DOI QR코드

DOI QR Code

Correlation between Bone Mineral Density Measured by Dual-Energy X-Ray Absorptiometry and Hounsfield Units Measured by Diagnostic CT in Lumbar Spine

  • Lee, Sungjoon (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Chung, Chun Kee (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Oh, So Hee (Department of Medical Statistics, Seoul National University Boramae Medical Center) ;
  • Park, Sung Bae (Department of Neurosurgery, Seoul National University Boramae Medical Center)
  • Received : 2013.02.19
  • Accepted : 2013.11.11
  • Published : 2013.11.28

Abstract

Objective : Use of quantitative computed tomography (CT) to evaluate bone mineral density was suggested in the 1970s. Despite its reliability and accuracy, technical shortcomings restricted its usage, and dual-energy X-ray absorptiometry (DXA) became the gold standard evaluation method. Advances in CT technology have reduced its previous limitations, and CT evaluation of bone quality may now be applicable in clinical practice. The aim of this study was to determine if the Hounsfield unit (HU) values obtained from CT correlate with patient age and bone mineral density. Methods : A total of 128 female patients who underwent lumbar CT for back pain were enrolled in the study. Their mean age was 66.4 years. Among them, 70 patients also underwent DXA. The patients were stratified by decade of life, forming five age groups. Lumbar vertebrae L1-4 were analyzed. The HU value of each vertebra was determined by averaging three measurements of the vertebra's trabecular portion, as shown in consecutive axial CT images. The HU values were compared between age groups, and correlations of HU value with bone mineral density and T-scores were determined. Results : The HU values consistently decreased with increasing age with significant differences between age groups (p<0.001). There were significant positive correlations (p<0.001) of HU value with bone mineral density and T-score. Conclusion : The trabecular area HU value consistently decreases with age. Based on the strong positive correlation between HU value and bone mineral density, CT-based HU values might be useful in detecting bone mineral diseases, such as osteoporosis.

Keywords

References

  1. Adams JE : Quantitative computed tomography. Eur J Radiol 71 : 415-424, 2009 https://doi.org/10.1016/j.ejrad.2009.04.074
  2. Eswaran SK, Gupta A, Adams MF, Keaveny TM : Cortical and trabecular load sharing in the human vertebral body. J Bone Miner Res 21 : 307-314, 2006
  3. Goldman LW : Principles of CT and CT technology. J Nucl Med Technol 35 : 115-128; quiz 129-130, 2007 https://doi.org/10.2967/jnmt.107.042978
  4. Goo HW : CT radiation dose optimization and estimation : an update for radiologists. Korean J Radiol 13 : 1-11, 2012 https://doi.org/10.3348/kjr.2012.13.1.1
  5. Keaveny TM, Hayes WC : A 20-year perspective on the mechanical properties of trabecular bone. J Biomech Eng 115 : 534-542, 1993 https://doi.org/10.1115/1.2895536
  6. Kim DH, Vaccaro AR : Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 6 : 479-487, 2006 https://doi.org/10.1016/j.spinee.2006.04.013
  7. Kim KH, Lee K, Ko YJ, Kim SJ, Oh SI, Durrance DY, et al. : Prevalence, awareness, and treatment of osteoporosis among Korean women : The Fourth Korea National Health and Nutrition Examination Survey. Bone 50 : 1039-1047, 2012 https://doi.org/10.1016/j.bone.2012.02.007
  8. Link TM, Koppers BB, Licht T, Bauer J, Lu Y, Rummeny EJ : In vitro and in vivo spiral CT to determine bone mineral density : initial experience in patients at risk for osteoporosis. Radiology 231 : 805-811, 2004 https://doi.org/10.1148/radiol.2313030325
  9. Miyabara Y, Holmes D 3rd, Camp J, Miller VM, Kearns AE : Comparison of calibrated and uncalibrated bone mineral density by CT to DEXA in menopausal women. Climacteric 15 : 374-381, 2012 https://doi.org/10.3109/13697137.2011.618566
  10. Papadakis AE, Karantanas AH, Papadokostakis G, Damilakis J : Assessment of the morpho-densitometric parameters of the lumbar pedicles in osteoporotic and control women undergoing routine abdominal MDCT examinations. J Bone Miner Metab 29 : 352-358, 2011 https://doi.org/10.1007/s00774-010-0227-7
  11. Papadakis AE, Karantanas AH, Papadokostakis G, Petinellis E, Damilakis J : Can abdominal multi-detector CT diagnose spinal osteoporosis? Eur Radiol 19 : 172-176, 2009 https://doi.org/10.1007/s00330-008-1099-2
  12. Prevention and management of osteoporosis. World Health Organ Tech Rep Ser 921 : 1-164, 2003
  13. Ross PD, Davis JW, Epstein RS, Wasnich RD : Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114 : 919-923, 1991 https://doi.org/10.7326/0003-4819-114-11-919
  14. 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 93 : 1057-1063, 2011 https://doi.org/10.2106/JBJS.J.00160
  15. Tay WL, Chui CK, Ong SH, Ng AC : Osteoporosis screening using areal bone mineral density estimation from diagnostic CT images. Acad Radiol 19 : 1273-1282, 2012 https://doi.org/10.1016/j.acra.2012.05.017

Cited by

  1. Use of computed tomography for assessing bone mineral density vol.37, pp.1, 2013, https://doi.org/10.3171/2014.5.focus1483
  2. Relation between Spongy Bone Density in the Maxilla and Skeletal Bone Density vol.17, pp.6, 2015, https://doi.org/10.1111/cid.12228
  3. Evaluation of Bone Thickness and Density in the Lower Incisors’ Region in Adults with Different Types of Skeletal Malocclusion using Cone-beam Computed Tomography vol.16, pp.8, 2013, https://doi.org/10.5005/jp-journals-10024-1733
  4. Thoracic and Lumbar Vertebral Bone Mineral Density Changes in a Natural Occurring Dog Model of Diffuse Idiopathic Skeletal Hyperostosis vol.10, pp.4, 2015, https://doi.org/10.1371/journal.pone.0124166
  5. Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis vol.31, pp.10, 2013, https://doi.org/10.1185/03007995.2015.1074892
  6. Use of internal references for assessing CT density measurements of the pelvis as replacement for use of an external phantom vol.44, pp.11, 2013, https://doi.org/10.1007/s00256-015-2206-5
  7. 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 uni vol.158, pp.7, 2013, https://doi.org/10.1007/s00701-016-2821-5
  8. Hyoid bone fusion and bone density across the lifespan: prediction of age and sex vol.12, pp.None, 2013, https://doi.org/10.1007/s12024-016-9769-x
  9. Diagnosing the Undiagnosed: Osteoporosis in Patients Undergoing Lumbar Fusion vol.41, pp.21, 2016, https://doi.org/10.1097/brs.0000000000001612
  10. Influence of IV Contrast Administration on CT Measures of Muscle and Bone Attenuation: Implications for Sarcopenia and Osteoporosis Evaluation vol.207, pp.5, 2016, https://doi.org/10.2214/ajr.16.16387
  11. Osteoporose na atenção primária: uma oportunidade para abordar os fatores de risco vol.56, pp.2, 2013, https://doi.org/10.1016/j.rbr.2015.03.004
  12. Changes in the Dickkopf-1 and tartrate-resistant acid phosphatase 5b serum levels in preschool children with nephrotic syndrome vol.4, pp.5, 2013, https://doi.org/10.3892/br.2016.631
  13. Bone mineral density predicts posttransplant survival among hepatocellular carcinoma liver transplant recipients vol.22, pp.8, 2013, https://doi.org/10.1002/lt.24458
  14. Combining Computed Tomography-Based Bone Density Assessment with FRAX Screening in Men with Prostate Cancer vol.19, pp.4, 2013, https://doi.org/10.1016/j.jocd.2016.04.011
  15. Effect of Osteoporosis on Bone Density of Orthognathic Osteotomy Sites in Maxillofacial Region vol.27, pp.7, 2013, https://doi.org/10.1097/scs.0000000000003064
  16. Clinical and Radiographic Outcomes of Transforaminal Lumbar Interbody Fusion in Patients with Osteoporosis vol.6, pp.7, 2016, https://doi.org/10.1055/s-0036-1578804
  17. A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis vol.7, pp.4, 2013, https://doi.org/10.1177/2151458516669204
  18. Opportunistic screening for osteoporosis by routine CT in Southern Europe vol.28, pp.3, 2013, https://doi.org/10.1007/s00198-016-3804-3
  19. Opportunistic Use of CT Imaging for Osteoporosis Screening and Bone Density Assessment : A Qualitative Systematic Review vol.99, pp.18, 2013, https://doi.org/10.2106/jbjs.16.00749
  20. Radioisotopic assessment of bone metabolism of the operated vertebra after inter-process stabilizer implantation in the lumbar segment of the spine vol.13, pp.1, 2013, https://doi.org/10.5114/aoms.2017.64718
  21. Characterization of 3D printing techniques: Toward patient specific quality assurance spine-shaped phantom for stereotactic body radiation therapy vol.12, pp.5, 2013, https://doi.org/10.1371/journal.pone.0176227
  22. Lumbar computed tomography scans are not appropriate surrogates for bone mineral density scans in primary adult spinal deformity vol.43, pp.6, 2013, https://doi.org/10.3171/2017.9.focus17476
  23. Lumbar computed tomography scans are not appropriate surrogates for bone mineral density scans in primary adult spinal deformity vol.43, pp.6, 2013, https://doi.org/10.3171/2017.9.focus17476
  24. Cauda equina syndrome in dogs - a review vol.87, pp.4, 2013, https://doi.org/10.2754/avb201887040321
  25. Does Greater Trochanter Decortication Affect Suture Anchor Pullout Strength in Abductor Tendon Repairs? A Biomechanical Study vol.46, pp.7, 2013, https://doi.org/10.1177/0363546518759033
  26. EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT vol.59, pp.7, 2013, https://doi.org/10.2967/jnumed.117.203265
  27. The frontal skull Hounsfield unit value can predict ventricular enlargement in patients with subarachnoid haemorrhage vol.8, pp.None, 2013, https://doi.org/10.1038/s41598-018-28471-1
  28. Proximal Femur Hounsfield Units on CT Colonoscopy Correlate With Dual-energy X-ray Absorptiometry vol.477, pp.4, 2013, https://doi.org/10.1097/corr.0000000000000480
  29. Lower Bone Density on Preoperative Computed Tomography Predicts Periprosthetic Fracture Risk in Total Ankle Arthroplasty vol.40, pp.1, 2019, https://doi.org/10.1177/1071100718799102
  30. Measurement Techniques and Utility of Hounsfield Unit Values for Assessment of Bone Quality Prior to Spinal Instrumentation : A Review of Current Literature vol.44, pp.4, 2019, https://doi.org/10.1097/brs.0000000000002813
  31. Bone Mineral Density as a Risk Factor for Patients Undergoing Surgery for Hepatocellular Carcinoma vol.43, pp.3, 2019, https://doi.org/10.1007/s00268-018-4861-x
  32. Supination External Rotational Ankle Fracture Injury Pattern Correlation With Regional Bone Density vol.40, pp.4, 2013, https://doi.org/10.1177/1071100718816680
  33. Opportunistic Osteoporosis Screening at Routine Abdominal and Thoracic CT: Normative L1 Trabecular Attenuation Values in More than 20 000 Adults vol.291, pp.2, 2013, https://doi.org/10.1148/radiol.2019181648
  34. Renal Cell Carcinoma with Primary Presentation via Metastasis to the Trigeminal Ganglion vol.126, pp.None, 2013, https://doi.org/10.1016/j.wneu.2019.02.118
  35. Machine Learning Model to Predict Osteoporotic Spine with Hounsfield Units on Lumbar Computed Tomography vol.62, pp.4, 2019, https://doi.org/10.3340/jkns.2018.0178
  36. Comparison of cross‐sectional geometrical properties and bone density of the proximal radius between Saint Bernard and other giant breed dogs vol.48, pp.6, 2013, https://doi.org/10.1111/vsu.13276
  37. Hounsfield Unit for Assessing Vertebral Bone Quality and Asymmetrical Vertebral Degeneration in Degenerative Lumbar Scoliosis vol.45, pp.22, 2013, https://doi.org/10.1097/brs.0000000000003639
  38. CT Derived Hounsfield Unit: An Easy Way to Determine Osteoporosis and Radiation Related Fracture Risk in Irradiated Patients vol.10, pp.None, 2013, https://doi.org/10.3389/fonc.2020.00742
  39. Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes : Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves vol.32, pp.1, 2020, https://doi.org/10.3171/2019.7.spine19654
  40. Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes : Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves vol.32, pp.1, 2020, https://doi.org/10.3171/2019.7.spine19654
  41. Automated opportunistic osteoporotic fracture risk assessment using computed tomography scans to aid in FRAX underutilization vol.26, pp.1, 2013, https://doi.org/10.1038/s41591-019-0720-z
  42. Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training vol.140, pp.3, 2013, https://doi.org/10.1007/s00402-019-03313-5
  43. Bone Mineral Density Mapping of Iliosacral Region: The Use of Hounsfield Units to Optimize Transsacral Screw Trajectory vol.185, pp.3, 2013, https://doi.org/10.1093/milmed/usz331
  44. Correlation between the Computed Tomography Values of the Screw Path and Pedicle Screw Pullout Strength: An Experimental Study in Porcine Vertebrae vol.14, pp.3, 2020, https://doi.org/10.31616/asj.2019.0170
  45. CT-Scan as an Opportunistic Osteoporosis Screening Tool in High-Risk Populations; A Diagnostic Study Conducted on a Sample of Urinary Stone Patients vol.17, pp.4, 2013, https://doi.org/10.5812/iranjradiol.102177
  46. The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up vol.49, pp.2, 2013, https://doi.org/10.3171/2020.5.focus20192
  47. The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up vol.49, pp.2, 2013, https://doi.org/10.3171/2020.5.focus20192
  48. Cross-sectional association of bone mineral density with coronary artery calcification in an international multi-ethnic population-based cohort of men aged 40–49: ERA JUMP study vol.30, pp.None, 2013, https://doi.org/10.1016/j.ijcha.2020.100618
  49. Safety and Tolerability of Stromal Vascular Fraction Combined with β-Tricalcium Phosphate in Posterior Lumbar Interbody Fusion: Phase I Clinical Trial vol.9, pp.10, 2020, https://doi.org/10.3390/cells9102250
  50. Ten-year fracture risk predicted by proximal femur Hounsfield units vol.31, pp.11, 2020, https://doi.org/10.1007/s00198-020-05477-y
  51. Osteoporosis screening using computed tomography for men with prostate cancer: results of a prospective study vol.15, pp.1, 2013, https://doi.org/10.1007/s11657-020-0711-1
  52. Differentiation of Traumatic Osteoporotic and Non-Osteoporotic Vertebral AO A3 Fractures by Analyzing the Posterior Edge Morphology—A Retrospective Feasibility Study vol.9, pp.12, 2013, https://doi.org/10.3390/jcm9123910
  53. Characteristics of Lumbar Bone Density in Middle-Aged and Elderly Subjects: A Correlation Study between T-Scores Determined by the DEXA Scan and Hounsfield Units from CT vol.2021, pp.None, 2013, https://doi.org/10.1155/2021/5443457
  54. Effect of stem position and length on bone-stem constructs after cementless hip arthroplasty : a finite element analysis vol.10, pp.4, 2013, https://doi.org/10.1302/2046-3758.104.bjr-2020-0043.r3
  55. The prognostic impact of skeletal muscle status and bone mineral density for resected distal cholangiocarcinoma vol.40, pp.5, 2013, https://doi.org/10.1016/j.clnu.2020.12.011
  56. Investigation on the contour and bone mineral density of the distal tibial cutting surface used for total ankle arthroplasty vol.29, pp.2, 2013, https://doi.org/10.1177/23094990211028048
  57. An Innovative Bioceramic Bone Graft with Platelet-Rich Plasma for Rapid Bone Healing and Regeneration in a Rabbit Model vol.11, pp.11, 2013, https://doi.org/10.3390/app11115271
  58. Quantifying Bone Quality Using Computed Tomography Hounsfield Units in the Mid-sagittal View of the Lumbar Spine vol.151, pp.None, 2013, https://doi.org/10.1016/j.wneu.2021.04.051
  59. Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis vol.16, pp.7, 2021, https://doi.org/10.1371/journal.pone.0253862
  60. Primary stability of fixation methods for periprosthetic fractures of the humerus: a biomechanical investigation vol.30, pp.9, 2021, https://doi.org/10.1016/j.jse.2020.12.027
  61. Best Practice Guidelines for Assessment and Management of Osteoporosis in Adult Patients Undergoing Elective Spinal Reconstruction vol.47, pp.2, 2022, https://doi.org/10.1097/brs.0000000000004268
  62. Deep learning takes the pain out of back breaking work - Automatic vertebral segmentation and attenuation measurement for osteoporosis vol.81, pp.None, 2022, https://doi.org/10.1016/j.clinimag.2021.08.009
  63. Mechanical and morphological properties of parietal bone in patients with sagittal craniosynostosis vol.125, pp.None, 2013, https://doi.org/10.1016/j.jmbbm.2021.104929