ArticleTomography (Ann Arbor, Mich.)2026
Opportunistic Screening for Low Bone Density Using Automated Vertebral Trabecular CT Attenuation from Low-Dose CT Acquired During FDG PET/CT: A Single-Center Retrospective Study.
Article in Tomography (Ann Arbor, Mich.), 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
objectivesTo evaluate the diagnostic performance of automated vertebral trabecular Hounsfield unit (HU) measurements derived from routine fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for identifying low bone density.
methodsThis retrospective study included 131 consecutive women (mean age, 53.5 ± 9.6 years) undergoing health screening with FDG PET/CT and dual-energy X-ray absorptiometry (DXA) between January 2020 and December 2024. A deep learning-based model (TotalSegmentator) automatically segmented the lumbar vertebrae (L1-L4). HU-based metrics in trabecular regions were calculated, and their correlations with DXA-derived bone mineral density (BMD) were assessed. Diagnostic performance was evaluated using receiver operating characteristic analysis. A multivariable logistic regression model incorporating mean HU, age, and body mass index was developed and internally validated using bootstrap resampling.
resultsAccording to WHO criteria, 47 of 131 participants (35.9%) had low bone density. Mean HU demonstrated strong diagnostic performance (area under the curve [95% confidence interval]: L1, 0.861 [0.800-0.923]; L2, 0.852 [0.788-0.915]; L3, 0.861 [0.800-0.921]; L4, 0.845 [0.781-0.909]). L1 mean HU provided the most balanced performance (sensitivity, 0.851; specificity, 0.750); L3 mean HU was slightly inferior. L1 mean HU was strongly correlated with BMD (r = 0.821,
conclusionsThe automated assessment of vertebral trabecular HU from routine FDG PET/CT provides a reliable and highly efficient method for screening low bone density without additional radiation exposure or cost.
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