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Open Access 01-10-2017 | Musculoskeletal

Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study

Authors: Robbert W. van Hamersvelt, Arnold M. R. Schilham, Klaus Engelke, Annemarie M. den Harder, Bart de Keizer, Harald J. Verhaar, Tim Leiner, Pim A. de Jong, Martin J. Willemink

Published in: European Radiology | Issue 10/2017

Abstract

Objectives

To investigate the accuracy of bone mineral density (BMD) quantification using dual-layer spectral detector CT (SDCT) at various scan protocols.

Methods

Two validated anthropomorphic phantoms containing inserts of 50–200 mg/cm³ calcium hydroxyapatite (HA) were scanned using a 64-slice SDCT scanner at various acquisition protocols (120 and 140 kVp, and 50, 100 and 200 mAs). Regions of interest (ROIs) were placed in each insert and mean attenuation profiles at monochromatic energy levels (90–200 keV) were constructed. These profiles were fitted to attenuation profiles of pure HA and water to calculate HA concentrations. For comparison, one phantom was scanned using dual energy X-ray absorptiometry (DXA).

Results

At both 120 and 140 kVp, excellent correlations (R = 0.97, P < 0.001) were found between true and measured HA concentrations. Mean error for all measurements at 120 kVp was -5.6 ± 5.7 mg/cm³ (-3.6 ± 3.2%) and at 140 kVp -2.4 ± 3.7 mg/cm³ (-0.8 ± 2.8%). Mean measurement errors were smaller than 6% for all acquisition protocols. Strong linear correlations (R² ≥ 0.970, P < 0.001) with DXA were found.

Conclusions

SDCT allows for accurate BMD quantification and potentially opens up the possibility for osteoporosis evaluation and opportunistic screening in patients undergoing SDCT for other clinical indications. However, patient studies are needed to extend and translate our findings.

Key points

• Dual-layer spectral detector CT allows for accurate bone mineral density quantification.

• BMD measurements on SDCT are strongly linearly correlated to DXA.

• SDCT, acquired for several indications, may allow for evaluation of osteoporosis.

• This potentially opens up the possibility for opportunistic osteoporosis screening.

Sànchez-Riera L, Carnahan E, Vos T et al (2014) The global burden attributable to low bone mineral density. Ann Rheum Dis 73:1635–1645CrossRefPubMed

Buckens CF, van der Graaf Y, Verkooijen HM et al (2015) Osteoporosis markers on low-dose lung cancer screening chest computed tomography scans predict all-cause mortality. Eur Radiol 25:132–139CrossRefPubMed

Cosman F, de Beur SJ, LeBoff MS et al (2014) Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 25:2359–2381CrossRefPubMedPubMedCentral

Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381CrossRefPubMed

Watts NB (2004) Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiometry (DXA). Osteoporos Int 15:847–854CrossRefPubMed

Engelke K, Adams JE, Armbrecht G et al (2008) 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 11:123–162CrossRefPubMed

Buckens CF, Dijkhuis G, de Keizer B et al (2015) Opportunistic screening for osteoporosis on routine computed tomography? An external validation study. Eur Radiol 25:2074–2079CrossRefPubMed

Pickhardt PJ, Pooler BD, Lauder T et al (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595CrossRefPubMedPubMedCentral

Romme EAPM, Murchison JT, Phang KF et al (2012) Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD. J Bone Miner Res 27:2338–2343CrossRefPubMed

10.

Engelke K, Lang T, Khosla S et al (2015) Clinical Use of Quantitative Computed Tomography-Based Advanced Techniques in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part III. J Clin Densitom 18:393–407CrossRefPubMed

11.

Pompe E, Willemink MJ, Dijkhuis GR et al (2015) Intravenous contrast injection significantly affects bone mineral density measured on CT. Eur Radiol 25:283–289CrossRefPubMed

12.

Genant HK, Boyd D (1977) Quantitative bone mineral analysis using dual energy computed tomography. Invest Radiol 12:545–551CrossRefPubMed

13.

Goodsitt MM, Rosenthal DI, Reinus WR, Coumas J (1987) Two postprocessing CT techniques for determining the composition of trabecular bone. Invest Radiol 22:209–215CrossRefPubMed

14.

Garner HW, Paturzo MM, Gaudier G et al (2017) Variation in Attenuation in L1 Trabecular Bone at Different Tube Voltages: Caution Is Warranted When Screening for Osteoporosis With the Use of Opportunistic CT. AJR Am J Roentgenol 208:165–170CrossRefPubMed

15.

Alvarez RE, Macovski A (1976) Energy-selective reconstructions in X-ray computerized tomography. Phys Med Biol 21:733–744CrossRefPubMed

16.

Vetter JR, Perman WH, Kalender WA et al (1986) Evaluation of a prototype dual-energy computed tomographic apparatus. II. Determination of vertebral bone mineral content. Med Phys 13:340–343CrossRefPubMed

17.

Nickoloff EL, Feldman F, Atherton JV (1988) Bone mineral assessment: new dual-energy CT approach. Radiology 168:223–228CrossRefPubMed

18.

Kalender WA, Klotz E, Suess C (1987) Vertebral bone mineral analysis: an integrated approach with CT. Radiology 164:419–423CrossRefPubMed

19.

Coumans J, Kosanetzky J, Zonneveld FW (1982) Computerized dual-energy imaging: a technical description. Medicamundi 27:125–132

20.

Wesarg S, Kirschner M, Becker M et al (2012) Dual-energy CT-based assessment of the trabecular bone in vertebrae. Methods Inf Med 51:398–405CrossRefPubMed

21.

Wichmann JL, Booz C, Wesarg S et al (2014) Dual-energy CT-based phantomless in vivo three-dimensional bone mineral density assessment of the lumbar spine. Radiology 271:778–784CrossRefPubMed

22.

Hofmann P, Sedlmair M, Krauss B, et al. (2016) Phantom-less bone mineral density (BMD) measurement using dual energy computed tomography-based 3-material decomposition. In: Tourassi GD, Armato SG (eds). International Society for Optics and Photonics, p 97853E

23.

Wait JMS, Cody D, Jones AK et al (2015) Performance Evaluation of Material Decomposition With Rapid-Kilovoltage-Switching Dual-Energy CT and Implications for Assessing Bone Mineral Density. AJR Am J Roentgenol 204:1234–1241CrossRefPubMed

24.

Kalender WA, Felsenberg D, Genant HK et al (1995) The European Spine Phantom--a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT. Eur J Radiol 20:83–92CrossRefPubMed

25.

Deak PD, Smal Y, Kalender WA (2010) Multisection CT Protocols: Sex- and Age-specific Conversion Factors Used to Determine Effective Dose from Dose-Length Product. Radiology 257:158–166CrossRefPubMed

26.

Bamberg F, Dierks A, Nikolaou K et al (2011) Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. Eur Radiol 21:1424–1429CrossRefPubMed

27.

Wang Y, Qian B, Li B et al (2013) Metal artifacts reduction using monochromatic images from spectral CT: evaluation of pedicle screws in patients with scoliosis. Eur J Radiol 82:e360–e366CrossRefPubMed

28.

Hubbell JH, Seltzer SM (2004) Tables of X-Ray mass attenuation coefficients and mass energy-absorption coefficients (version 1.4). http://physics.nist.gov/xaamdi

29.

Ward RJ, Roberts CC, Bencardino JT, et al. (2016) American College of Radiology ACR Appropriateness Criteria: Osteoporosis and Bone Mineral Density. Rest Am Coll Radiol

30.

Wichmann JL, Booz C, Wesarg S et al (2015) Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength. Eur Radiol 25:1714–1720CrossRefPubMed

31.

Johnson TR, Fink C, Schönberg SO, Reiser M (2011) Dual Energy CT in Clinical Practice, Medical Radiology. Springer-Verlag, BerlinCrossRef

Title: Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study
Authors: Robbert W. van Hamersvelt
Arnold M. R. Schilham
Klaus Engelke
Annemarie M. den Harder
Bart de Keizer
Harald J. Verhaar
Tim Leiner
Pim A. de Jong
Martin J. Willemink
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 10/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4801-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Accuracy of bone mineral density quantification using dual-layer spectral detector CT: a phantom study

Abstract

Objectives

Methods

Results

Conclusions

Key points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key points

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