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      Bone mineral density measurements derived from dual-layer spectral CT enable opportunistic screening for osteoporosis

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          Abstract

          Objective

          To investigate the in vivo applicability of non-contrast-enhanced hydroxyapatite (HA)-specific bone mineral density (BMD) measurements based on dual-layer CT (DLCT).

          Methods

          A spine phantom containing three artificial vertebral bodies with known HA densities was measured to obtain spectral data using DLCT and quantitative CT (QCT), simulating different patient positions and grades of obesity. BMD was calculated from virtual monoenergetic images at 50 and 200 keV. HA-specific BMD values of 174 vertebrae in 33 patients (66 ± 18 years; 33% women) were determined in non-contrast routine DLCT and compared with corresponding QCT-based BMD values.

          Results

          Examining the phantom, HA-specific BMD measurements were on a par with QCT measurements. In vivo measurements revealed strong correlations between DLCT and QCT ( r = 0.987 [95% confidence interval, 0.963–1.000]; p < 0.001) and substantial agreement in a Bland–Altman plot.

          Conclusion

          DLCT-based HA-specific BMD measurements were comparable with QCT measurements in in vivo analyses. This suggests that opportunistic DLCT-based BMD measurements are an alternative to QCT, without requiring phantoms and specific protocols.

          Key Points

          • DLCT-based hydroxyapatite-specific BMD measurements show a substantial agreement with QCT-based BMD measurements in vivo.

          • DLCT-based hydroxyapatite-specific measurements are on a par with QCT in spine phantom measurements.

          • Opportunistic DLCT-based BMD measurements may be a feasible alternative for QCT, without requiring dedicated examination protocols or a phantom.

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          Most cited references32

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          Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study.

          Fractures have largely been assessed by their impact on quality of life or health care costs. We conducted this study to evaluate the relation between fractures and mortality. A total of 7753 randomly selected people (2187 men and 5566 women) aged 50 years and older from across Canada participated in a 5-year observational cohort study. Incident fractures were identified on the basis of validated self-report and were classified by type (vertebral, pelvic, forearm or wrist, rib, hip and "other"). We subdivided fracture groups by the year in which the fracture occurred during follow-up; those occurring in the fourth and fifth years were grouped together. We examined the relation between the time of the incident fracture and death. Compared with participants who had no fracture during follow-up, those who had a vertebral fracture in the second year were at increased risk of death (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.1-6.6); also at risk were those who had a hip fracture during the first year (adjusted HR 3.2, 95% CI 1.4-7.4). Among women, the risk of death was increased for those with a vertebral fracture during the first year (adjusted HR 3.7, 95% CI 1.1-12.8) or the second year of follow-up (adjusted HR 3.2, 95% CI 1.2-8.1). The risk of death was also increased among women with hip fracture during the first year of follow-up (adjusted HR 3.0, 95% CI 1.0-8.7). Vertebral and hip fractures are associated with an increased risk of death. Interventions that reduce the incidence of these fractures need to be implemented to improve survival.
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            Dual-energy CT-based monochromatic imaging.

            We summarize how virtual monochromatic images are synthesized from dual-energy CT using image-domain and projection-domain methods. The quality of virtual monochromatic images is compared with that of polychromatic single-energy images acquired at different tube potentials and the same radiation dose. Clinical applications of dual-energy CT-based virtual monochromatic imaging are reviewed, including beam-hardening correction, contrast and noise optimization, metal artifact reduction, and material differentiation. Virtual monochromatic images synthesized from dual-energy CT data have the potential to reduce beam-hardening artifacts and to provide quantitative measurements. If there is no desire to obtain material-specific information or to correct for metal or beam-hardening artifacts from the dual-energy data, however, it is better to perform a conventional single-energy scan at the optimal tube potential.
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              Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation.

              Continuous computed tomographic (CT) scanning of organ volumes during a single breath hold was studied. The authors modified the table feed mechanism of a continuously rotating CT scanner to allow patient transport at low, but accurately controlled, speeds (0.1-11.0 mm/sec) during continuous 1-second scanning. An algorithm was designed to reconstruct artifact-free images for arbitrary table positions from the helical data by interpolating between adjacent scans. Section sensitivity profiles were enlarged; the section width for a 10-mm section and a speed of 10.0 mm/sec was increased by a factor of 1.3, compared with the nominal value. Clinical examples were presented for studies of lung nodules and studies enhanced with contrast medium. Major advantages are the possibility of continuous scanning of extended volumes within a breath-hold period and retrospective, arbitrary selection of anatomic levels.
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                Author and article information

                Contributors
                ferdinand.roski@tum.de
                Journal
                Eur Radiol
                Eur Radiol
                European Radiology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0938-7994
                1432-1084
                21 May 2019
                21 May 2019
                2019
                : 29
                : 11
                : 6355-6363
                Affiliations
                [1 ]GRID grid.6936.a, ISNI 0000000123222966, Department of Radiology, Klinikum rechts der Isar, School of Medicine, , Technical University of Munich, ; Ismaninger Strasse 22, 81675 Munich, Germany
                [2 ]GRID grid.6936.a, ISNI 0000000123222966, Biomedical Physics & Munich School of BioEngineering, , Technical University of Munich, ; 85748 Garching, Germany
                [3 ]GRID grid.6936.a, ISNI 0000000123222966, Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, , Technical University of Munich, ; Ismaninger Strasse 22, 81675 Munich, Germany
                [4 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Department of Radiology, Perelman School of Medicine, , University of Pennsylvania, ; 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104 USA
                Author information
                http://orcid.org/0000-0002-0938-2266
                Article
                6263
                10.1007/s00330-019-06263-z
                6795615
                31115622
                5c923cea-20e5-40ab-a10e-fa2c2cecc2bc
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 26 February 2019
                : 22 April 2019
                : 2 May 2019
                Funding
                Funded by: European Research Council
                Award ID: ERC-StG-2014 637164
                Award Recipient :
                Funded by: European Research Council
                Award ID: H2020, AdG 695045
                Award Recipient :
                Funded by: Deutsche Forschungsgemeinschaft
                Award ID: Gottfried Wilhelm Leibniz program
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;
                Award ID: 13GW0072C
                Award Recipient :
                Categories
                Musculoskeletal
                Custom metadata
                © European Society of Radiology 2019

                Radiology & Imaging
                bone density,osteoporosis,tomography, x-ray computed
                Radiology & Imaging
                bone density, osteoporosis, tomography, x-ray computed

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