Opportunistic bone density screening for the abdominal radiologist using colored CT images: a pilot retrospective study

Andrew Smith, Majid Khan, Elliot Varney, Boshen Liu, Manohar Roda, Chris Reed, Robert Morris, David Joyner, Seth T. Lirette, Thomas Mosley

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of the study was to develop an accurate and reproducible method for detecting low spinal bone density on abdominal CT images. Methods: For this IRB-approved HIPAA-compliant single-center retrospective study, nonenhanced CT images of the lower abdomen were obtained in 631 African-American participants. Mean attenuation of L3/L4 was associated with quantitative CT bone density (QCT) in a randomly selected training cohort (N = 511), and receiver operating characteristics analysis was used to identify the optimal mean attenuation threshold for differentiating normal from low bone density. Custom image processing software was used to generate grayscale and colored CT images of the midline spine, with green for normal and red for low bone density. Five radiologists independently assessed bone density at L3/L4 in a validation cohort (N = 120) using various methods: QCT, visual assessment of sagittal grayscale images (Grayscale), quantitative measurement of mean attenuation on a midline sagittal image (Attenuation), and visual assessment of a midline sagittal colored image (Color). Accuracy was calculated using the average QCT bone density as a reference standard. Inter-observer agreement was assessed using intraclass correlation coefficient (ICC). Results: The optimal mean attenuation threshold for differentiating normal from low bone density at L3/L4 was 145 Hounsfield Units. The average accuracy of Grayscale, Attenuation, and Color methods was 58, 87, and 91% (p < 0.001), respectively. Inter-observer agreement was poor for Grayscale (ICC: 0.20; 95% CI 0.12, 0.28) and excellent for both Attenuation (ICC: 0.85; 95% CI 0.73, 0.91) and Color methods (ICC: 0.87; 95% CI 0.83, 0.90). Conclusion: Detection of low spinal bone density using colored abdominal CT images was highly accurate and reproducible.

Original languageEnglish (US)
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Jan 1 2018

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Bone Density
Retrospective Studies
Health Insurance Portability and Accountability Act
Radiologists
Research Ethics Committees
ROC Curve
African Americans
Abdomen
Spine
Software

Keywords

  • Bone density
  • Computed tomography
  • Opportunistic screening
  • Osteoporosis

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

Cite this

Opportunistic bone density screening for the abdominal radiologist using colored CT images : a pilot retrospective study. / Smith, Andrew; Khan, Majid; Varney, Elliot; Liu, Boshen; Roda, Manohar; Reed, Chris; Morris, Robert; Joyner, David; Lirette, Seth T.; Mosley, Thomas.

In: Abdominal Radiology, 01.01.2018.

Research output: Contribution to journalArticle

Smith, Andrew ; Khan, Majid ; Varney, Elliot ; Liu, Boshen ; Roda, Manohar ; Reed, Chris ; Morris, Robert ; Joyner, David ; Lirette, Seth T. ; Mosley, Thomas. / Opportunistic bone density screening for the abdominal radiologist using colored CT images : a pilot retrospective study. In: Abdominal Radiology. 2018.
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abstract = "Purpose: The purpose of the study was to develop an accurate and reproducible method for detecting low spinal bone density on abdominal CT images. Methods: For this IRB-approved HIPAA-compliant single-center retrospective study, nonenhanced CT images of the lower abdomen were obtained in 631 African-American participants. Mean attenuation of L3/L4 was associated with quantitative CT bone density (QCT) in a randomly selected training cohort (N = 511), and receiver operating characteristics analysis was used to identify the optimal mean attenuation threshold for differentiating normal from low bone density. Custom image processing software was used to generate grayscale and colored CT images of the midline spine, with green for normal and red for low bone density. Five radiologists independently assessed bone density at L3/L4 in a validation cohort (N = 120) using various methods: QCT, visual assessment of sagittal grayscale images (Grayscale), quantitative measurement of mean attenuation on a midline sagittal image (Attenuation), and visual assessment of a midline sagittal colored image (Color). Accuracy was calculated using the average QCT bone density as a reference standard. Inter-observer agreement was assessed using intraclass correlation coefficient (ICC). Results: The optimal mean attenuation threshold for differentiating normal from low bone density at L3/L4 was 145 Hounsfield Units. The average accuracy of Grayscale, Attenuation, and Color methods was 58, 87, and 91{\%} (p < 0.001), respectively. Inter-observer agreement was poor for Grayscale (ICC: 0.20; 95{\%} CI 0.12, 0.28) and excellent for both Attenuation (ICC: 0.85; 95{\%} CI 0.73, 0.91) and Color methods (ICC: 0.87; 95{\%} CI 0.83, 0.90). Conclusion: Detection of low spinal bone density using colored abdominal CT images was highly accurate and reproducible.",
keywords = "Bone density, Computed tomography, Opportunistic screening, Osteoporosis",
author = "Andrew Smith and Majid Khan and Elliot Varney and Boshen Liu and Manohar Roda and Chris Reed and Robert Morris and David Joyner and Lirette, {Seth T.} and Thomas Mosley",
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T1 - Opportunistic bone density screening for the abdominal radiologist using colored CT images

T2 - a pilot retrospective study

AU - Smith, Andrew

AU - Khan, Majid

AU - Varney, Elliot

AU - Liu, Boshen

AU - Roda, Manohar

AU - Reed, Chris

AU - Morris, Robert

AU - Joyner, David

AU - Lirette, Seth T.

AU - Mosley, Thomas

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AB - Purpose: The purpose of the study was to develop an accurate and reproducible method for detecting low spinal bone density on abdominal CT images. Methods: For this IRB-approved HIPAA-compliant single-center retrospective study, nonenhanced CT images of the lower abdomen were obtained in 631 African-American participants. Mean attenuation of L3/L4 was associated with quantitative CT bone density (QCT) in a randomly selected training cohort (N = 511), and receiver operating characteristics analysis was used to identify the optimal mean attenuation threshold for differentiating normal from low bone density. Custom image processing software was used to generate grayscale and colored CT images of the midline spine, with green for normal and red for low bone density. Five radiologists independently assessed bone density at L3/L4 in a validation cohort (N = 120) using various methods: QCT, visual assessment of sagittal grayscale images (Grayscale), quantitative measurement of mean attenuation on a midline sagittal image (Attenuation), and visual assessment of a midline sagittal colored image (Color). Accuracy was calculated using the average QCT bone density as a reference standard. Inter-observer agreement was assessed using intraclass correlation coefficient (ICC). Results: The optimal mean attenuation threshold for differentiating normal from low bone density at L3/L4 was 145 Hounsfield Units. The average accuracy of Grayscale, Attenuation, and Color methods was 58, 87, and 91% (p < 0.001), respectively. Inter-observer agreement was poor for Grayscale (ICC: 0.20; 95% CI 0.12, 0.28) and excellent for both Attenuation (ICC: 0.85; 95% CI 0.73, 0.91) and Color methods (ICC: 0.87; 95% CI 0.83, 0.90). Conclusion: Detection of low spinal bone density using colored abdominal CT images was highly accurate and reproducible.

KW - Bone density

KW - Computed tomography

KW - Opportunistic screening

KW - Osteoporosis

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