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Diagnostic power of vertebral hydroxyapatite concentration measurements in spectral CT for osteoporosis-associated fractures and impact of intravenous contrast administration

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate the diagnostic power of using vertebral hydroxyapatite concentration measurements in unenhanced and contrast-enhanced spectral CT for detecting and predicting the risk of osteoporosis-associated fractures.

Methods

L1 of 210 patients (105 men, 105 women; mean age, 64 years, range, 19–103 years) who had undergone spectral CT examinations from January 1, 2018, to March 1, 2019, were retrospectively analyzed. Patient data for 3 years after spectral CT were retrieved from electronic medical record information systems to obtain the incidence of osteoporotic fractures. Baseline vertebral cancellous hydroxyapatite concentration from unenhanced and contrast-enhanced late-arterial-phase images was measured. The receiver operating characteristic curves were used to evaluate the diagnostic power for detecting and predicting the 3-year risk of osteoporosis-associated fractures using hydroxyapatite concentrations in both phases.

Results

The hydroxyapatite concentrations in both phases had good diagnostic power to detect fractures at baseline. The sensitivity and specificity for predicting one or more osteoporosis-associated fractures within 3 years after spectral CT were 76.80% and 93.10%, respectively, using the cutoff of 74.79 mg/cm3 in vertebral hydroxyapatite concentration in the unenhanced CT phase, and 82.87% and 82.76%, respectively, using the cutoff of 84.65 mg/cm3 in the late-arterial phase. Furthermore, there was no significant difference in the diagnosis between unenhanced and enhanced CT-derived hydroxyapatite concentrations (p = 0.360).

Conclusions

Both unenhanced and enhanced spectral CT-derived hydroxyapatite concentrations can accurately detect and predict future risk of osteoporosis-associated fractures. The hydroxyapatite concentration assessed in the late-arterial phase may have a similar diagnostic efficacy to that in the unenhanced phase.

Key Points

• A cutoff of 74.79 mg/cm3 of vertebral hydroxyapatite concentration in the unenhanced CT scans had 76.80% sensitivity and 93.10% specificity to predict one or more osteoporosis-associated fractures within 3 years after spectral CT examinations.

• A cutoff of 84.65 mg/cm3 of vertebral hydroxyapatite concentration in the late-arterial-enhanced CT scans had 82.87% sensitivity and 82.76% specificity to predict one or more osteoporosis-associated fractures within 3 years after spectral CT examinations.

• The hydroxyapatite concentration assessed in the late-arterial phase may have a similar diagnostic efficacy to that in the unenhanced phase.

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

GSI:

Gemstone spectral imaging

MD:

Material decomposition

ROC:

Receiver operating characteristic

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Acknowledgements

Taking this opportunity, the authors express sincere appreciation to the people who gave our team great support. Yang Zhang, MA, carried out proofreading and improved the language of this paper. This paper cannot conclude without their help and contribution. Hereby again, the study team addresses our sincere gratitude.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology Department, Capital Medical University Affiliated Beijing Friendship Hospital, 95 YongAn Road, Beijing, 100050, People’s Republic of China

    Qiang Ma, Xinmeng Hou, Chenglin Zhao, Yuanyuan Yan, Xiaoyue Cheng, Daqing Ma & Zhenghan Yang

  2. CT Research Center, GE Healthcare China, Beijing, China

    Jianying Li

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  1. Qiang Ma
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  2. Xinmeng Hou
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  3. Chenglin Zhao
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Corresponding authors

Correspondence to Qiang Ma or Zhenghan Yang.

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The scientific guarantor of this publication is Qiang Ma and Zhenghan Yang.

Conflict of Interest

Jianying Li works at the CT Research Center, GE Healthcare China.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• observational study

• diagnostic study

• performed at one institution

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Ma, Q., Hou, X., Zhao, C. et al. Diagnostic power of vertebral hydroxyapatite concentration measurements in spectral CT for osteoporosis-associated fractures and impact of intravenous contrast administration. Eur Radiol 33, 4016–4023 (2023). https://doi.org/10.1007/s00330-022-09383-1

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  • DOI: https://doi.org/10.1007/s00330-022-09383-1

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