Top

Published in:

01-02-2015 | Musculoskeletal

Intravenous contrast injection significantly affects bone mineral density measured on CT

Authors: Esther Pompe, Martin J. Willemink, Gawein R. Dijkhuis, Harald J. J. Verhaar, Firdaus A. A. Mohamed Hoesein, Pim A. de Jong

Published in: European Radiology | Issue 2/2015

Abstract

Objective

The objective is to evaluate the effect of intravenous contrast media on bone mineral density (BMD) assessment by comparing unenhanced and contrast-enhanced computed tomography (CT) examinations performed for other indications.

Methods

One hundred and fifty-two patients (99 without and 53 with malignant neoplasm) who underwent both unenhanced and two contrast-enhanced (arterial and portal venous phase) abdominal CT examinations in a single session between June 2011 and July 2013 were included. BMD was evaluated on the three examinations as CT-attenuation values in Hounsfield Units (HU) in the first lumbar vertebra (L1).

Results

CT-attenuation values were significantly higher in both contrast-enhanced phases, compared to the unenhanced phase (p < 0.01). In patients without malignancies, mean ± standard deviation (SD) HU-values increased from 128.8 ± 48.6 HU for the unenhanced phase to 142.3 ± 47.2 HU for the arterial phase and 147.0 ± 47.4 HU for the portal phase (p < 0.01). In patients with malignancies, HU-values increased from 112.1 ± 38.1 HU to 126.2 ± 38.4 HU and 130.1 ± 37.3 HU (p < 0.02), respectively. With different thresholds to define osteoporosis, measurements in the arterial and portal phase resulted in 7-25 % false negatives.

Conclusions

Our study showed that intravenous contrast injection substantially affects BMD-assessment on CT and taking this into account may improve routine assessment of low BMD in nonquantitative CT.

Key Points

• Routine CT may gain a role in bone attenuation measurements for osteoporosis

• Contrast media injection has substantial influence on CT-derived bone density

• Contrast-enhanced CT leads to underestimation of osteoporosis compared to unenhanced CT

• Adjusting for contrast injection phase may improve CT screening protocols for osteoporosis.

Raisz LG (2005) Screening for Osteoporosis. N Engl J Med 353:164–171PubMedCrossRef

NIH (2001) Consensus development panel on osteoporosis prevention, diagnosis and therapy. JAMA 285:785–795CrossRef

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

Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778PubMedCrossRef

Pickhardt P, Pooler B, Lauder T, Muñoz del Rio A, Bruce RJ, Binkley N (2014) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595CrossRef

Summers RM, Baecher N, Yao J et al (2011) Feasibility of simultaneous CT colonography and fully-automated bone mineral densitometry in a single examination. J Comput Assist Tomogr 35:212–216PubMedCentralPubMedCrossRef

Bauer JS, Link TM (2009) Advances in osteoporosis imaging. Eur J Radiol 71:440–449PubMedCrossRef

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 27:2338–2343PubMedCrossRef

Bauer JS, Henning TD, Müeller D et al (2007) Volumetric quantitative CT of the spine and hip derived from contrast-enhanced MDCT: conversion factors. AJR Am J Roentgenol 188:1294–1301PubMedCrossRef

10.

Gruber M, Bauer JS, Dobritz M et al (2013) Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry. Eur Radiol 23:505–512PubMedCrossRef

11.

De Jong WU, de Jong PA, Vliegenthart R et al (2014) Association of COPD and smoking status with bone density and vertebral fractures in male lung cancer screening participants. J Bone Miner Res. doi:10.1002/jbmr.2248

12.

Baum T, Müller D, Dobritz M et al (2011) BMD measurements of the spine derived from sagittal reformations of contrast-enhanced MDCT without dedicated software. Eur J Radiol 80:e140–e145PubMedCrossRef

13.

Schwaiger BJ, Gersing AS, Baum T, Noel PB, Zimmer C, Bauer JS (2014) Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A3893

14.

Riggs BL, Melton LJ (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S–511SPubMedCrossRef

15.

Link TM, Koppers BB, Licht T et al (2004) In vitro and in vivo spiral CT to determine bone mineral density: initial experience in patients at risk for osteoporosis. Radiology 231:805–811PubMedCrossRef

16.

Hopper KD, Wang MP, Kunselman AR (2000) The use of clinical CT for baseline bone density assessment. J Comput Assist Tomogr 24:896–899PubMedCrossRef

17.

Steiger P, Block JE, Steiger S et al (1990) Spinal bone mineral density measured with quantitative CT : effect of region of interest, vertebral level, and technique. Radiology 175:537–543PubMedCrossRef

18.

Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRef

19.

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 11:123–162PubMedCrossRef

20.

Unnanuntana A, Gladnick BP, Donnelly E, Lane JM (2010) The assessment of fracture risk. J Bone Joint Surg Am 92:743–753PubMedCentralPubMedCrossRef

21.

Papadakis AE, Karantanas AH, Papadokostakis G et al (2009) Can abdominal multi-detector CT diagnose spinal osteoporosis? Eur Radiol 19:172–176PubMedCrossRef

22.

Guise TA (2006) Bone loss and fracture risk associated with cancer therapy. Oncologist 11:1121–1131PubMedCrossRef

23.

Pickhardt PJ, Lee LJ, Muñoz del Rio A, Papadokostakis G et al (2011) Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared against the DXA reference standard. J Bone Min Res 26:2194–2203CrossRef

24.

Ohara T, Hirai T, Muro S et al (2008) Relationship between pulmonary emphysema and osteoporosis assessed by CT in patients with COPD. Chest 134:1244–1249PubMedCrossRef

Title: Intravenous contrast injection significantly affects bone mineral density measured on CT
Authors: Esther Pompe
Martin J. Willemink
Gawein R. Dijkhuis
Harald J. J. Verhaar
Firdaus A. A. Mohamed Hoesein
Pim A. de Jong
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3408-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intravenous contrast injection significantly affects bone mineral density measured on CT

Abstract

Objective

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 2/2015

Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib

Image-guided microwave thermoablation of hepatic tumours using novel robotic guidance: an early experience

Cerebral aneurysm treatment using flow-diverting stents: in-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: preliminary results

Detection and quantification of the solid component in pulmonary subsolid nodules by semiautomatic segmentation

Primary hepatic angiosarcoma: multi-institutional comprehensive cancer centre review of multiphasic CT and MR imaging in 35 patients