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Development of a system to assess the two- and three-dimensional bone mineral density of the lumbar vertebrae from clinical quantitative CT images

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Abstract

Summary

This study developed a system to quantify the lumbar spine’s bone mineral density (BMD) in two and three dimensions for osteoporosis screening using quantitative CT images. Measuring the two-dimensional BMD could reproduce the BMD measurement performed in dual-energy X-ray absorptiometry, and an accurate diagnosis of osteoporosis was possible.

Purpose

To date, the assessment of bone mineral density (BMD) using CT images has been made in three dimensions, leading to errors in detecting osteoporosis based on the two-dimensional assessments of BMD using dual-energy X-ray absorptiometry (DXA-BMD). Herein, we aimed to develop a system that measures two- and three-dimensional lumbar BMD from quantitative CT images and validated the accuracy of the system in diagnosing osteoporosis with regard to the DXA classification.

Methods

Fifty-nine pairs of spinal CT and DXA images were analyzed. First, the three-dimensional BMD was measured at the axial slice of the L1 vertebra on CT images (L1-vBMD). Then, the L1-L4 vertebrae were segmented from the CT images to measure the three-dimensional BMD at the trabecular region of the L1-L4 vertebral bodies (CT-vBMD). Lastly, the segmented vertebrae were projected onto the coronal plane to measure the two-dimensional BMD (CT-aBMD). Each parameter was correlated with DXA-BMD, and the receiver operating characteristic (ROC) curve to diagnose osteoporosis was assessed.

Results

The correlation coefficients of DXA-BMD with L1-vBMD, CT-vBMD, and CT-aBMD were 0.364, 0.456, and 0.911, respectively (all p < 0.01). In the ROC curve analysis to diagnose osteoporosis, the area under the curve for CT-aBMD (0.941) was significantly higher than those for L1-vBMD (0.582) and CT-vBMD (0.657) (both p < 0.01).

Conclusion

Compared with L1-vBMD and CT-vBMD, CT-aBMD could accurately predict DXA-BMD and detect patients with osteoporosis. Given that our method can quantify BMD in both two and three dimensions, it could be used to screen for osteoporosis from quantitative CT images.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by the Japan Osteoporosis Foundation Grant for Bone Research, and Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (KAKENHI) numbers 19H01176, 20H04550, and 21K16655.

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Authors and Affiliations

  1. Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Keisuke Uemura, Takahito Fujimori, Sotaro Kono, Kazuma Takashima, Shota Takenaka, Takashi Kaito & Seiji Okada

  2. Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan

    Yoshito Otake, Yuga Shimomoto & Yoshinobu Sato

  3. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Hidetoshi Hamada & Nobuhiko Sugano

Authors
  1. Keisuke Uemura
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  2. Takahito Fujimori
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  3. Yoshito Otake
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  4. Yuga Shimomoto
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  11. Nobuhiko Sugano
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  12. Seiji Okada
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Contributions

Keisuke Uemura: conceptualization, methodology, code writing, validation, formal analysis, data curation, writing—original draft, writing—review and editing, visualization, funding acquisition. Takahito Fujimori: resources, data curation, writing—review and editing. Yoshito Otake: resources, methodology, writing—review and editing, supervision, funding acquisition. Yuga Shimomoto: code writing, Sotaro Kono: writing—review and editing. Kazuma Takashima: writing—review and editing. Hidetoshi Hamada: writing—review and editing. Shota Takenaka: resources, Takashi Kaito: resources, Yoshinobu Sato: resources, writing—review and editing, supervision, funding acquisition. Nobuhiko Sugano: writing—review and editing, supervision. Seiji Okada: supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Keisuke Uemura.

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Ethical approval

All procedures performed in this study were performed per the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board at Osaka University.

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Informed consent was obtained from all patients in the form of opt-out.

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Uemura, K., Fujimori, T., Otake, Y. et al. Development of a system to assess the two- and three-dimensional bone mineral density of the lumbar vertebrae from clinical quantitative CT images. Arch Osteoporos 18, 22 (2023). https://doi.org/10.1007/s11657-023-01216-y

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