Photon-counting CT Spectral Localizer Radiographs for Lumbar Areal Bone Mineral Density Quantification: A Clinical Study on Accuracy, Reliability, and Diagnostic Performance for Osteoporosis
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Abstract
Rationale and Objectives
To explore the accuracy, reliability, and diagnostic performance of photon-counting CT (PCCT) spectral localizer radiographs (SLRs) for quantifying lumbar areal bone mineral density (BMD) and detecting osteoporosis (T-score ≤−2.5).
Materials and Methods
This prospective study recruited consecutive participants from April to July 2024. Participants each underwent a dual-energy X-ray absorptiometry (DXA) examination serving as the gold-standard reference for aBMD (aBMDDXA) and a PCCT scan to obtain SLR. The SLRs were reconstructed into hydroxyapatite (HA) and water maps. Lumbar vertebrae (L1 to L4) and soft tissue were blindly and semiautomatically segmented on HA and water maps to calculate aBMDSLR. The agreement and relative absolute error (RAE) between aBMDSLR and aBMDDXA were calculated. Factors that might influence the RAE were evaluated. Using DXA results as the reference, the diagnostic performance of PCCT-SLRs for osteoporosis was assessed.
Results
A total of 159 participants (88 females) with a median age of 66 years (interquartile range [IQR], 55–72 years) were included. The median (IQR) aBMDDXA and aBMDSLR values were 1.095 (0.936–1.261) g/cm2 and 1.086 (0.932–1.255) g/cm2, respectively. There was excellent agreement between the two methods (mean bias = −0.57%). The median (IQR) RAE was 2.65% (1.23–4.07%). The RAE was unaffected by age, body mass index, aBMD, sex, tube voltage, or tube current. The sensitivity and specificity of PCCT-SLRs for osteoporosis diagnosis were 92.31% (12/13) and 98.63% (144/146), respectively.
Conclusion
The PCCT-SLR is an accurate and reliable approach for lumbar aBMD quantification in humans, with high diagnostic performance for osteoporosis.
期刊介绍：
Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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