Comparing lumbar computed tomography Hounsfield units and magnetic resonance imaging vertebral bone quality scores for diagnosing osteoporosis and osteopenia in degenerative spinal populations: a systematic review and diagnostic meta-analysis.

Routine MRI for opportunistic osteoporosis screening: diagnostic accuracy of vertebral bone quality and a novel femoral bone quality score compared with DXA.

VBQ can serve as an opportunistic exploratory screening marker of low BMD and FBQcsf may complement VBQ by identifying early marrow-related changes, although further validation is required.

Comparative Diagnostic Performance of Cone Beam Computed Tomography and Dual‐Energy X‐Ray Absorptiometry for Low Bone Density Assessment. A Systematic Review and Meta‐Analysis

ABSTRACT Objective This systematic review evaluated the diagnostic accuracy of CBCT for BMD assessment using DEXA as the reference standard and aimed to quantify its performance through meta‐analysis. Materials and Methods This review included prospective and retrospective observational studies assessing CBCT's diagnostic performance in detecting low BMD, with DEXA as the reference. Searches in PubMed, Embase, and Scopus identified 13 eligible studies involving adult participants (≥ 18 years). Two reviewers independently extracted data and assessed study quality using the QUADAS‐2 tool. Meta‐analysis was conducted using random‐effects models. Results Pooled sensitivity and specificity of CBCT for detecting low BMD were 0.58 (95% CI: 0.50–0.67) and 0.78 (95% CI: 0.69–0.86), respectively. The summary receiver operating characteristic (SROC) curve showed an area under the curve (AUC) of 0.73 (95% CI: 0.69–0.77), indicating moderate diagnostic accuracy. Subgroup analyses revealed heterogeneity influenced by sample size and anatomical site. Conclusion CBCT demonstrates moderate diagnostic accuracy in detecting low BMD, with better specificity than sensitivity. While promising, standardization of CBCT protocols and larger studies are needed to confirm its role in clinical assessment. PROSPERO Registration Number (CRD42024598958).

Beyond Bone Density Alone: Opportunistic Identification of Vertebral Compression Fractures in Breast Cancer Survivors Using Artificial Intelligence-Derived Vertebral Bone Density and Paraspinal Muscle–Fat Metrics

Background/Objectives: This study aimed to evaluate whether artificial intelligence-derived vertebral volumetric bone mineral density (AI-vBMD) and paraspinal intermuscular adipose tissue (IMAT) ratio from routine computed tomography (CT) could identify moderate-to-severe vertebral compression fractures (VCFs) in breast cancer survivors, and whether paraspinal IMAT ratio and routinely available clinical variables improved diagnostic performance. Methods: This retrospective study included 275 women with breast cancer who underwent routine non-contrast CT and lumbar quantitative computed tomography (QCT). Hounsfield unit-derived volumetric bone mineral density (HU-vBMD) was derived using a QCT-referenced HU-to-vBMD conversion equation, whereas AI-vBMD and paraspinal IMAT ratio were extracted using automated software. Moderate-to-severe VCF was defined as Genant grade ≥ 2. Agreement with QCT-vBMD was assessed using correlation, intraclass correlation coefficient (ICC), and Bland–Altman analysis. Model discrimination was evaluated using receiver operating characteristic analysis and DeLong tests. Results: Moderate-to-severe VCF was present in 75 patients (27.3%). HU-vBMD and AI-vBMD showed excellent agreement with QCT-vBMD (ICC, 0.978 and 0.987, respectively). AI-vBMD outperformed HU-vBMD for identifying VCFs (AUC, 0.738 vs. 0.714; p < 0.001). IMAT ratio showed comparable standalone discrimination to AI-vBMD (AUC, 0.760 vs. 0.738; p = 0.604). Adding IMAT ratio to AI-vBMD improved discrimination (AUC, 0.786 vs. 0.738; p = 0.038). The full model incorporating clinical covariates achieved the highest AUC (0.828; 95% CI, 0.778–0.878). Conclusions: AI-vBMD and paraspinal IMAT ratio automatically extracted from routine CT improved the diagnostic assessment of prevalent moderate-to-severe VCFs in breast cancer survivors. This study supports an automated CT-based approach that integrates vertebral bone density and paraspinal muscle–fat information for opportunistic identification of clinically relevant VCFs.

Potential physiological determinants of diagnostic discordance between an MRI-derived lumbar vertebral bone quality score and DXA T-scores.

Lumbar VBQ-DXA discordance is associated with a physiological signature characterized by triglyceride-rich lipoproteins, glycation burden, and conjugated bilirubin, which may complement VBQ by identifying metabolically vulnerable, marrow-related bone quality changes that are not fully captured by DXA-derived T-scores.

Hounsfield unit measurements from different regions of interest in lumbar spine CT: correlation with DEXA-derived bone mineral density and fracture status.

OBJECTIVE This study compared Hounsfield unit (HU) measurements obtained from different regions of interest (ROIs) on lumbar CT for assessing bone mineral density (BMD) and discriminating osteoporosis and thoracolumbar fragility fracture status, aiming to evaluate whether ROI selection meaningfully influences HU-based assessment. METHODS Five HU measurement methods were evaluated using lumbar CT. Their correlations with dual-energy X-ray absorptiometry (DEXA)-derived BMD and their discriminative performance for osteoporosis and thoracolumbar fragility fracture status were analyzed. Receiver operating characteristic (ROC) curves were constructed, and pairwise comparisons of areas under the curve (AUCs) were performed using the DeLong test. A sensitivity analysis was additionally conducted after excluding substituted vertebral levels and recalculating mean lumbar HU using only non-substituted vertebrae. RESULTS All five HU measurement methods showed significant correlations with DEXA-derived BMD, and no statistically significant differences in discriminative performance were observed among the five ROI methods in the primary analysis. In the sensitivity analysis excluding substituted vertebral levels, the AUCs remained comparable across methods for osteoporosis (0.816-0.826) and thoracolumbar fragility fracture status (0.677-0.689), with all pairwise DeLong tests showing no statistically significant differences (all p > 0.05). CONCLUSION Different lumbar CT ROI methods demonstrated comparable performance in assessing BMD and discriminating thoracolumbar fragility fracture status, and sensitivity analysis confirmed that exclusion of substituted vertebral levels did not materially affect the results. No ROI method showed statistically significant superiority, suggesting that ROI selection may be guided by clinical feasibility and workflow convenience rather than by diagnostic performance alone. ADVANCES IN KNOWLEDGE This study compares five commonly used lumbar CT HU measurement methods and shows that their performance is broadly similar. The findings suggest that ROI selection may be guided primarily by clinical feasibility and workflow convenience, although further external validation is required before routine clinical application.

Comparison of dual-energy X-ray absorptiometry and lumbar radiographs using deep learning for osteoporosis diagnosis.