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Correlation between Hounsfield unit derived from head, thorax, abdomen, spine and pelvis CT and t-scores from DXA

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Skeletal Radiology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 28 September 2021

Abstract

Objectives

CT examination can potentially be utilised for early detection of bone density changes with no additional procedure and radiation dose. We hypothesise that the Hounsfield unit (HU) measured from CT images is correlated to the t-scores derived from dual energy X-ray absorptiometry (DXA) in multiple anatomic regions.

Materials & methods

Data were obtained retrospectively from all patients who underwent both CT examinations – brain (frontal bone), thorax (T7), abdomen (L3), spine (T7 & L3) or pelvis (left hip) – and DXA between 2014 and 2018 in our centre. To ensure comparability, the period between CT and DXA studies must not exceed one year. Correlations between HU values and t-scores were calculated using Pearson’s correlation. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was used to determine threshold HU values for predicting osteoporosis.

Results

The inclusion criteria were met by 1043 CT examinations (136 head, 537 thorax, 159 lumbar and 151 left hip). The left hip consistently provided the most robust correlations (r = 0.664–0.708, p < 0.001) and the best AUC (0.875–0.893). Meanwhile, thorax T7 and lumbar L3 showed average correlations (range of r values is 0.497–0.679, p < 0.001, AUC range = 0.680–0.783, 95% CI 0.561–0.922, all p < 0.02) and moderate AUC (0.680–0.783). Frontal bone shows low correlation and weak AUC with r < 0.5, AUC = 0.538–0.655, all p > 0.05.

Conclusion

HU values derived from the hip, T7 and L3 provided a good to moderate correlation to t-scores with a good prediction for osteoporosis. The suggested optimal thresholds may be used in clinical settings after external validations are performed.

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Authors and Affiliations

  1. Radiology Department, Hospital Putrajaya, Precint 7, 62000, Putrajaya, Malaysia

    Mohamad Farhan Mohamad Amin & Wan Mezlina Wan Zakaria

  2. Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia

    Mohamad Farhan Mohamad Amin & Noorazrul Yahya

  3. Radiology Department, Hospital Tengku Ampuan Rahimah, Jalan Langat, 41200, Klang, Selangor, Malaysia

    Mohamad Farhan Mohamad Amin

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Appendix

Appendix

Table 1 The characteristics of the study patients from CT scan (n = 1043)
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Table 2 The HU values based on BMD categories (based on number of examinations)
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Amin, M.F.M., Zakaria, W.M.W. & Yahya, N. Correlation between Hounsfield unit derived from head, thorax, abdomen, spine and pelvis CT and t-scores from DXA. Skeletal Radiol 50, 2525–2535 (2021). https://doi.org/10.1007/s00256-021-03801-z

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