Comparisons of hounsfield units and volumetric bone density in discriminating vertebral fractures on lumber CT scans

• Published in: British journal of radiology
• Main Authors: Zhou, Fengyun, Zhang, Wenshuang, Geng, Jian, Liu, Yandong, Yuan, Yi, Ma, Kangkang, Cheng, Zitong, Huang, Pengju, Cheng, Xiaoguang, Wang, Ling, Liu, Yajun
• Format: Journal Article
• Language: English
• Published: England 08-03-2024
• Subjects: Vertebral fractures; Quantitative computer tomography; Hounsfield units; Volumetric bone mineral density
• ISSN: 1748-880X

To compare the performance of areal Hounsfield units (aHU), volumetric Hounsfield units (vHU), and volumetric bone mineral density (vBMD) by quantitative CT (QCT) in discriminating vertebral fractures (VFs) risk.
We retrospectively included CT scans of the lumber spine 101 VFs cases (60 women, mean age: 64 ± 4 years; 41 men, mean age: 73 ± 10 years) and sex- and age-matched 101 control subjects (60 women, mean age: 64 ± 4 years; 41 men, mean age: 72 ± 7 years). In order to assess the discriminatory capability of aHU, vHU, and vBMD measurements at the L1 and L2 levels in identifying vertebral fractures, we conducted binary logistic regression and receiver operating characteristic (ROC) curve analyses in men and women. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
In both men and women with and without VFs, aHU, vHU, and vBMD were highly correlated with each other (r2 from 0.832 to 0.957, all p < 0.001). There was a statistically significant difference in aHU, vHU, and vBMD between subjects with and without VFs (p < 0.001). When age, gender and BMI were taken into account as covariances and adjusted simultaneously, odds ratios (ORs) for aHU, vHU, and vBMD values, which represent the risk of VFs, were significant (p < 0.001). Compared with aHU and vHU, vBMD was more strongly associated with VF risk (vBMD: OR, 6.29; 95% CI, 3.83-10.35 vs vHU: OR, 3.64; 95% CI, 2.43-5.46 vs aHU: OR, 2.56; 95% CI, 1.79-3.67). In both men and women, further, vBMD had higher values for AUC, sensitivity, specificity, PPV, and NPV compared to vHU, with vHU in turn surpassing aHU. The area under the receiver operating characteristic curve (AUC) for discriminating VFs using the average aHU, vHU, and vBMD of two vertebrae was 0.72, 0.77 and 0.87 in men and 0.76, 0.79, and 0.86 in women. In both men and women, there exist statistically significant differences in the AUC when employing the three measurements-namely, aHU, vHU, and vBMD-to discriminate fractures (p < 0.05).
The QCT-measured volumetric bone mineral density is more associated with acute VFs than vHU and aHU values of the lumber spine. Although the use of vHU and aHU values for the diagnosis of osteoporosis and discriminating fracture risk is limited to scanner- and imaging protocol-specific, they have great potential for opportunistic osteoporosis screening, particularly vHU.