Opportunistic Bone Mineral Density Measurement Using Photon-Counting Detector CT Spectral Localizer Images: A Prospective Study
Abstract
BACKGROUND. Spectral localizer images from photon-counting detector (PCD) CT can be used for bone mineral density (BMD) evaluation given their 2D projectional nature and material decomposition capability. As all CT examinations include localizer images, this approach could allow opportunistic osteoporosis screening of patients undergoing clinically indicated imaging with PCD CT. OBJECTIVE . The purpose of this study was to assess the use of PCD CT spectral localizer images for opportunistic derivation of areal BMD (aBMD) values and T-scores, with dual-energy x-ray absorptiometry (DEXA) used as the reference standard. METHODS. This prospective study included patients 18 years old or older who were scheduled for a clinically indicated lumbar spine CT examination between October 2023 and February 2024 and who underwent DEXA within the previous 13 months or were scheduled for DEXA within the subsequent 13 months. Participants underwent lumbar spine CT by PCD CT including spectral localizer images. The lumbar spine aBMD was extracted from clinical DEXA reports. ROIs were placed on lumbar vertebral bodies and background soft tissues to extract areal densities from spectral localizer images using material decomposition; areal densities were used to derive lumbar spine aBMD values. The aBMD values were used to derive T-scores, which were classified as representing normal (≥ -1.0) or abnormal ( RESULTS. The study included 51 participants (31 women and 20 men; mean age, 62 years [range…
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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.”
From In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT (2025) · cites this paper as [22]
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.”
From In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT (2025) · cites this paper as [22]
El Sadaney et al found a poor agreement between DXA and spectral localizer radiograph-derived aBMD values as evidenced by Lin's concordance correlation coefficients between 0.55 and 0.68.
“El Sadaney et al22 compared the aBMD from spectral localizer radiographs to DXA. In distinction to our study, authors found a poor agreement between DXA and spectral localizer radiograph-derived aBMD values as evidenced by Lin's concordance correlation coefficients between 0.55 and 0.68.”
From In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT (2025) · cites this paper as [22]
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.”
From In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT (2025) · cites this paper as [22]
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”
From In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT (2025) · cites this paper as [22]
Cites
A guideline of selecting and reporting intraclass correlation coefficients for reliability research
Koo, T. K., & Li, M. Y. (2016) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2016.02.012 · Cited by 29,639 · see citing works
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Moser, L. J., Klambauer, K., Diaz Machicado, M. C., Frey, D., Mergen, V., Eberhard, M., Nowak, T., Schmidt, B., Flohr, T., Distler, O., et al. (2025) · Investigative Radiology · doi:10.1097/rli.0000000000001159 · Cited by 8 · see citing works
Self-citation
- Authors
- El Sadaney, A. O., Ferrero, A., Rajendran, K., Jasper, S., Mazza, G. L., Broski, S. M., Shanblatt, E., Nowak, T., Fletcher, J. G., McCollough, C. H., & Baffour, F. I.
- Affiliations
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905.
- Mayo Clinic (US)
- Siemens Healthcare (United States) (US)
- ORCID
- Venue
- American Journal of Roentgenology
- Publisher
- American Roentgen Ray Society
- Published
- 2025-01
- Volume
- 224
- Issue
- 1
- Pages
- e2431909-e2431909
- ISSN
- 0002-9580 (ISSN-L)
- 0361-803X
- 1546-3141
- OpenAlex
- W4403894976
- Cited by
- 19
- References
- 1
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 2
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Roentgenology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Advanced X-ray and CT Imaging
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Digital Radiography and Breast Imaging
- Keywords
- bone mineral density, opportunistic screening, osteoporosis screening, photon-counting CT, material decomposition, dual-energy CT
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Lumbar Vertebrae, Male, Middle Aged, Osteoporosis, Prospective Studies, Tomography, X-Ray Computed, Absorptiometry, Photon, Bone Density, Photons
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