Dual-Energy CT-based Opportunistic Volumetric Bone Mineral Density Assessment of the Distal Radius

Leon D. Gruenewald*, Vitali Koch, Simon S. Martin, Ibrahim Yel, Scherwin Mahmoudi, Simon Bernatz, Katrin Eichler, Tatjana Gruber-Rouh, Daniel Pinto Dos Santos, Tommaso D'Angelo, Stefan Wesarg, Eva Herrmann, Rejane Golbach, Marlin Handon, Thomas J. Vogl, Christian Booz

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)


Background: In patients with distal radius fractures (DRFs), low bone mineral density (BMD) is associated with bone substitute use during surgery and bone nonunion, but BMD information is not regularly available. Purpose: To evaluate the feasibility of dual-energy CT (DECT)-based BMD assessment from routine examinations in the distal radius and the relationship between the obtained BMD values, the occurrence of DRFs, bone nonunion, and use of surgical bone substitute. Materials and Methods: Scans in patients who underwent routine dual-source DECT in the distal radius between January 2016 and December 2021 were retrospectively acquired. Phantomless BMD assessment was performed using the delineated trabecular bone of a nonfractured segment of the distal radius and both DECT image series. CT images and health records were examined to determine fracture severity, surgical management, and the occurrence of bone nonunion. Associations of BMD with the occurrence of DRFs, bone nonunion, and bone substitute use at surgical treatment were examined with generalized additive models and receiver operating characteristic analysis. Results: This study included 263 patients (median age, 52 years; IQR, 36–64 years; 132 female patients), of whom 192 were diagnosed with fractures. Mean volumetric BMD was lower in patients who sustained a DRF (93.9 mg/cm 3 vs 135.4 mg/cm 3; P < .001), required bone substitutes (79.6 mg/cm 3 vs 95.5 mg/cm 3; P < .001), and developed bone nonunion (71.1 mg/cm 3 vs 96.5 mg/cm 3; P < .001). Receiver operating characteristic curve analysis identified these patients with an area under the curve of 0.71–0.91 (P < .001). Lower BMD increased the risk to sustain DRFs, develop bone nonunion, and receive bone substitutes at surgery (P < .001). Conclusion: DECT-based BMD assessment at routine examinations is feasible and could help predict surgical bone substitute use and the occurrence of bone nonunion in patients with DRFs.

Original languageEnglish
Article numbere223150
Issue number2
Early online date8 Aug 2023
Publication statusPublished - Aug 2023

Bibliographical note

Funding Information:
Disclosures of conflicts of interest: L.D.G. No relevant relationships. V.K. Member of Radiology editorial board. S.S.M. No relevant relationships. I.Y. No relevant relationships. S.M. No relevant relationships. S.B. No relevant relationships. K.E. No relevant relationships. T.G.R. No relevant relationships. D.P.D.S. Grant from the German Federal Ministry of Health; royalties from Amboss; consulting fees from Cook Medical; payment or honoraria for lectures from Bayer. T.D. No relevant relationships. S.W. No relevant relationships. E.H. No relevant relationships. R.G. No relevant relationships. M.H. No relevant relationships. T.J.V. No relevant relationships. C.B. Payment or honoraria for lectures from Siemens Healthineers.

Publisher Copyright:
© RSNA, 2023.


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