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The effect of contrast media on CT measures of bone mineral density: a systematic review

Skeletal Radiology volume 52, pages 687–694 (2023)Cite this article

Abstract

Objective

The aim was to systematically assess the literature on possible effect of administration of iodinated contrast media on CT-estimated bone mineral density (BMD).

Materials and methods

The Web of Science and PubMed databases were searched. Studies that used both CT principles of BMD measurement (volumetric quantitative BMD and CT attenuation in Hounsfield Units) were included. The baseline patient data, skeletal site, contrast medium data (if reported), and change in BMD on contrast-enhanced CT scans were collected.

Results

Sixteen studies met our review criteria, the majority of which was performed on lumbar spine, and the others on proximal femur. Almost all studies reported a significant increase in BMD values on the contrast-enhanced CT scans, ranging from 0.8 to 30.3%. The increase was most frequently reported to be about 10 to 15% for the spine and 5 to 10% for the femur. In addition to the difference in skeletal site, some authors found the contrast effect was age-, sex-, and contrast dose-dependent. BMD values in arterial phase were generally somewhat lower than in venous phase, and the effect of contrast in venous phase was more predictable.

Conclusion

The review revealed significant changes in BMD values between unenhanced and contrast-enhanced CT. The change was more pronounced in lumbar spine than in proximal femur and appeared to depend on age, sex, contrast dose, and postcontrast imaging protocol. The review suggests the understanding of all mentioned factors during the interpretation of BMD measured on contrast-enhanced CT.

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Fig. 1

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Split-Dalmatia County Health Center, Kavanjinova 2, 21000, Split, Croatia

    Zvonimir Kutleša

  2. Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000, Split, Croatia

    Kristian Jerković, Ivan Ordulj & Danijela Budimir Mršić

  3. School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia

    Danijela Budimir Mršić

  4. University Department of Health Studies, University of Split, Ruđera Boškovića 35, 21000, Split, Croatia

    Danijela Budimir Mršić

Authors
  1. Zvonimir Kutleša
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  2. Kristian Jerković
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  3. Ivan Ordulj
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Correspondence to Danijela Budimir Mršić.

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Kutleša, Z., Jerković, K., Ordulj, I. et al. The effect of contrast media on CT measures of bone mineral density: a systematic review. Skeletal Radiol 52, 687–694 (2023). https://doi.org/10.1007/s00256-022-04222-2

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  • DOI: https://doi.org/10.1007/s00256-022-04222-2

Keywords

  • Osteoporosis
  • Computed tomography
  • Bone mineral density
  • Hounsfield unit
  • Contrast media