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Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT

Acta Neurochirurgica volume 158, pages 1421–1427 (2016)Cite this article

Abstract

Background

Dual-energy X-ray absorptiometry (DEXA) scan is an easy and cost-effective method of assessing bone mineral density (BMD). However, in patients with degenerative changes of the spine, overestimation of T-score on DEXA scan can occur despite low BMD during pedicle screw placement in spine surgery. The goal of this study is to assess BMD using Hounsfield unit (HU) measurements from computed tomography (CT) and to correlate these with DEXA-assessed T-scores in non-degenerative and degenerative patients.

Methods

This study included 80 non-degenerative and 30 degenerative patients who underwent DEXA and spine CT assessment. The HU value on the mid-body axial images of CT and DEXA-assessed T-scores were measured from the L1-4 vertebrae.

Results

In the non-degenerative group, HU values had a strong positive correlation with BMD and T-score, exhibiting correlation coefficients (r) greater than 0.7: the r-value (p value) between HU and T-score of the L1 vertebra was 0.701 (<0.001); 0.709 (<0.001) for L2; 0.709 (<0.001) for L3; 0.649 (<0.001) for L4; and 0.734 (<0.001) for L1-4. BMD assessed as +100 HU matched a T-score of -2.0 while +150, +200 HU matched T-scores of -1.0, 0.0. The differences were significant (p < 0.001). In the degenerative group, there was a weak positive correlation with r of approximately 0.4: the r-value (p value) was 0.300 (0.104); 0.457 (0.013); 0.433 (0.017); 0.447 (0.013) at each segment and 0.398 (0.031) for L1-4.

Conclusions

HU values provide a meaningful assessment of BMD and have a strong correlation with T-score. However, in degenerative patients, the T-score tended to be higher than the actual BMD. BMD assessment using HU might be helpful in predicting real BMD in patients undergoing instrumentation surgery with degenerative changes of the spine.

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Author information

Affiliations

  1. Department of Neurosurgery, Kyung Hee University Hospital, Seoul, South Korea

    Man Kyu Choi

  2. Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, South Korea

    Sung Min Kim

  3. Department of Neurosurgery, Bon Neurosurgery Clinic, Paju, South Korea

    Jae Kwan Lim

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  1. Man Kyu Choi
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  2. Sung Min Kim
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Correspondence to Sung Min Kim.

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Conflict of interest

The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

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No funding was received for this research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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This retrospective manner was approved by permission of our institutional review board (IRB) and the board permitted waiver of informed consent.

Additional information

IRB number: KMC IRB 1516-04

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Choi, M.K., Kim, S.M. & Lim, J.K. Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT. Acta Neurochir 158, 1421–1427 (2016). https://doi.org/10.1007/s00701-016-2821-5

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  • DOI: https://doi.org/10.1007/s00701-016-2821-5

Keywords

  • BMD
  • Degenerative spine
  • DEXA scan
  • Hounsfield units