Abstract
Summary
Commercial software is generally needed to measure the areal bone mineral density (aBMD) of the proximal femur from clinical computed tomography (CT) images. This study developed and verified an open-source reproducible system to quantify CT-aBMD to screen osteoporosis using clinical CT images.
Purpose
For existing CT images acquired for various reasons other than osteoporosis, it might be beneficial to estimate areal BMD as assessed by dual-energy X-ray absorptiometry (DXA-based BMD) to ascertain the bone status based on DXA. In this study, we aimed to (1) develop an open-source reproducible measurement system to quantify DXA-based BMD from CT images and (2) validate its accuracy.
Methods
This study analyzed 75 pairs of hip CT and DXA images of women that were acquired for the preoperative assessment of total hip arthroplasty. From the CT images, the femur and a calibration phantom were automatically segmented using pre-trained codes/models available at https://github.com/keisuke-uemura. The proximal femoral region was isolated by manually selected landmarks and was projected onto the coronal plane to measure the areal density (CT-aHU). The calibration phantom was employed to convert the CT-aHU into CT-aBMD. Each parameter was correlated with DXA-based BMD, and the residual errors of CT images to estimate the T-scores in DXA were calculated using the standard error of estimate (SEE).
Results
The correlation coefficients of DXA-based BMD with CT-aHU and CT-aBMD were 0.947 and 0.950, respectively (both p < 0.001). The SEE for quantifying the T-scores in DXA were 0.51 and 0.50 for CT-aHU and CT-aBMD, respectively.
Conclusion
With the method developed herein, CT permits estimation of the DXA-based BMD of the proximal femur within the standard DXA total hip region of interest with an SEE of 0.5 in T-scores. The radiation dose for CT acquisition needs consideration; therefore, our data do not provide a rationale for performing CT for screening osteoporosis. However, on CT images already acquired for clinical indications other than osteoporosis, researchers may use this open-source system to investigate osteoporosis status through the estimated DXA-based BMD of the proximal femur.
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Data availability
The model/code used for the femur and phantom segmentation and the bone mineral density analysis can be accessed via https://github.com/keisuke-uemura.
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Funding
This study was supported by the Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (KAKENHI) Numbers 19H01176, 20H04550, and 21K16655.
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Conceptualization: Keisuke Uemura; methodology: Keisuke Uemura, Yoshito Otake; code writing: Keisuke Uemura, Yoshito Otake, Hiroki Makino, Mazen Soufi; formal analysis and investigation: Keisuke Uemura, Makoto Iwasa; writing—original draft preparation: Keisuke Uemura; Writing—review and editing: Yoshito Otake, Masaki Takao, Mazen Soufi, Nobuhiko Sugano, Yoshinobu Sato; funding acquisition: Keisuke Uemura, Yoshito Otake, Yoshinobu Sato. All authors read and approved the final manuscript.
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All procedures performed in this study were performed according to the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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This study was approved by the Institutional Review Board of each participating hospital, and written informed consent was waived because of the retrospective design.
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Uemura, K., Otake, Y., Takao, M. et al. Development of an open-source measurement system to assess the areal bone mineral density of the proximal femur from clinical CT images. Arch Osteoporos 17, 17 (2022). https://doi.org/10.1007/s11657-022-01063-3
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DOI: https://doi.org/10.1007/s11657-022-01063-3