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Effect of IV contrast on lumbar trabecular attenuation at routine abdominal CT: correlation with DXA and implications for opportunistic osteoporosis screening

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Abstract

Summary

Osteoporosis remains under-diagnosed. Routine abdominal CT can provide opportunistic screening, but the effect of IV contrast is largely unknown. The overall performance for predicting osteoporosis was similar between enhanced and unenhanced scans. Therefore, both non-contrast and contrast-enhanced abdominal CT scans can be employed for opportunistic osteoporosis screening.

Introduction

Osteoporosis is an important yet under-diagnosed public health concern. Lumbar attenuation measurement at routine abdominal CT can provide a simple opportunistic initial screen, but the effect of IV contrast has not been fully evaluated.

Methods

Mean trabecular CT attenuation values (in Hounsfield units, HU) at the L1 vertebral level were measured by oval region-of-interest (ROI) on both the unenhanced and IV-contrast-enhanced CT series in 157 adults (mean age, 62.0). All patients underwent correlative central DXA within 6 months of CT. Based on DXA BMD of the lumbar spine, femoral neck, and total proximal femur: osteoporosis, osteopenia, and normal BMD was present in 33, 77, and 47, respectively. Statistical analysis included Bland-Altman plots and receiver operating characteristic (ROC) curves.

Results

Mean difference (±SD) in L1 trabecular attenuation between enhanced and unenhanced CT series was +11.2 HU (±19.2) (95 % CI, 8.16–14.22 HU), an 8 % difference. Intra-patient variation was substantial, but no overall trend in the HU difference was seen according to underlying BMD. ROC area under the curve (AUC) for unenhanced and enhanced CT for diagnosing osteoporosis were similar at 0.818 and 0.830, respectively (p = 0.632). Thresholds for maintaining 90 % specificity for osteoporosis were 90 HU for unenhanced and 102 HU for enhanced CT. Thresholds for maintaining 90 % sensitivity for osteoporosis were 139 HU for unenhanced and 144 HU for enhanced CT. Similar diagnostic performance was seen for diagnosing low BMD (osteoporosis or osteopenia) using higher HU cut-offs.

Conclusion

Contrast-enhanced CT shows an average increase of 11 HU over the unenhanced series for L1 trabecular attenuation. The overall performance for predicting osteoporosis is similar between the enhanced and unenhanced scans, thus either can be employed for initial opportunistic screening.

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Conflicts of interest

Dr. Pickhardt is co-founder of VirtuoCTC, shareholder in Cellectar Biosciences, and consultant for Check-Cap, KIT, and Bracco; Drs. Lauder, Pooler, Muñoz del Rio, Rosas, Bruce, and Binkley declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA

    P. J. Pickhardt, T. Lauder, B. D. Pooler, A. Muñoz del Rio, H. Rosas, R. J. Bruce & N. Binkley

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  1. P. J. Pickhardt
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  2. T. Lauder
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  3. B. D. Pooler
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  4. A. Muñoz del Rio
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  5. H. Rosas
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  6. R. J. Bruce
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  7. N. Binkley
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Correspondence to P. J. Pickhardt.

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Pickhardt, P.J., Lauder, T., Pooler, B.D. et al. Effect of IV contrast on lumbar trabecular attenuation at routine abdominal CT: correlation with DXA and implications for opportunistic osteoporosis screening. Osteoporos Int 27, 147–152 (2016). https://doi.org/10.1007/s00198-015-3224-9

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  • DOI: https://doi.org/10.1007/s00198-015-3224-9

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