ArticleZeitschrift fur medizinische Physik2026
Standardization of bone mineral density and microstructure from high-resolution CT-scans of the spine in a multicenter setting.
Article in Zeitschrift fur medizinische Physik, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeQuantitative Computed Tomography (QCT) has not fully addressed the need to reduce intra- and inter-scanner variability for Osteoporosis and bone-related studies, which can lead to inaccuracies when pooling data from different CT manufacturers, models, devices, or protocols. In this context, the aim of this work was to develop ex vivo methods for the standardization of bone mineral density and microstructural parameters. MATERIALS AND
methodsSix human vertebral body specimens embedded in poly-methyl methacrylate (PMMA) were scanned ex vivo inside an anthropomorphic abdomen phantom in eight different CT-scanners. We measured 3D trabecular and cortical bone mineral density (Tb.BMD and Ct.BMD at the peeled spongiosa and the vertical cortex, respectively), trabecular separation (Tb.Sp) and cortical thickness (Ct.Th). Standardization of Tb.BMD and Ct.BMD across CT-scanners was conducted by correcting for the influence of PMMA and kernel related differences in the segmented cortical volume. For Tb.BMD and Ct.BMD two CT-scanners, where the majority of the patients were scanned, were used as reference. For Tb.Sp standardization we accounted for the image binarization threshold and used high-resolution peripheral QCT (HR-pQCT) as reference. Cross-calibration factors were obtained for each CT-scanner from which the cross-calibrated measures xTb.BMD, xCt.BMD and xTb.Sp were computed both ex vivo and in vivo. Agreement of the ex vivo measurements with respect to the references was quantified with Lin's concordance correlation coefficient (r
resultsAfter cross-calibration the overall ex vivo mean Tb.BMD across CT-scanners was basically maintained, changing only from 119.0 mgHA/cm
conclusionThe improved inter-scanner agreement with corresponding reduced variability underscores the importance of cross-calibration of bone mineral density and microstructural parameters. For the in vivo application of the methods, cross-calibrated Tb.Sp improved fracture prediction in patients, whereas cross-calibrated BMD had no discernible impact, possibly due to the distribution of patients across the participating CT-centers and the already high fracture classification power of Tb.BMD.
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