Vertebral and Femoral Bone Mineral Density (BMD) Assessment with Dual-Energy CT versus DXA Scan in Postmenopausal Females

TL;DR

This study compares dual-energy CT and DXA scans for measuring bone density in postmenopausal women, finding better agreement at the femoral neck.

Contribution

The study introduces dual-energy CT as a potential alternative to DXA for BMD assessment in postmenopausal women.

Findings

DECT showed a good linear correlation with DXA at the femoral neck (R2: 0.341).

Vertebral BMD measurements showed inverse correlation between DECT and DXA (R2: −0.042).

Femoral neck BMD results were less affected by cortical and trabecular bone overlap.

Abstract

This study aimed to demonstrate the potential role of dual-energy CT in assessing bone mineral density (BMD) using hydroxyapatite–fat material pairing in postmenopausal women. A retrospective study was conducted on 51 postmenopausal female patients who underwent DXA and DECT examinations for other clinical reasons. DECT images were acquired with spectral imaging using a 256-slice system. These images were processed and visualized using a HAP–fat material pair. Statistical analysis was performed using the Bland–Altman method to assess the agreement between DXA and DECT HAP–fat measurements. Mean BMD, vertebral, and femoral T-scores were obtained. For vertebral analysis, the Bland–Altman plot showed an inverse correlation (R2: −0.042; RMSE: 0.690) between T-scores and DECT HAP–fat values for measurements from L1 to L4, while a good linear correlation (R2: 0.341; RMSE: 0.589) was found for measurements at the femoral neck. In conclusion, we demonstrate the enhanced importance of BMD calculation through DECT, finding a statistically significant correlation only at the femoral neck where BMD results do not seem to be influenced by the overlap of the measurements on cortical and trabecular bone. This outcome could be beneficial in the future by reducing radiation exposure for patients already undergoing follow-up for chronic conditions.

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