Diagnostic accuracy of quantitative dual-energy CT-based bone mineral density assessment in comparison to Hounsfield unit measurements using dual x-ray absorptiometry as standard of reference
Diagnostic accuracy of quantitative dual-energy CT-based bone mineral density assessment in comparison to Hounsfield unit measurements using dual x-ray absorptiometry as standard of reference
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DOI：
10.1016/j.ejrad.2020.109321
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发表时间：
2020-11-01
影响因子：
3.3
通讯作者：
Wichmann, Julian L.
中科院分区：
文献类型：
--
作者：
Booz, Christian;Noeske, Jochen;Wichmann, Julian L.
目的：评估基于体积材料分解的无体模双能计算机断层扫描（DECT）评估腰椎骨矿物质密度（BMD）检测骨质疏松症的诊断准确性，并与双能X线吸收仪（DXA）作为参考标准的Hounsfield单位（HU）测量值进行比较。回顾性分析了30天内接受临床指征第三代双源DECT和DXA的28例男性，25例女性;平均年龄52岁，范围23-87岁。对于体积BMD评估，应用了使用材料分解的专用DECT后处理软件，该软件能够对小梁BMD分布进行彩色编码的三维映射。手动HU测量是通过定义五个小梁感兴趣区域（ROI），每个椎骨，如文献所建议的。DXA T评分作为参考标准（骨质疏松症：T < -2.5）。灵敏度、特异性和曲线下面积（AUC）是诊断准确性的主要指标。基于患者的最佳DECT推导的BMD临界值为84 mg/cm（3），检测骨质疏松症的灵敏度为96%（22/23），特异性为93%（28/30），CT最佳衰减截止值为139 HU时，诊断骨质疏松的敏感性为65%（15/23），特异性为93%（28/30）。基于患者的总体AUC为0.930（体积DECT）和0.790（HU分析）（p < .001）。Pearson积差相关显示DECT BMD与DXA值之间的相关性（r=0.780）高于HU与DXA值之间的相关性（r=0.528 <0.001）。结论：与HU测量值相比，无创容积DECT测量值对腰椎BMD的评估更准确，对骨质疏松症的诊断准确性上级。
Purpose: To assess the diagnostic accuracy of phantomless dual-energy computed tomography (DECT)-based volumetric material decomposition to assess bone mineral density (BMD) of the lumbar spine for the detection of osteoporosis compared to Hounsfield unit (HU) measurements with dual x-ray absorptiometry (DXA) as reference standard.Method: A total of two hundred lumbar vertebrae in 53 patients (28 men, 25 women; mean age, 52 years, range, 23-87 years) who had undergone clinically-indicated third-generation dual-source DECT and DXA within 30 days were retrospectively analyzed. For volumetric BMD assessment, dedicated DECT postprocessing software using material decomposition was applied, which enables color-coded three-dimensional mapping of the trabecular BMD distribution. Manual HU measurements were performed by defining five trabecular regions of interest (ROI) per vertebra as suggested by literature. The DXA T-score served as standard of reference (osteoporosis: T < -2.5). Sensitivity, specificity and the area under the curve (AUC) were primary metrics of diagnostic accuracy.Results: An optimal patient-based DECT-derived BMD cut-off of 84 mg/cm(3) yielded 96 % sensitivity (22/23) and 93 % specificity (28/30) for detecting osteoporosis, while an optimal CT attenuation cut-off of 139 HU showed 65 % sensitivity (15/23) and 93 % specificity (28/30) for the detection of osteoporosis. Overall patient-based AUC were 0.930 (volumetric DECT) and 0.790 (HU analysis) (p < .001). Pearson's product-moment correlation showed higher correlation between DECT BMD and DXA values (r=0.780) compared to HU and DXA values (r=0.528) < .001).Conclusions: Phantomless volumetric DECT yielded significantly more accurate BMD assessment of the lumbar spine and superior diagnostic accuracy of osteoporosis compared to HU measurements.