Three-material decomposition with spectral CT to assess bone mineral density for the early diagnosis of osteoporosis

Abstract

Osteoporosis, a prevalent skeletal disorder affecting postmenopausal women and older adults, leads to reduced bone mass and deteriorating bone microarchitecture, resulting in heightened fracture risk. Early diagnosis is crucial for timely treatment and fracture prevention. Bone mineral density (BMD) estimation is pivotal in this regard, with trabecular tissue providing key insights. Dual-Energy X-ray Absorptiometry (DXA) and Quantitative Computed Tomography (QCT) are the current clinical standards but come with several limitations. Spectral CT, a promising technology, overcomes these limitations by employing dual-energy techniques. It quantifies materials based on distinct attenuation properties at different energy levels. A three-material decomposition technique shows potential in dual-energy CT, enabling BMD quantification without a calibration phantom and addressing adipose tissue influence. This review explores the application of three-material decomposition in spectral CT for osteoporosis BMD assessment, evaluating existing techniques, strengths, and limitations, and offering insights into spectral CT’s potential in early diagnosis and osteoporosis management, outlining future directions, including technological advancements and improved BMD analysis using three-material decomposition in spectral CT.