A novel approach to evaluation of lumbar bone density using Hounsfield units in volume of interest on computed tomography imaging

Author:

Fujimoto Masashi1,Miyazaki Takahiro2,Yamamoto Atsushi3,Ikezawa Munenari4,Tanioka Satoru5,Nishikawa Hirofumi1,Mizuno Masaki26,Suzuki Hidenori1

Affiliation:

1. Departments of Neurosurgery and

2. Department of Neurosurgery, Suzuka Kaisei Hospital, Kou-cho, Suzuka, Mie, Japan;

3. Department of Neurosurgery, Mie Prefectural General Medical Center, Hinaga, Yokkaichi, Mie, Japan;

4. Department of Neurosurgery, Mie Chuo Medical Center, Hisai-myojin-cho, Tsu, Mie, Japan; and

5. Charité Lab for Artificial Intelligence in Medicine, Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany

6. Minimum-Invasive Neurospinal Surgery, Mie University Graduate School of Medicine, Edobashi, Tsu, Mie, Japan;

Abstract

OBJECTIVE The purpose of this retrospective study was to evaluate the relationship between bone mineral density (BMD), as assessed with dual-energy x-ray absorptiometry (DEXA), and Hounsfield units (HU) measured in volumes of interest (VOIs) and regions of interest (ROIs) on lumbar spine CT. METHODS A retrospective analysis was performed on data of lumbar vertebrae obtained from patients who underwent both DEXA and lumbar spine CT scan within a 6-month period. Vertebrae with a history of compression fracture, infectious spondylitis, cement reinforcement, or lumbar surgery were excluded. HU measurements were performed in the VOI and ROI (midaxial, midcoronal, and midsagittal sections) with CT, whereas BMD was assessed with DEXA. Statistical analyses, including correlation assessments and receiver operating characteristic (ROC) curve analyses, were performed. RESULTS This analysis included 712 lumbar vertebrae, with a median patient age of 72.0 years. BMD values and HU measurements in the VOI increased sequentially from L1 to L4, whereas HU values in the ROI did not show a consistent pattern. HU values in the VOI consistently showed a stronger correlation with BMD than those in the ROI. ROC analysis revealed patient-level cutoff values for the diagnosis of osteoporosis at different lumbar vertebral levels with high sensitivity and specificity, as well as an excellent area under the curve. CONCLUSIONS This is the first study to introduce a novel approach using the HU value in the VOI to assess bone health at the lumbar spine. There is a strong correlation between the HU value in the VOI and BMD, and the HU value in the VOI can be used to predict osteoporosis.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Reference28 articles.

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2. Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives;Pennington Z,2021

3. ACR Appropriateness Criteria® osteoporosis and bone mineral density: 2022 update;Yu JS,2022

4. Osteoporosis imaging: state of the art and advanced imaging;Link TM,2012

5. Radiology of osteoporosis;Link TM,2016

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