David Zopfs1, Simon Lennartz1,2,3, Charlotte Zaeske1, Martin Merkt4, Kai Roman Laukamp1, Robert Peter Reimer1, David Maintz1, Jan Borggrefe1, Nils Grosse Hokamp1. 1. University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany. 2. Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany. 3. Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA. 4. University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Abstract
OBJECTIVE: To evaluate phantomless assessment of volumetric bone mineral density (vBMD) based on virtual non-contrast images of arterial (VNCa) and venous phase (VNCv) derived from spectral detector CT in comparison to true non-contrast (TNC) images and adjusted venous phase conventional images (CIV(adjusted)). METHODS: 104 consecutive patients who underwent triphasic spectral detector CT between January 2018 and April 2019 were retrospectively included. TNC, VNCa, VNCv and venous phase images (CIV) were reconstructed. vBMD was obtained by two radiologists using an FDA/CE-cleared software. Average vBMD of the first three lumbar vertebrae was determined in each reconstruction; vBMD of CIV was adjusted for contrast enhancement as suggested earlier. RESULTS: vBMD values obtained from CIV(adjusted) are comparable to vBMD values derived from TNC images (91.79 ± 36.52 vs 90.16 ± 41.71 mg/cm3, p = 1.00); however, vBMD values derived from VNCa and VNCv (42.20 ± 22.50 and 41.98 ± 23.3 mg/cm3 respectively) were significantly lower as compared to vBMD values from TNC and CIV(adjusted) (all p ≤ 0.01). CONCLUSION: Spectral detector CT-derived virtual non-contrast images systematically underestimate vBMD and therefore should not be used without appropriate adjustments. Adjusted venous phase images provide reliable results and may be utilized for an opportunistic BMD screening in CT examinations. ADVANCES IN KNOWLEDGE: Adjustments of venous phase images facilitate opportunistic assessment of vBMD, while spectral detector CT-derived VNC images systematically underestimate vBMD.
OBJECTIVE: To evaluate phantomless assessment of volumetric bone mineral density (vBMD) based on virtual non-contrast images of arterial (VNCa) and venous phase (VNCv) derived from spectral detector CT in comparison to true non-contrast (TNC) images and adjusted venous phase conventional images (CIV(adjusted)). METHODS: 104 consecutive patients who underwent triphasic spectral detector CT between January 2018 and April 2019 were retrospectively included. TNC, VNCa, VNCv and venous phase images (CIV) were reconstructed. vBMD was obtained by two radiologists using an FDA/CE-cleared software. Average vBMD of the first three lumbar vertebrae was determined in each reconstruction; vBMD of CIV was adjusted for contrast enhancement as suggested earlier. RESULTS: vBMD values obtained from CIV(adjusted) are comparable to vBMD values derived from TNC images (91.79 ± 36.52 vs 90.16 ± 41.71 mg/cm3, p = 1.00); however, vBMD values derived from VNCa and VNCv (42.20 ± 22.50 and 41.98 ± 23.3 mg/cm3 respectively) were significantly lower as compared to vBMD values from TNC and CIV(adjusted) (all p ≤ 0.01). CONCLUSION: Spectral detector CT-derived virtual non-contrast images systematically underestimate vBMD and therefore should not be used without appropriate adjustments. Adjusted venous phase images provide reliable results and may be utilized for an opportunistic BMD screening in CT examinations. ADVANCES IN KNOWLEDGE: Adjustments of venous phase images facilitate opportunistic assessment of vBMD, while spectral detector CT-derived VNC images systematically underestimate vBMD.
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