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Cited by 8Bone health and osteoporosis researchAdvanced X-ray and CT ImagingDigital Radiography and Breast Imaging

In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT

Open access
Moser, Lukas Jakob, Klambauer, Konstantin, Diaz Machicado, Maria Carolina, Frey, Diana, Mergen, Victor, Eberhard, Matthias, Nowak, Tristan, Schmidt, Bernhard +3 more·2025·Investigative Radiology
DOI 10.1097/rli.0000000000001159PMC PMC12233169
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Abstract

Purpose: The aim of this study was to determine in a prospective patient study the accuracy of areal bone mineral density (aBMD) measurements with spectral localizer radiographs obtained with a clinical photon-counting detector computed tomography (PCD-CT) scanner in comparison with dual-energy x-ray absorptiometry (DXA). Methods: In this institutional review board–approved, prospective study, 41 patients (15 females, 26 males; mean age 61.3 years, age range 35–78 years) underwent PCD-CT of the abdomen with a spectral localizer radiograph (tube voltage 140 kVp, tube current 30 mA) and DXA within a median of 45 days. aBMD values were derived for lumbar vertebrae L1–L4 from both methods and were compared with linear regression, Pearson correlation, intraclass correlation coefficients (ICCs), and Bland-Altman plots. T-scores were calculated on a patient level and were compared between methods. Results: DXA and spectral localizer radiographs showed strong correlation in aBMD measurements ( R = 0.97, P < 0.001) and patient level T-scores ( R = 0.99, P < 0.001). There was a strong agreement between aBMD from both methods (ICC, 0.96; 95% CI, 0.94–0.97). Bland-Altman analysis revealed a very small mean difference in aBMD between methods (mean absolute error 0.019 g/cm 2 ) with narrow limits of agreement (−0.083 g/cm 2 to 0.121 g/cm 2 ). Similarly, there were small differences in regard to the T-score (mean absolute error 0.156) with narrow limits of agreement (−0.422 to 0.734) between methods. ICCs indicated an excellent agreement between T-scores from DXA and spectral localizer radiographs (ICC, 0.98; 95% confidence interval, 0.95–0.99). Conclusions: Our prospective patient study indicates that spectral localizer radiographs obtained with a clinical PCD-CT system enable accurate quantification of the lumbar bone areal mineral density. This opens up the opportunity for opportunistic screening of osteoporosis in patients who undergo CT for other indications.

AI snapshot

Written from the paper’s full text.

TL;DR

In a prospective study of 41 patients, areal bone mineral density (aBMD) and T-scores from spectral localizer radiographs on a clinical photon-counting detector CT (PCD-CT) scanner showed strong agreement with DXA. The authors conclude this supports opportunistic osteoporosis screening from routine CT localizer radiographs.

Key findings

  • For aBMD, spectral localizer radiographs and DXA correlated strongly (R = 0.97; 95% CI, 0.96–0.98; P < 0.001), with excellent agreement (ICC, 0.96; 95% CI, 0.94–0.97), a mean absolute error of 0.019 g/cm², and 95% limits of agreement from −0.083 to 0.121 g/cm².
  • For patient-level T-scores, correlation was R = 0.99 (95% CI, 0.97–0.99; P < 0.001), ICC was 0.98 (95% CI, 0.95–0.99), mean absolute error was 0.156, and 95% limits of agreement were −0.422 to 0.734.
  • WHO bone density categories were concordant in 39/41 patients (95%); spectral localizer radiographs recategorized 2 patients, one from osteopenia to osteoporosis and one from osteopenia to normal.
  • BMI was significantly associated with differences in aBMD (β = 0.00; 95% CI, 0.00–0.01; P < 0.001) and T-score (β = 0.03; 95% CI, 0.01–0.05; P = 0.001), albeit with very low effect size; age was not independently associated (P = 0.09 and P = 0.20).

Methods

  • Prospective single-center, IRB-approved study (March–October 2024) included 41 patients (15 females, 26 males; mean age 61.3 ± 10.8 years, range 35–78 years) scheduled for clinically indicated chest/abdomen or abdomen CT on a clinical dual-source PCD-CT scanner; spectral localizer radiographs used 140 kVp, 30 mA, 2 energy bins, and 0.1 mGy volume CTDI, with DXA performed at a median of 45 days (IQR, 32–59 days).
  • aBMD was derived for lumbar vertebrae L1–L4 from spectral localizer radiographs using material decomposition into hydroxyapatite and water maps, manual ROIs, and a soft-tissue correction formula; DXA served as the reference standard, and patient-level mean aBMD was used to calculate T-scores with WHO categories.
  • Analyses included linear regression, Pearson correlation, intraclass correlation coefficients, Bland-Altman plots, paired t tests, and multivariable linear regression for age and BMI, performed in R version 4.4.1 with significance at P < 0.05.

Limitations

  • The paper states: relatively small sample size; manual lumbar vertebral segmentation by 1 reader; aBMD quantification from spectral localizer radiographs currently requires prototype software; and only lumbar vertebrae were analyzed, not femoral neck or distal radius.
  • Evident from the text: single-center design, one clinical PCD-CT scanner/software version, and one DXA system limit generalizability; DXA-guided segmentation of spectral localizer radiographs may not reflect a fully blinded clinical workflow.
  • Evident from the text: attrition occurred before final analysis (18/64 consented participants canceled or missed DXA, and 5 consecutive patients had localizer raw data lost), which may introduce selection or attrition bias.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1097/rli.0000000000001159

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 20 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Age did not have an independent relationship with the difference of aBMD between DXA and spectral localizer radiographs (P = 0.09).

    “Multivariable models revealed that age did not have an independent relationship with the difference of aBMD and T-scores between DXA and spectral localizer radiographs (P = 0.09 and P = 0.20, respectively).”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was a trend toward higher T-scores from spectral localizers in vertebrae with higher BMD compared with DXA, and vice versa.

    “Similar to the observation for aBMD, there was a trend toward higher T-scores from spectral localizers in vertebrae with higher BMD in comparison to DXA, and vice versa (Fig. 5).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Eleven (26.8%, 11/41) patients were diagnosed with osteopenia in spectral localizers.

    “Eleven (26.8%, 11/41) patients were diagnosed with osteopenia in spectral localizers (Fig. 7).”
    Quote in the paperNot a substantial claim
  • Findingown data

    DXA and spectral localizer radiographs showed a strong positive correlation in patient-level T-scores (R = 0.99; 95% CI, 0.97-0.99; P < 0.001).

    “patient level T-scores (R = 0.99, P < 0.001)”
    • Also stated in: § Comparison of Spectral Localizer Radiographs and DXA for T-Score Calculation · boosted
      “T-scores derived from DXA and from spectral localizer radiographs showed a very strong positive correlation (R = 0.99; 95% CI, 0.97–0.99; P < 0.001)”
    Quote in the paperSubstantial claim
  • Findingown data

    BMI was significantly associated with differences in T-score between modalities (β = 0.03; 95% CI, 0.01-0.05; P = 0.001), albeit with a very low effect size.

    “BMI was significantly associated with differences in aBMD between modalities (β = 0.00; 95% CI, 0.00–0.01; P < 0.001) and T-score (β = 0.03; 95% CI, 0.01–0.05; P = 0.001), albeit with a very low effect size.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 23
  • May combine two claims. 19

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    These findings are in line with previous reports using quantitative CT, dual-energy CT, and dual-energy CT-based localizer radiographs.

    “These findings are in line with previous reports using quantitative CT,18 dual-energy CT,18–20 and dual-energy CT–based localizer radiographs.10”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [18] Li X Li X Li J,. The accuracy of bone mineral density measurement using dual-energy spectral CT and quantitative CT: a comparative phantom study. Clin Radiol. 2020; 75: 320.e9– 320.e15. 31882174 source
    • cites [19] Roski F Hammel J Mei K,. Bone mineral density measurements derived from dual-layer spectral CT enable opportunistic screening for osteoporosis. Eur Radiol. 2019; 29: 6355– 6363. 31115622 PMC6795615 source
    • cites [20] van Hamersvelt RW Schilham AMR Engelke K,. Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study. Eur Radiol. 2017; 27: 4351– 4359. 28374079 PMC5579207 source
    • cites [10] Laugerette A Schwaiger BJ Brown K,. DXA-equivalent quantification of bone mineral density using dual-layer spectral CT scout scans. Eur Radiol. 2019; 29: 4624– 4634. 30758656 source

  • May combine two claims.

    Premisecitation

    DXA-derived aBMD precision declines with increasing BMI and paraspinal fat, which may negatively impact the correlation with spectral localizer radiograph-derived aBMD.

    “It is known that DXA-derived aBMD precision declines with increasing BMI and paraspinal fat,23,24 which may negatively impact the correlation with spectral localizer radiograph-derived aBMD.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [23] Yu EW Thomas BJ Brown JK,. Simulated increases in body fat and errors in bone mineral density measurements by DXA and QCT. J Bone Miner Res. 2012; 27: 119– 124. 21915902 PMC3864640 source

      The Introduction states that DXA precision declines with increasing BMI, and the Discussion reports that simulated fat layering worsened DXA precision. The study used circumferential fat layers around normal-weight volunteers, not measurements of paraspinal fat specifically. The proposed effect on correlation with spectral localizer radiograph-derived aBMD is the citing authors’ inference, rather than a finding attributed to this source. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [24] Nelson L Gulenchyn KY Atthey M,. Is a fixed value for the least significant change appropriate? J Clin Densitom. 2010; 13: 18– 23. 20171565 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    DXA is the clinical reference standard to quantify BMD, yielding areal bone mineral density (aBMD).

    “Dual-energy x-ray absorptiometry (DXA) is the clinical reference standard to quantify BMD, yielding the areal bone mineral density (aBMD).5”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [5] Kanis JA Cooper C Rizzoli R,. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019; 30: 3– 44. 30324412 PMC7026233 source

  • May combine two claims.

    Findingown data

    In 24 (58.5%, 24/41) patients, spectral localizer radiographs revealed normal bone density, recategorizing 1 patient with osteopenia according to DXA to normal bone density with spectral localizer radiographs.

    “In 24 (58.5%, 24/41) patients, spectral localizer radiographs revealed normal bone density, hereby recategorizing 1 patient with osteopenia according to DXA to normal bone density with spectral localizer radiographs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    DXA revealed 5 (12.2%, 5/41) patients with osteoporosis, 13 patients (31.7%, 13/41) with osteopenia, and 23 (56.1%, 23/41) patients with normal bone density.

    “When categorizing T-scores according to WHO guidelines into normal, osteopenia, and osteoporosis, DXA revealed 5 (12.2%, 5/41) patients with osteoporosis, 13 patients (31.7%, 13/41) with osteopenia, and 23 (56.1%, 23/41) patients with normal bone density.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was a trend toward higher aBMD values from spectral localizer radiographs in vertebrae with higher density compared with DXA, and vice versa.

    “There was a trend toward higher aBMD values from spectral localizer radiographs in vertebrae with higher density in comparison with DXA, and vice versa (Fig. 3).”
    • Also stated in: § DISCUSSION · plain
      “we observed a trend toward higher aBMD values from spectral localizer radiographs in vertebrae with higher density as compared with DXA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Spectral localizer radiograph-derived T-scores led to a diagnosis of osteoporosis in 6 patients (14.6%, 6/41), with 1 patient being recategorized from osteopenia in DXA to osteoporosis.

    “Spectral localizer radiograph-derived T-scores lead to a diagnosis of osteoporosis in 6 patients (14.6%, 6/41), with 1 patient being recategorized from osteopenia in DXA to osteoporosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The patients in our study had an average BMI of 25.3 kg/m2, whereas the cohort in the study by El Sadaney et al had an average BMI of 30 kg/m2.

    “The patients in our study had an average BMI of 25.3 kg/m2, whereas the cohort in the study by El Sadaney et al22 had an average BMI of 30 kg/m2.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] El Sadaney AO Ferrero A Rajendran K,. Opportunistic bone mineral density measurement using photon-counting detector CT spectral localizer images: a prospective study. AJR Am J Roentgenol. 2024. 39475199 source

  • May combine two claims.

    Findingown data

    There were small differences in T-score between methods (mean absolute error 0.156) with narrow limits of agreement (−0.422 to 0.734).

    “Similarly, there were small differences in regard to the T-score (mean absolute error 0.156) with narrow limits of agreement (−0.422 to 0.734) between methods.”
    • Also stated in: § Comparison of Spectral Localizer Radiographs and DXA for T-Score Calculation · plain
      “Bland-Altman analysis for T-scores between spectral localizer radiographs and DXA showed a small mean absolute error of 0.156, with 95% limits of agreement of −0.422 and 0.734.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Mean aBMD according to DXA was 0.99 g/cm2; mean aBMD according to spectral localizer radiographs was 1.00 g/cm2.

    “The mean aBMD according to DXA was 0.99 g/cm2; the mean aBMD according to spectral localizer radiographs was 1.00 g/cm2.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Bland-Altman analysis revealed a very small mean difference in aBMD between methods (mean absolute error 0.019 g/cm2) with narrow limits of agreement (−0.083 g/cm2 to 0.121 g/cm2).

    “Bland-Altman analysis revealed a very small mean difference in aBMD between methods (mean absolute error 0.019 g/cm2) with narrow limits of agreement (−0.083 g/cm2 to 0.121 g/cm2).”
    • Also stated in: § Comparison of Spectral Localizer Radiographs and DXA for aBMD Calculation · plain
      “Bland-Altman analysis revealed a small mean absolute error of 0.019 g/cm2 between modalities, with narrow 95% limits of agreement of −0.083 g/cm2 and 0.121 g/cm2.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The median time interval between CT and DXA was 45 days (interquartile range, 32-59 days).

    “The median time interval between CT and DXA was 45 days (interquartile range, 32–59 days).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    The final study population included 41 patients (15 females, 26 males; mean age 61.3 ± 10.8 years, range 35-78 years).

    “Thus, the final study population included 41 patients (15 females, 26 males; mean age 61.3 ± 10.8 years, range 35–78 years) (Table 1, Fig. 2).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 1 patient, 2 vertebrae (L3 and L4) were excluded due to a stent obstructing the spectral localizer image and DXA scan.

    “In 1 patient, 2 vertebrae (L3 and L4) were excluded due to a stent obstructing the spectral localizer image and DXA scan.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    In total, 162 vertebrae from 41 patients were included in the final analysis.

    “In total, 162 vertebrae from 41 patients were therefore included in the final analysis.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Another potential advantage of aBMD calculation from spectral localizer radiographs is that reference values can be taken from previous large-scale DXA studies, and the definition of osteoporosis according to WHO is based on area and not volume BMD values.

    “Another potential advantage of aBMD calculation from spectral localizer radiographs is the fact that reference values can be taken from previous large-scale DXA studies, and that the definition of osteoporosis according to the WHO is based on area and not on volume BMD values.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    El Sadaney et al accepted a wider interval between DXA and spectral localizer radiographs from 13 months before to 13 months after CT, whereas in our prospective study, the median time of DXA was 45 days after CT.

    “El Sadaney et al22 accepted a wider interval between DXA and spectral localizer radiographs from 13 months before to 13 months after CT, whereas in our prospective study, the median time of DXA was 45 days after CT.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] El Sadaney AO Ferrero A Rajendran K,. Opportunistic bone mineral density measurement using photon-counting detector CT spectral localizer images: a prospective study. AJR Am J Roentgenol. 2024. 39475199 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    It is possible that the observed trend toward higher aBMD values from spectral localizer radiographs at higher density may not be primarily related to errors in density quantification from spectral localizer radiographs but from those of the reference standard DXA.

    “Thus, it is possible that this observed trend may not be primarily related to errors in density quantification from spectral localizer radiographs but from those of the reference standard DXA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    We found a high accuracy of aBMD using spectral localizer radiographs from PCD-CT as compared with DXA; the average difference being as small as 0.019 g/cm2.

    “We found a high accuracy of aBMD using spectral localizer radiographs from PCD-CT as compared with the clinical reference standard DXA; the average difference being as small as 0.019 g/cm2.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    aBMD quantification from spectral localizer radiographs has the same limitations as DXA, including measurement errors caused by overlaying soft tissue, vessel calcifications, and previously administered enteral contrast media.

    “Still, aBMD quantification from spectral localizer radiographs has the same limitations as DXA, including measurement errors caused by overlaying soft tissue, vessel calcifications, and previously administered enteral contrast media.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Vertebrae potentially unsuited for aBMD quantification (for example because of severe degenerative changes) can be excluded after viewing the cross-sectional CT images.

    “In addition, vertebrae that are potentially unsuited for aBMD quantification (for example because of severe degenerative changes) can be excluded after viewing the cross-sectional CT images.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Differences in body constitution, possibly also induced by therapy, may have contributed to the weaker correlation between DXA and localizer radiographs in El Sadaney et al.

    “Differences in body constitution, possibly also induced by therapy, may have contributed to the weaker correlation between DXA and localizer radiographs in El Sadaney et al.22”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] El Sadaney AO Ferrero A Rajendran K,. Opportunistic bone mineral density measurement using photon-counting detector CT spectral localizer images: a prospective study. AJR Am J Roentgenol. 2024. 39475199 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Another DXA scanner was used than in our study, which may have also resulted in differences in accuracy.

    “Furthermore, another DXA scanner was used than in our study, which may have also resulted in differences in accuracy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Two phantom studies using a clinically approved PCD-CT scanner confirmed these initial observations and showed accurate results in regard to aBMD quantification as compared with phantom specifications and with the clinical reference standard DXA.

    “More recently, 2 phantom studies using a clinically approved PCD-CT scanner confirmed these initial observations and showed accurate results in regard to aBMD quantification as compared with phantom specifications and with the clinical reference standard DXA.12,13”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Jasper S Swicklik J Baffour F,. Quantitative assessment of areal bone mineral density using multi-energy localizer radiographs from photon-counting detector CT. Phys Med Biol. 2024; 69: 22NT01. 39481230 source
    • cites [13] Moser LJ Pitteloud J Mergen V,. Bone mineral density assessment using spectral topograms from a clinical photon-counting detector CT system: a phantom evaluation. AJR Am J Roentgenol. 2024; 222: e2330347. 37937835 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In further 5 consecutive patients, the localizer radiograph raw data were lost due to a hard drive failure.

    “In further 5 consecutive patients, the localizer radiograph raw data were lost due to a hard drive failure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    From the initially screened 86 participants, 64 (74.4%) provided consent for study participation.

    “From the initially screened 86 participants, 64 (74.4%) provided consent for study participation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This prospective study had ethics committee approval (no. BASEC 2023-D0116).

    “This prospective study had ethics committee approval (no. BASEC 2023-D0116).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Segmentation of lumbar vertebrae was performed manually by 1 reader, which might have induced errors.

    “Second, segmentation of lumbar vertebrae was performed manually by 1 reader, which might have induced errors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Eligible patients had to provide written informed consent to participate in the study before undergoing CT.

    “Eligible patients had to provide written informed consent to participate in the study before undergoing CT.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    We analyzed only lumbar vertebrae but not the femoral neck or distal radius, which are also often used for BMD assessments in clinical routine.

    “Finally, we analyzed only lumbar vertebrae but not the femoral neck or distal radius, which are also often used for BMD assessments in clinical routine.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    From these 64 participants, 18 (28.1%) canceled or did not show up for the DXA appointment.

    “From these 64 participants, 18 (28.1%) canceled or did not show up for the DXA appointment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    El Sadaney et al performed segmentations of the lumbar vertebrae blinded from corresponding DXA segmentations, whereas we performed a readout in spectral localizer radiographs exactly matching the DXA segmentations; this matching of segmentations between modalities minimizes a segmentation bias, which may introduce differences not inherently related to the modalities.

    “Finally, El Sadaney et al22 performed segmentations of the lumbar vertebrae blinded from corresponding DXA segmentations, whereas we performed a readout in spectral localizer radiographs exactly matching the DXA segmentations. This matching of segmentations between modalities minimizes a segmentation bias, which may introduce differences not inherently related to the modalities.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] El Sadaney AO Ferrero A Rajendran K,. Opportunistic bone mineral density measurement using photon-counting detector CT spectral localizer images: a prospective study. AJR Am J Roentgenol. 2024. 39475199 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Alternatively, 1 localizer radiograph obtained with a dual-layer CT scanner enables quantification of the aBMD.

    “Alternatively, 1 localizer radiograph obtained with a dual-layer CT scanner enables quantification of the aBMD.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Laugerette A Schwaiger BJ Brown K,. DXA-equivalent quantification of bone mineral density using dual-layer spectral CT scout scans. Eur Radiol. 2019; 29: 4624– 4634. 30758656 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Quantification of aBMD from spectral localizer radiographs of PCD-CT is currently possible only with prototype software.

    “Third, the quantification of the aBMD from spectral localizer radiographs of PCD-CT is currently possible only with prototype software.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The sample size of this study was relatively small.

    “First the sample size of this study was relatively small.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was prospective and single-center.

    “In this prospective single-center study, patients ≥20 years of age scheduled for a clinically indicated CT examination of the chest and abdomen or of the abdomen on a clinical PCD-CT scanner between March 2024 and October 2024 were asked for study inclusion.”
    Quote in the paperNot a substantial claim
36 of 36

  • The paper relies on this without support.

    The median 45-day interval between CT and DXA is short enough that lumbar BMD did not change materially between the two measurements.

    “The median time interval between CT and DXA was 45 days (interquartile range, 32–59 days).”

  • The paper relies on this without support.

    The study population is representative of the broader population of patients undergoing CT for other indications who would be candidates for opportunistic BMD screening.

    “This opens up the opportunity for opportunistic screening of osteoporosis in patients who undergo CT for other indications.”
2 of 2

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Authors
Moser, L. J., Klambauer, K., Diaz Machicado, M. C., Frey, D., Mergen, V., Eberhard, M., Nowak, T., Schmidt, B., Flohr, T., Distler, O., & Alkadhi, H.
Affiliations
University of Zurich (CH)
Corresponding author
Alkadhi, Hatem
ORCID
Venue
Investigative Radiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2025-02-04
Volume
60
Issue
8
Pages
535-542
ISSN
  • 0020-9996 (ISSN-L)
  • 1536-0210
DOI
10.1097/rli.0000000000001159
PMC
PMC12233169
OpenAlex
W4407114104
Semantic Scholar
cd30963a725bf779b44e34a82682632e999c2f71
Cited by
8
References
24
Citations by year
2026: 7 · 2025: 1
FWCI
7.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Investigative Radiology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Physical Sciences › Engineering › Biomedical Engineering › Advanced X-ray and CT Imaging
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Digital Radiography and Breast Imaging
Keywords
photon-counting CT, dual-energy X-ray absorptiometry, lumbar spine, osteoporosis screening, measurement agreement, T-score, opportunistic screening
MeSH terms
Adult, Aged, Female, Humans, Lumbar Vertebrae, Male, Middle Aged, Osteoporosis, Prospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed, Reproducibility of Results, Absorptiometry, Photon, Bone Density

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-27.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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