Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA.

Löffler, Maximilian T; Jacob, Alina; Scharr, Andreas; Sollmann, Nico; Burian, Egon; El Husseini, Malek; Sekuboyina, Anjany; Tetteh, Giles; Zimmer, Claus; Gempt, Jens; Baum, Thomas; Kirschke, Jan S

doi:10.1007/s00330-020-07655-2

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2021

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Title:: Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA.
Document type:: Journal Article
Author(s):: Löffler, Maximilian T; Jacob, Alina; Scharr, Andreas; Sollmann, Nico; Burian, Egon; El Husseini, Malek; Sekuboyina, Anjany; Tetteh, Giles; Zimmer, Claus; Gempt, Jens; Baum, Thomas; Kirschke, Jan S
Abstract:: OBJECTIVES: To compare spinal bone measures derived from automatic and manual assessment in routine CT with dual energy X-ray absorptiometry (DXA) in their association with prevalent osteoporotic vertebral fractures using our fully automated framework ( https://anduin.bonescreen.de ) to assess various bone measures in clinical CT. METHODS: We included 192 patients (141 women, 51 men; age 70.2 ± 9.7 years) who had lumbar DXA and CT available (within 1 year). Automatic assessment of spinal bone measures in CT included segmentation of vertebrae using a convolutional neural network (CNN), reduction to the vertebral body, and extraction of bone mineral content (BMC), trabecular and integral volumetric bone mineral density (vBMD), and CT-based areal BMD (aBMD) using asynchronous calibration. Moreover, trabecular bone was manually sampled (manual vBMD). RESULTS: A total of 148 patients (77%) had vertebral fractures and significantly lower values in all bone measures compared to patients without fractures (p ≤ 0.001). Except for BMC, all CT-based measures performed significantly better as predictors for vertebral fractures compared to DXA (e.g., AUC = 0.885 for trabecular vBMD and AUC = 0.86 for integral vBMD vs. AUC = 0.668 for DXA aBMD, respectively; both p < 0.001). Age- and sex-adjusted associations with fracture status were strongest for manual vBMD (OR = 7.3, [95%] CI 3.8-14.3) followed by automatically assessed trabecular vBMD (OR = 6.9, CI 3.5-13.4) and integral vBMD (OR = 4.3, CI 2.5-7.6). Diagnostic cutoffs of integral vBMD for osteoporosis (< 160 mg/cm3) or low bone mass (160 ≤ BMD < 190 mg/cm3) had sensitivity (84%/41%) and specificity (78%/95%) similar to trabecular vBMD. CONCLUSIONS: Fully automatic osteoporosis screening in routine CT of the spine is feasible. CT-based measures can better identify individuals with reduced bone mass who suffered from vertebral fractures than DXA. KEY POINTS: • Opportunistic osteoporosis screening of spinal bone measures derived from clinical routine CT is feasible in a fully automatic fashion using a deep learning-driven framework ( https://anduin.bonescreen.de ). • Manually sampled volumetric BMD (vBMD) and automatically assessed trabecular and integral vBMD were the best predictors for prevalent vertebral fractures. • Except for bone mineral content, all CT-based bone measures performed significantly better than DXA-based measures. • We introduce diagnostic thresholds of integral vBMD for osteoporosis (< 160 mg/cm3) and low bone mass (160 ≤ BMD < 190 mg/cm3) with almost equal sensitivity and specificity compared to conventional thresholds of quantitative CT as proposed by the American College of Radiology (osteoporosis < 80 mg/cm3).
Journal title abbreviation:: Eur Radiol
Year:: 2021
Journal volume:: 31
Journal issue:: 8
Pages contribution:: 6069-6077
Fulltext / DOI:: doi:10.1007/s00330-020-07655-2
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/33507353
Print-ISSN:: 0938-7994
TUM Institution:: Fachgebiet Neuroradiologie (Prof. Zimmer); Neurochirurgische Klinik und Poliklinik
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