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Background <p>Opportunistic anemia screening from routinely acquired CT scans is attractive in patients undergoing neuroimaging or thoracic imaging for other indications. However, the relative and combined diagnostic performance of intracranial and thoracic CT parameters remains unclear.</p> Purpose <p>To compare cranial and thoracic CT attenuation metrics for opportunistic anemia assessment and to determine whether internally normalized blood–tissue difference metrics are more robust than absolute attenuation values.</p> Methods <p>This retrospective single-center study included 357 adult inpatients (85 anemic, 272 non-anemic) who underwent paired non-contrast head and chest CT with hemoglobin testing within 24&#xa0;h. Two radiologists measured attenuation in the superior sagittal sinus, gray matter, left ventricle, ascending aorta, interventricular septum, and spinal canal on two CT scanners. Blood–tissue difference metrics were calculated, including SSS–GM and AA–IVS. Correlation analyses, scanner-stratified group comparisons, and receiver operating characteristic analyses were performed. AUCs were compared using the DeLong test, and an exploratory combined logistic model was evaluated.</p> Results <p>Absolute attenuation values varied substantially between scanners. After scanner stratification, blood-pool attenuation was consistently lower in anemic patients, whereas reference tissue attenuation remained relatively stable. The SSS–GM difference showed the strongest correlation with hemoglobin (<i>r</i> = 0.58, <i>P</i> &lt; 0.001) and the best performance among individual metrics (AUC, 0.810 [95% CI 0.751, 0.869]). The best thoracic metric was AA–IVS (AUC, 0.731 [95% CI 0.665, 0.797]). SSS–GM significantly outperformed AA–IVS (<i>P</i> = 0.024) and AA–SC (<i>P</i> = 0.033). A combined logistic model integrating SSS–GM and AA–IVS yielded the highest numerical AUC (0.831 [95% CI 0.775, 0.888]) but provided only modest incremental improvement.</p> Conclusions <p>Internally normalized CT attenuation difference metrics were more robust than absolute attenuation values for opportunistic anemia assessment in the presence of scanner-related variability. Among them, the SSS–GM difference showed the strongest discrimination, while combining cranial and thoracic metrics provided only limited additional benefit.</p>

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Comparative and combined head and chest CT attenuation for opportunistic anemia detection: a scanner-stratified analysis

  • 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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  • Bingxue Cheng,
  • Jiahui Zhang,
  • Yuqi Xu,
  • Ziyu Bai,
  • Shengrong Zhong,
  • Juan Peng,
  • Yun Peng,
  • Fen Huang

摘要

Background

Opportunistic anemia screening from routinely acquired CT scans is attractive in patients undergoing neuroimaging or thoracic imaging for other indications. However, the relative and combined diagnostic performance of intracranial and thoracic CT parameters remains unclear.

Purpose

To compare cranial and thoracic CT attenuation metrics for opportunistic anemia assessment and to determine whether internally normalized blood–tissue difference metrics are more robust than absolute attenuation values.

Methods

This retrospective single-center study included 357 adult inpatients (85 anemic, 272 non-anemic) who underwent paired non-contrast head and chest CT with hemoglobin testing within 24 h. Two radiologists measured attenuation in the superior sagittal sinus, gray matter, left ventricle, ascending aorta, interventricular septum, and spinal canal on two CT scanners. Blood–tissue difference metrics were calculated, including SSS–GM and AA–IVS. Correlation analyses, scanner-stratified group comparisons, and receiver operating characteristic analyses were performed. AUCs were compared using the DeLong test, and an exploratory combined logistic model was evaluated.

Results

Absolute attenuation values varied substantially between scanners. After scanner stratification, blood-pool attenuation was consistently lower in anemic patients, whereas reference tissue attenuation remained relatively stable. The SSS–GM difference showed the strongest correlation with hemoglobin (r = 0.58, P < 0.001) and the best performance among individual metrics (AUC, 0.810 [95% CI 0.751, 0.869]). The best thoracic metric was AA–IVS (AUC, 0.731 [95% CI 0.665, 0.797]). SSS–GM significantly outperformed AA–IVS (P = 0.024) and AA–SC (P = 0.033). A combined logistic model integrating SSS–GM and AA–IVS yielded the highest numerical AUC (0.831 [95% CI 0.775, 0.888]) but provided only modest incremental improvement.

Conclusions

Internally normalized CT attenuation difference metrics were more robust than absolute attenuation values for opportunistic anemia assessment in the presence of scanner-related variability. Among them, the SSS–GM difference showed the strongest discrimination, while combining cranial and thoracic metrics provided only limited additional benefit.