AI-Driven Opportunistic CT Osteoporosis Screening and Establishment of Normative Values

BackgroundOsteoporosis is underdiagnosed and undertreated prompting the exploration of opportunistic screening using CT and artificial intelligence (AI). PurposeTo develop a reproducible deep learning-based convolutional neural network to automatically place a 3D region of interest (ROI) in trabecular bone, develop a correction method to normalize attenuation across different CT protocols or and scanner models, and to establish thresholds for osteoporosis in a large diverse population. MethodsA deep learning-based method was developed to automatically quantify trabecular attenuation using a 3D ROI of the thoracic and lumbar spine on chest, abdomen, or spine CTs, adjusted for different tube voltages and scanner models. Normative values, thresholds for osteoporosis of trabecular attenuation of the spine were established across a diverse population, stratified by age, sex, race, and ethnicity using reported prevalence of osteoporosis by the WHO. Results538,946 CT examinations from 283,499 patients (mean age 65 years{+/-}15, 51.2% women and 55.5% White), performed on 50 scanner models using six different tube voltages were analyzed. Hounsfield Units at 80 kVp versus 120 kVp differed by 23%, and different scanner models resulted in differences of values by < 10%. Automated ROI placement of 1496 vertebra was validated by manual radiologist review, demonstrating >99% agreement. Mean trabecular attenuation was higher in young women (<50 years) than young men (p<.001) and decreased with age, with a steeper decline in postmenopausal women. In patients older than 50 years, trabecular attention was higher in males than females (p<.001). Trabecular attenuation was highest in Blacks, followed by Asians and lowest in Whites (p<.001). The threshold for L1 in diagnosing osteoporosis was 80 HU. ConclusionDeep learning-based automated opportunistic osteoporosis screening can identify patients with low bone mineral density that undergo CT scans for clinical purposes on different scanners and protocols. Key Results 3 main results/conclusionsO_LIIn a study of 538,946 CT examinations performed in 283,499 patients using different scanner models and imaging protocols, an automated deep learning-based convolutional neural network was able to accurately place a three-dimensional regions of interest within thoracic and lumbar vertebra to measure trabecular attenuation. C_LIO_LITube voltage had a larger influence on attenuation values (23%) than scanner model (<10%). C_LIO_LIA threshold of 80 HU was identified for L1 to diagnose osteoporosis using an automated three-dimensional region of interest. C_LI