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European Radiology

, Volume 25, Issue 2, pp 283–289 | Cite as

Intravenous contrast injection significantly affects bone mineral density measured on CT

  • Esther PompeEmail author
  • Martin J. Willemink
  • Gawein R. Dijkhuis
  • Harald J. J. Verhaar
  • Firdaus A. A. Mohamed Hoesein
  • Pim A. de Jong
Musculoskeletal

Abstract

Objective

The objective is to evaluate the effect of intravenous contrast media on bone mineral density (BMD) assessment by comparing unenhanced and contrast-enhanced computed tomography (CT) examinations performed for other indications.

Methods

One hundred and fifty-two patients (99 without and 53 with malignant neoplasm) who underwent both unenhanced and two contrast-enhanced (arterial and portal venous phase) abdominal CT examinations in a single session between June 2011 and July 2013 were included. BMD was evaluated on the three examinations as CT-attenuation values in Hounsfield Units (HU) in the first lumbar vertebra (L1).

Results

CT-attenuation values were significantly higher in both contrast-enhanced phases, compared to the unenhanced phase (p < 0.01). In patients without malignancies, mean ± standard deviation (SD) HU-values increased from 128.8 ± 48.6 HU for the unenhanced phase to 142.3 ± 47.2 HU for the arterial phase and 147.0 ± 47.4 HU for the portal phase (p < 0.01). In patients with malignancies, HU-values increased from 112.1 ± 38.1 HU to 126.2 ± 38.4 HU and 130.1 ± 37.3 HU (p < 0.02), respectively. With different thresholds to define osteoporosis, measurements in the arterial and portal phase resulted in 7-25 % false negatives.

Conclusions

Our study showed that intravenous contrast injection substantially affects BMD-assessment on CT and taking this into account may improve routine assessment of low BMD in nonquantitative CT.

Key Points

Routine CT may gain a role in bone attenuation measurements for osteoporosis

Contrast media injection has substantial influence on CT-derived bone density

Contrast-enhanced CT leads to underestimation of osteoporosis compared to unenhanced CT

Adjusting for contrast injection phase may improve CT screening protocols for osteoporosis.

Keywords

Osteoporosis Screening Computed tomography Contrast media Bone mineral density 

Abbreviations and acronyms

BMI

Body mass index

BMD

Bone mineral density

CT

Computed tomography

DXA

Dual-energy x-ray absorptiometry

HU

Hounsfield unit

L1

Lumbar vertebral body 1

qCT

Quantitative computed tomography

ROI

Region of interest

Notes

Acknowledgments

The scientific guarantor of this publication is Dr. P.A. de Jong. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because the Medical Research Involving Human Subjects Act (WMO) does not apply to the study. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

References

  1. 1.
    Raisz LG (2005) Screening for Osteoporosis. N Engl J Med 353:164–171PubMedCrossRefGoogle Scholar
  2. 2.
    NIH (2001) Consensus development panel on osteoporosis prevention, diagnosis and therapy. JAMA 285:785–795CrossRefGoogle Scholar
  3. 3.
    Kanis J and the WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report. Osteoporos Int 4:368–381CrossRefGoogle Scholar
  4. 4.
    Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778PubMedCrossRefGoogle Scholar
  5. 5.
    Pickhardt P, Pooler B, Lauder T, Muñoz del Rio A, Bruce RJ, Binkley N (2014) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595CrossRefGoogle Scholar
  6. 6.
    Summers RM, Baecher N, Yao J et al (2011) Feasibility of simultaneous CT colonography and fully-automated bone mineral densitometry in a single examination. J Comput Assist Tomogr 35:212–216PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Bauer JS, Link TM (2009) Advances in osteoporosis imaging. Eur J Radiol 71:440–449PubMedCrossRefGoogle Scholar
  8. 8.
    Romme EAPM, Murchison JT, Phang KF et al (2012) Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD. J Bone Miner Res 27:2338–2343PubMedCrossRefGoogle Scholar
  9. 9.
    Bauer JS, Henning TD, Müeller D et al (2007) Volumetric quantitative CT of the spine and hip derived from contrast-enhanced MDCT: conversion factors. AJR Am J Roentgenol 188:1294–1301PubMedCrossRefGoogle Scholar
  10. 10.
    Gruber M, Bauer JS, Dobritz M et al (2013) Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry. Eur Radiol 23:505–512PubMedCrossRefGoogle Scholar
  11. 11.
    De Jong WU, de Jong PA, Vliegenthart R et al (2014) Association of COPD and smoking status with bone density and vertebral fractures in male lung cancer screening participants. J Bone Miner Res. doi: 10.1002/jbmr.2248 Google Scholar
  12. 12.
    Baum T, Müller D, Dobritz M et al (2011) BMD measurements of the spine derived from sagittal reformations of contrast-enhanced MDCT without dedicated software. Eur J Radiol 80:e140–e145PubMedCrossRefGoogle Scholar
  13. 13.
    Schwaiger BJ, Gersing AS, Baum T, Noel PB, Zimmer C, Bauer JS (2014) Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol. doi: 10.3174/ajnr.A3893 Google Scholar
  14. 14.
    Riggs BL, Melton LJ (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S–511SPubMedCrossRefGoogle Scholar
  15. 15.
    Link TM, Koppers BB, Licht T et al (2004) In vitro and in vivo spiral CT to determine bone mineral density: initial experience in patients at risk for osteoporosis. Radiology 231:805–811PubMedCrossRefGoogle Scholar
  16. 16.
    Hopper KD, Wang MP, Kunselman AR (2000) The use of clinical CT for baseline bone density assessment. J Comput Assist Tomogr 24:896–899PubMedCrossRefGoogle Scholar
  17. 17.
    Steiger P, Block JE, Steiger S et al (1990) Spinal bone mineral density measured with quantitative CT : effect of region of interest, vertebral level, and technique. Radiology 175:537–543PubMedCrossRefGoogle Scholar
  18. 18.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRefGoogle Scholar
  19. 19.
    Engelke K, Adams JE, Armbrecht G et al (2008) Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom 11:123–162PubMedCrossRefGoogle Scholar
  20. 20.
    Unnanuntana A, Gladnick BP, Donnelly E, Lane JM (2010) The assessment of fracture risk. J Bone Joint Surg Am 92:743–753PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Papadakis AE, Karantanas AH, Papadokostakis G et al (2009) Can abdominal multi-detector CT diagnose spinal osteoporosis? Eur Radiol 19:172–176PubMedCrossRefGoogle Scholar
  22. 22.
    Guise TA (2006) Bone loss and fracture risk associated with cancer therapy. Oncologist 11:1121–1131PubMedCrossRefGoogle Scholar
  23. 23.
    Pickhardt PJ, Lee LJ, Muñoz del Rio A, Papadokostakis G et al (2011) Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared against the DXA reference standard. J Bone Min Res 26:2194–2203CrossRefGoogle Scholar
  24. 24.
    Ohara T, Hirai T, Muro S et al (2008) Relationship between pulmonary emphysema and osteoporosis assessed by CT in patients with COPD. Chest 134:1244–1249PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Esther Pompe
    • 1
    Email author
  • Martin J. Willemink
    • 1
  • Gawein R. Dijkhuis
    • 1
  • Harald J. J. Verhaar
    • 1
  • Firdaus A. A. Mohamed Hoesein
    • 1
  • Pim A. de Jong
    • 1
  1. 1.Department of Radiology and Internal Medicine-GeriatricsUniversity Medical Center UtrechtUtrechtNetherlands

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