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Current Medical Imaging


ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Could Computed Tomography Hounsfield Unit Values of Lumbar Vertebrae Detect Osteoporosis?

Author(s): Elif Hocaoglu*, Ercan Inci and Meltem Vural

Volume 17, Issue 8, 2021

Published on: 12 January, 2021

Page: [988 - 995] Pages: 8

DOI: 10.2174/1573405617999210112193545

Price: $65


Background: Dual-energy X-ray absorptiometry (DEXA) scanning has several disadvantages determining osteoporosis, especially for the degenerative spine.

Introduction: This study aims to determine spinal osteoporosis in patients suffering from lumbar degenerative disease using computed tomography (CT).

Methods: A total of 547 subjects that underwent DEXA and abdominal CT within a period of three months were examined retrospectively and separated into groups based on lumbar degenerative alteration on the CT scan. The subjects that showed degenerative severity at L1–L4, in at least two levels, were graded and placed in the degenerative group (Group D, n=350). In contrast, the other subjects constituted the control group (Group C, n=197). The Hounsfield unit (HU) of the vertebral body trabecular bone, the T-score, and bone mineral density (BMD) of L1–L4 and hips were determined from the CT images. CT-HU parameters for osteoporosis acquired from the control group were used to ascertain undiagnosed osteoporosis.

Results: The CT-HU was positively correlated with T-score and lumbar BMD for both groups (P<0.001), while the L1–L4 correlation was higher in Group C than in Group D. Based on linear regression, the T-score and CT-HU for L1-L4 osteoporosis were 129, 136, 129 and 120 HU, respectively in Group C. Undiagnosed spinal osteoporosis was greater in Group D compared to the controls (44.2% vs. 9.6%, respectively) based on the CT-HU thresholds.

Conclusion: Lumbar spine degeneration can augment BMD and T-score, resulting in the underestimation of lumbar osteoporosis. The osteoporosis threshold determined by CT-HU may be a valuable technique to determine undiagnosed spinal osteoporosis.

Keywords: Osteoporosis, hounsfield unite (HU), T-score, computed tomography, lumbar spinal degeneration, bone mineral density.

Graphical Abstract
Kadam NS, Chiplonkar SA, Khadilkar AV, Khadilkar VV. Prevalence of osteoporosis in apparently healthy adults above 40 years of age in Pune City, India. Indian J Endocrinol Metab 2018; 22(1): 67-73.
[] [PMID: 29535940]
Thulkar J, Singh S. Overview of research studies on osteoporosis in menopausal women since the last decade. J Midlife Health 2015; 6(3): 104-7.
[] [PMID: 26538986]
Chin DK, Park JY, Yoon YS, et al. Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease. Osteoporos Int 2007; 18(9): 1219-24.
[] [PMID: 17387420]
Celi M, Rao C, Scialdoni A, et al. Bone mineral density evaluation in osteoporosis: why yes and why not? Aging Clin Exp Res 2013; 25(Suppl. 1): S47-9.
[] [PMID: 24046042]
Muraki S, Yamamoto S, Ishibashi H, et al. Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int 2004; 15(9): 724-8.
[] [PMID: 14997287]
Engelke K, Adams JE, Armbrecht G, et al. 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 2008; 11(1): 123-62.
[] [PMID: 18442757]
Budoff MJ, Khairallah W, Li D, et al. Trabecular bone mineral density measurement using thoracic and lumbar quantitative computed tomography. Acad Radiol 2012; 19(2): 179-83.
[] [PMID: 22112461]
Ward RJ, Roberts CC, Bencardino JT, et al. Expert Panel on Musculoskeletal Imaging. ACR appropriateness criteria: osteoporosis and bone mineral density. J Am Coll Radiol 2017; 14(5S): S189-202.
[] [PMID: 28473075]
Graffy PM, Lee SJ, Ziemlewicz TJ, Pickhardt PJ. Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening. AJR Am J Roentgenol 2017; 209(3): 491-6.
[] [PMID: 28639828]
Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 2013; 158(8): 588-95.
[] [PMID: 23588747]
Pickhardt PJ, Lauder T, Pooler BD, et al. Effect of IV contrast on lumbar trabecular attenuation at routine abdominal CT: correlation with DXA and implications for opportunistic osteoporosis screening. Osteoporos Int 2016; 27(1): 147-52.
[] [PMID: 26153046]
Schreiber JJ, Anderson PA, Hsu WK. Use of computed tomography for assessing bone mineral density. Neurosurg Focus 2014; 37(1)E4
[] [PMID: 24981903]
Gausden EB, Nwachukwu BU, Schreiber JJ, Lorich DG, Lane JM. Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. J Bone Joint Surg Am 2017; 99(18): 1580-90.
[] [PMID: 28926388]
Lee SJ, Binkley N, Lubner MG, Bruce RJ, Ziemlewicz TJ, Pickhardt PJ. Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int 2016; 27(3): 1131-6.
[] [PMID: 26419470]
Gittoes N. Osteoporosis: pathophysiology and clinical management. Clin Endocrinol (Oxf) 2003; 59(6): 826-7.
[] [PMID: 14974931]
Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am 2011; 93(11): 1057-63.
[] [PMID: 21655899]
Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28(4): 215-9.
[] [PMID: 10384992]
Zou D, Li W, Deng C, Du G, Xu N. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J 2019; 28(8): 1758-66.
[] [PMID: 30306332]
Pappou IP, Girardi FP, Sandhu HS, et al. Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis. Spine 2006; 31(14): 1614-20.
[] [PMID: 16778698]
Adams MA, Pollintine P, Tobias JH, Wakley GK, Dolan P. Intervertebral disc degeneration can predispose to anterior vertebral fractures in the thoracolumbar spine. J Bone Miner Res 2006; 21(9): 1409-16.
[] [PMID: 16939399]
Arabi A, Baddoura R, Awada H, et al. Discriminative ability of dual-energy X-ray absorptiometry site selection in identifying patients with osteoporotic fractures. Bone 2007; 40(4): 1060-5.
[] [PMID: 17223616]
Hamdy RC, Petak SM, Lenchik L. International Society for Clinical Densitometry Position Development Panel and Scientific Advisory Committee. Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis? J Clin Densitom 2002; 5: S11-8.
[] [PMID: 12464707]
Salzmann SN, Shirahata T, Yang J, et al. Regional bone mineral density differences measured by quantitative computed tomography: does the standard clinically used L1-L2 average correlate with the entire lumbosacral spine? Spine J 2019; 19(4): 695-702.
[] [PMID: 30343044]
Wagner SC, Formby PM, Helgeson MD, Kang DG. Diagnosing the undiagnosed: osteoporosis in patients undergoing lumbar fusion. Spine 2016; 41(21): E1279-83.
[] [PMID: 27802255]
Choi MK, Kim SM, Lim JK. Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT. Acta Neurochir (Wien) 2016; 158(7): 1421-7.
[] [PMID: 27177734]
Shuhart CR, Yeap SS, Anderson PA, et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom 2019; 22(4): 453-71.
[] [PMID: 31400968]

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