Simultaneous screening for osteoporosis at CT colonography: Bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard
Open accessAbstract
The purpose of this study was to evaluate the utility of lumbar spine attenuation measurement for bone mineral density (BMD) assessment at screening computed tomographic colonography (CTC) using central dual-energy X-ray absorptiometry (DXA) as the reference standard. Two-hundred and fifty-two adults (240 women and 12 men; mean age 58.9 years) underwent CTC screening and central DXA BMD measurement within 2 months (mean interval 25.0 days). The lowest DXA T-score between the spine and hip served as the reference standard, with low BMD defined per World Health Organization as osteoporosis (DXA T-score ≤ −2.5) or osteopenia (DXA T-score between −1.0 and −2.4). Both phantomless quantitative computed tomography (QCT) and simple nonangled region-of-interest (ROI) multi-detector CT (MDCT) attenuation measurements were applied to the T12–L5 levels. The ability to predict osteoporosis and low BMD (osteoporosis or osteopenia) by DXA was assessed. A BMD cut-off of 90 mg/mL at phantomless QCT yielded 100% sensitivity for osteoporosis (29 of 29) and a specificity of 63.8% (143 of 224); 87.2% (96 of 110) below this threshold had low BMD and 49.6% (69 of 139) above this threshold had normal BMD at DXA. At L1, a trabecular ROI attenuation cut-off of 160 HU was 100% sensitive for osteoporosis (29 of 29), with a specificity of 46.4% (104 of 224); 83.9% (125 of 149) below this threshold had low BMD and 57.5% (59/103) above had normal BMD at DXA. ROI performance was similar at all individual T12–L5 levels. At ROC analysis, AUC for osteoporosis was 0.888 for phantomless QCT [95% confidence interval (CI) 0.780–0.946] and ranged from 0.825 to 0.853 using trabecular ROIs at single lumbar levels (0.864; 95% CI 0.752–0.930 at multivariate analysis). Supine-prone reproducibility was better with the simple ROI method compared with QCT. It is concluded that both phantomless QCT and simple ROI attenuation measurements of the lumbar spine are effective for BMD screening at CTC with high sensitivity for osteoporosis, as defined by the DXA T-score. © 2011 American Society for Bone and Mineral Research
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The simpler approach used in this study was as or more effective and more reproducible than spine QCT for predicting DXA results.
“We previously showed that the simpler approach used in this study was as or more effective and more reproducible than spine QCT for predicting DXA results (14).”
From Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications (2013) · cites this paper as [14]
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Pickhardt, P. J., Pooler, B. D., Lauder, T., del Rio, A. M., Bruce, R. J., & Binkley, N. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-8-201304160-00003 · Cited by 954 · see citing works
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Murray, T. É., Williams, D., & Lee, M. J. (2017) · Abdominal Radiology · doi:10.1007/s00261-017-1124-5 · Cited by 69 · see citing works
Berger-Groch, J., Thiesen, D. M., Ntalos, D., Hennes, F., & Hartel, M. J. (2020) · European Spine Journal · doi:10.1007/s00586-020-06292-z · Cited by 57 · see citing works
- Authors
- Pickhardt, P. J., Lee, L. J., Muñoz del Rio, A., Lauder, T., Bruce, R. J., Summers, R. M., Pooler, B. D., & Binkley, N.
- Affiliations
- University of Wisconsin–Madison (US)
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- National Institutes of Health (US)
- Corresponding author
- Pickhardt, Perry J
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-05-16
- Volume
- 26
- Issue
- 9
- Pages
- 2194-2203
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- PMC
- PMC3304444
- OpenAlex
- W2006628712
- Cited by
- 320
- References
- 1
- Citations by year
- 2026: 22 · 2025: 25 · 2024: 29 · 2023: 29 · 2022: 28 · 2021: 23 · 2020: 30 · 2019: 14 · 2018: 24 · 2017: 16 · 2016: 28 · 2015: 18 · 2014: 18 · 2013: 11 · 2012: 4
- FWCI
- 11.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (R01CA144835)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Physical Sciences › Engineering › Biomedical Engineering › Medical Imaging and Analysis
- Physical Sciences › Engineering › Biomedical Engineering › Advanced X-ray and CT Imaging
- Keywords
- osteoporosis screening, CT colonography, bone mineral density, quantitative computed tomography, dual-energy X-ray absorptiometry, osteopenia, trabecular bone, receiver operating characteristic, diagnostic accuracy, older adults, T-score thresholds, hip bone density, lumbar spine
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Lumbar Vertebrae, Male, Mass Screening, Middle Aged, Osteoporosis, Reference Standards, ROC Curve, Reproducibility of Results, Absorptiometry, Photon, Bone Density, Observer Variation, Prevalence, Colonography, Computed Tomographic, Fractures, Compression, Multidetector Computed Tomography
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