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Objective <p>To identify practical vertebral HU measurement strategies for opportunistic bone mineral density (BMD) screening using routine CT.</p> Methods <p>Seven anatomical segmental combinations were defined: upper thoracic (T1–T4, UT), mid-thoracic (T5–T8, MT), lower thoracic (T9–T12, LT), thoracolumbar (T11–L2, TL), upper lumbar (L1–L2, UL), lower lumbar (L3–L5, LL), and sacral (S1–S2, SA). Correlations between HU and DEXA-derived T-score were analyzed for both single vertebrae and multi-segment combinations, using the full-segment average (T1–S2, TS) as reference. Stepwise linear regression across 19 vertebrae generated an exploratory combination (EC) model. ROC analysis and age–sex subgroup analyses were performed.</p> Results <p>A total of 300 patients were enrolled (150 males, 150 females; mean age 54.94 ± 14.39 years). Both single- and multi-segment measurements correlated positively with T-score. TS showed the strongest correlation (<i>r</i> = 0.799) and highest predictive performance (AUC = 0.914). Among single vertebrae, T5 showed the strongest correlation (<i>r</i> = 0.785). Among anatomical combinations, TL showed one of the strongest correlations (<i>r</i> = 0.787) and favorable predictive performance (AUC = 0.912). Subgroup analyses showed stable TL performance across sex groups, whereas the strongest correlation and predictive performance were observed in the 51–60-year age subgroup.</p> Conclusion <p>Both single- and multi-segment HU measurements were effective for BMD assessment. The TL segment represents a practical HU-based assessment approach for opportunistic osteoporosis screening on routine CT, with stable predictive performance and practical clinical value.</p>

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Which vertebral levels provide practical HU-based assessment for osteoporosis screening? A comparative analysis from T1 to S2

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Ze Zhou,
  • Yan-Xiang Hou,
  • Xin-Yu Dong,
  • Jia-Qi Wang,
  • Lu-Ping Zhou,
  • Yu Chen,
  • Pei-Lin Jin,
  • Hua-Qing Zhang,
  • Chong-Yu Jia,
  • Liang Kang,
  • Hui-Ya Ma,
  • Cai-Liang Shen,
  • Ren-Jie Zhang

摘要

Objective

To identify practical vertebral HU measurement strategies for opportunistic bone mineral density (BMD) screening using routine CT.

Methods

Seven anatomical segmental combinations were defined: upper thoracic (T1–T4, UT), mid-thoracic (T5–T8, MT), lower thoracic (T9–T12, LT), thoracolumbar (T11–L2, TL), upper lumbar (L1–L2, UL), lower lumbar (L3–L5, LL), and sacral (S1–S2, SA). Correlations between HU and DEXA-derived T-score were analyzed for both single vertebrae and multi-segment combinations, using the full-segment average (T1–S2, TS) as reference. Stepwise linear regression across 19 vertebrae generated an exploratory combination (EC) model. ROC analysis and age–sex subgroup analyses were performed.

Results

A total of 300 patients were enrolled (150 males, 150 females; mean age 54.94 ± 14.39 years). Both single- and multi-segment measurements correlated positively with T-score. TS showed the strongest correlation (r = 0.799) and highest predictive performance (AUC = 0.914). Among single vertebrae, T5 showed the strongest correlation (r = 0.785). Among anatomical combinations, TL showed one of the strongest correlations (r = 0.787) and favorable predictive performance (AUC = 0.912). Subgroup analyses showed stable TL performance across sex groups, whereas the strongest correlation and predictive performance were observed in the 51–60-year age subgroup.

Conclusion

Both single- and multi-segment HU measurements were effective for BMD assessment. The TL segment represents a practical HU-based assessment approach for opportunistic osteoporosis screening on routine CT, with stable predictive performance and practical clinical value.