int. Soc. Clin. Densitom. 11, 123–162. https://doi.org/10.1016/j.jocd.2007.12.010
5. Engelke, K., Adams, J.E., Armbrecht, G., Augat, P., Bogado, C.E., Bouxsein, M.L., Felsenberg, D., Ito, M., Prevrhal, S., Hans, D.B., Lewiecki, E.M., 2008b. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J. Clin. Densitom. Off. J. Int. Soc. Clin. Densitom. 11, 123–162. https://doi.org/10.1016/j.jocd.2007.12.010
6. Goldman, L.W., 2007. Principles of CT and CT technology. J. Nucl. Med. Technol. 35, 115–128; quiz 129–130. https://doi.org/10.2967/jnmt.107.042978
7. Hendrickson, N.R., Pickhardt, P.J., del Rio, A.M., Rosas, H.G., Anderson, P.A., 2018. Bone Mineral Density T-Scores Derived from CT Attenuation Numbers (Hounsfield Units): Clinical Utility and Correlation with Dual-energy X-ray Absorptiometry. Iowa Orthop. J. 38, 25–31.
8. Jang, S., Graffy, P.M., Ziemlewicz, M.P.H.T.J., Lee, S.J., Summers, R.M., Pickhardt, P.J., 2019a. Opportunistic Osteoporosis Screening at Routine Abdominal and Thoracic CT : Normative L1 Trabecular Attenuation Values in More than 20 000 Adults.
9. Jang, S., Graffy, P.M., Ziemlewicz, T.J., Lee, S.J., Summers, R.M., Pickhardt, P.J., 2019b. Opportunistic Osteoporosis Screening at Routine Abdominal and Thoracic CT: Normative L1 Trabecular Attenuation Values in More than 20 000 Adults. Radiology 291, 360–367. https://doi.org/10.1148/radiol.2019181648
10. Karaguzel, G., Holick, M.F., 2010. Diagnosis and treatment of osteopenia. Rev. Endocr. Metab. Disord. 11, 237–251. https://doi.org/10.1007/s11154-010-9154-0
11. Kranioti, E.F., Bonicelli, A., García-Donas, J.G., 2019. Bone-mineral density: clinical significance, methods of quantification and forensic applications. Res. Rep. Forensic Med. Sci. Volume 9, 9–21. https://doi.org/10.2147/RRFMS.S164933
12. Lalruatfela, R., Kotian, R.P., Panakkal, N.C., 2020. Correlation Of Bone Mineral Density Measured In Quantitative Computed Tomography With Hounsfield Unit. https://doi.org/10.21203/rs.3.rs-34551/v1
13. Lorente-ramos, R., Azpeitia-armán, J., García-gómez, J.M., Díez-martínez, P., Grande-bárez, M., 2011. Dual-Energy X-Ray Absorptiometry in the Diagnosis of Osteoporosis: A Practical Guide 897–904. https://doi.org/10.2214/AJR.10.5416
14. Pickhardt, P.J., Pooler, B.D., Lauder, T., del Rio, A.M., Bruce, R.J., Binkley, N., 2013. Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications. Ann. Intern. Med. 158, 588–595. https://doi.org/10.7326/0003-4819-158-8-201304160-00003
15. Rüegsegger, P., Niederer, P., Anliker, M., 1974. An extension of classical bone mineral measurements. Ann. Biomed. Eng. 2, 194–205. https://doi.org/10.1007/BF02368490
16. Schreiber, J.J., Anderson, P.A., Hsu, W.K., 2014. Use of computed tomography for assessing bone mineral density. Neurosurg. Focus 37, E4. https://doi.org/10.3171/2014.5.FOCUS1483
17. T Sözen, L, Ö., Nç, B., 2017. An overview and management of osteoporosis. Eur. J. Rheumatol. 4. https://doi.org/10.5152/eurjrheum.2016.048
18. Zou, D., Li, W., Deng, C., Du, G., Xu, N., 2019. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur. Spine J. Off. Publ. Eur. Spine Soc. Eur. Spinal Deform. Soc. Eur. Sect. Cerv. Spine Res. Soc. 28, 1758–1766. https://doi.org/10.1007/s00586-018-5776-9
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