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Eur Radiol Exp. 2017;1(1):11. doi: 10.1186/s41747-017-0017-2. Epub 2017 Sep 20.

Evaluation of bone mineral density of the lumbar spine using a novel phantomless dual-energy CT post-processing algorithm in comparison with dual-energy X-ray absorptiometry.

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1Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
2Siemens Healthcare, Computed Tomography Division, Forchheim, Germany.
3Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.



Current techniques for evaluation of bone mineral density (BMD) commonly require phantom calibration. The purpose of this study was to evaluate a novel algorithm for phantomless in vivo dual-energy computed tomography (DECT)-based assessment of BMD of the lumbar spine in comparison with dual-energy X-ray absorptiometry (DEXA).


Data from clinically indicated DECT and DEXA examinations within two months comprising the lumbar spine of 47 patients were retrospectively evaluated. By using a novel automated dedicated post-processing algorithm for DECT, the trabecular bone of lumbar vertebrae L1-L4 was selected and analysed. Linear correlation was analysed using Pearson's product-moment correlation coefficient for the comparison of the results from DECT and DEXA.


A total of 186 lumbar vertebrae in 47 patients (mean age, 58 years; age range, 24-85 years) were analysed, 24 men (mean age, 55 years; age range, 24-85 years) and 23 women (mean age, 59 years; age range, 31-80 years). Mean BMD of L1-L4 determined with DEXA was 0.985 g/cm2 and 20/47 patients (42.6%) showed an osteoporotic BMD (T score lower than - 2.5) of at least two vertebrae. Average DECT-based BMD of L1-L4 was 86.8 mg/cm3. Regression analysis demonstrated a lack of correlation between DECT- and DEXA-based BMD values with a Pearson's product-moment correlation coefficient r = 0.4205.


Dedicated post-processing of DECT data using a novel algorithm for retrospective phantomless BMD assessment of the trabecular bone of lumbar vertebrae from clinically indicated DECT examinations is feasible.


Bone mineral density; Computed tomography; Dual-energy X-ray absorptiometry; Dual-energy computed tomography; Osteoporosis

Conflict of interest statement

This retrospective study was performed according to regulations issued by our local Institutional Review Board.PCH, MS, BS and TGF are employees of Siemens Healthcare. JLW received speaker’s fees from Siemens Healthcare and GE Healthcare. The remaining authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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