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Cited by 197Bone health and osteoporosis researchSpinal Fractures and Fixation TechniquesMedical Imaging and Analysis

Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA

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Löffler, Maximilian T., Jacob, Alina, Valentinitsch, Alexander, Rienmüller, Anna, Zimmer, Claus, Ryang, Yu-Mi, Baum, Thomas, Kirschke, Jan S.·2019·European Radiology
DOI 10.1007/s00330-019-06018-wPMC PMC6682570
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Abstract

To compare opportunistic quantitative CT (QCT) with dual energy X-ray absorptiometry (DXA) in their ability to predict incident vertebral fractures. We included 84 patients aged 50 years and older, who had routine CT including the lumbar spine and DXA within a 12-month period (baseline) as well as follow-up imaging after at least 12 months or who sustained an incident vertebral fracture documented earlier. Patients with bone disorders aside from osteoporosis were excluded. Fracture status and trabecular bone mineral density (BMD) were retrospectively evaluated in baseline CT and fracture status was reassessed at follow-up. BMDQCT was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners. Sixteen patients had incident vertebral fractures showing lower mean BMDQCT than patients without fracture (p = 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMDQCT (4.07; 95% CI, 1.98–8.38), as well as after adjusting for age, sex, and prevalent fractures (2.54; 95% CI, 1.09–5.90). For DXA, a statistically significant increase in relative hazard per SD decrease in T-score was only observed after age and sex adjustment (1.57; 95% CI, 1.04–2.38). The predictability of incident vertebral fractures was good by BMDQCT (AUC = 0.76; 95% CI, 0.64–0.89) and non-significant by T-scores. Asynchronously calibrated CT scanners showed good long-term stability (linear drift ranging from − 0.55 to − 2.29 HU per year). Opportunistic screening of mainly neurosurgical and oncologic patients in CT performed for indications other than densitometry allows for better risk assessment of imminent vertebral fractures than dedicated DXA. • Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients. • More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA. • Standard ACR QCT-cutoff values for osteoporosis (< 80 mg/cm 3 ) and osteopenia (≤ 120 mg/cm 3 ) can also be applied scanner independently in calibrated opportunistic QCT.

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  • Previously published HU-to-BMD conversion equations were used for all CT scanners in this study.

    “Previously published HU-to-BMD conversion equations were used for all CT scanners in this study [22].”

    From Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA (2021) · cites this paper as [22]

    The Methods (Opportunistic QCT) state that HU-to-BMD conversion equations were calculated by linear regression using phantom measurements for the scanners in this study. Table 4 (Results) lists the resulting scanner-specific equations. The paper does not describe using previously published conversion equations for all scanners; the previously investigated values mentioned in Methods are contrast-enhancement correction offsets. (LLM, conf=0.92)

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Cited by

Sorted by citations

Authors
Löffler, M. T., Jacob, A., Valentinitsch, A., Rienmüller, A., Zimmer, C., Ryang, Y.-M., Baum, T., & Kirschke, J. S.
Affiliations
TUM Klinikum (DE)
Corresponding author
Löffler, Maximilian T.
ORCID
Venue
European Radiology
Publisher
Springer Science and Business Media LLC
Published
2019-02-21
Volume
29
Issue
9
Pages
4980-4989
ISSN
  • 0938-7994 (ISSN-L)
  • 1432-1084
DOI
10.1007/s00330-019-06018-w
PMC
PMC6682570
OpenAlex
W2917426823
Cited by
197
References
3
Citations by year
2026: 26 · 2025: 29 · 2024: 34 · 2023: 44 · 2022: 19 · 2021: 30 · 2020: 11 · 2019: 2 · 2016: 1
FWCI
16.48
Type
journal article
Language
en
Open access
Licence
Locations
  • European Radiology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • mediaTUM (Technical University of Munich) (submittedVersion, other-oa)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
Funders
H2020 European Research Council (637164)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Surgery › Spinal Fractures and Fixation Techniques
  • Physical Sciences › Engineering › Biomedical Engineering › Medical Imaging and Analysis
Keywords
dual-energy X-ray absorptiometry, osteoporosis, trabecular bone mineral density, osteopenia, fracture risk prediction, lumbar spine, older adults
MeSH terms
Aged, Bone Diseases, Metabolic, Calibration, Female, Humans, Lumbar Vertebrae, Male, Mass Screening, Middle Aged, Retrospective Studies, Tomography, X-Ray Computed, Absorptiometry, Photon, Bone Density, Spinal Fractures, Osteoporotic Fractures

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