Comparison of volumetric and areal bone mineral density in CT and scout scans using spectral detector technology

BACKGROUND: To determine whether denoised areal bone mineral density (BMD) measurements from scout scans in spectral detector computed tomography (CT) correlate with volumetric trabecular BMD for opportunistic osteoporosis screening. METHODS: A 64-slice single-source dual-layer spectral CT scanner was used to acquire scout scan data of 228 lumbar vertebral bodies within 57 patients. Scout scans in anterior–posterior (AP) view were performed with a dose of < 0.06 mSv and spectrally decomposed into areal BMD (aBMD) values. A spectral dictionary denoising algorithm was applied to increase the signal-to-noise ratio (SNR). Volumetric trabecular bone mineral density (vBMD) was determined via material decomposition. A 3D convolutional network for image segmentation and labeling was applied for automated vBMD quantification. Projected maps were used to compare the classification accuracy of AP and lateral scout scans. RESULTS: The denoising algorithm led to the minimization of anticorrelated noise in spectral maps and an SNR increase from 5.23 to 13.4 (p < 0.002). Correlation analysis between vBMD and measured AP aBMD, projected AP, and lateral aBMD showed a Pearson correlation coefficient of 0.68, 0.81, and 0.90, respectively. The sensitivity and specificity for the osteoporosis classification task were higher in lateral projection images than in AP crystallizing in an increased area under the curve value of 0.99 versus 0.90. CONCLUSION: Denoised material-specific aBMD maps show a positive correlation to vBMD, enabling spectral scout scans as an opportunistic predictor for osteoporotic patients. This could be applied routinely as a screening tool in patients undergoing a CT examination. RELEVANCE STATEMENT: Scout-based DEXA could be applied routinely as a screening tool in patients undergoing a CT examination. KEY POINTS: • Spectral scout scans can be used as a dual-energy x-ray absorptiometry-like screening tool. • Spectral dictionary denoising on projection images increases the signal-to-noise ratio. • Positive correlation between volumetric and areal bone mineral density is observed. • Lateral projections increase osteoporosis classification accuracy compared to anterior-posterior projections. GRAPHICAL ABSTRACT: [Image: see text]