News | Cardiac Imaging | July 15, 2020

Cardiac CT Can Double as Osteoporosis Test

The Mindways Solid phantom with volume of interest in the quality assurance phantom (red circles, left side). A participant's noncontrast-enhanced axial CT (right side) with volume of interest (yellow circles) in the trabecular bone compartment of three vertebrae for bone mineral density measurements. Image courtesy of Radiological Society of North America

The Mindways Solid phantom with volume of interest in the quality assurance phantom (red circles, left side). A participant's noncontrast-enhanced axial CT (right side) with volume of interest (yellow circles) in the trabecular bone compartment of three vertebrae for bone mineral density measurements. Image courtesy of Radiological Society of North America

July 15, 2020 — Cardiac CT exams performed to assess heart health also provide an effective way to screen for osteoporosis, potentially speeding treatment to the previously undiagnosed, according to a study published in Radiology.

Osteoporosis is a disease that causes the bones to weaken and become vulnerable to fracture. It affects an estimated 200 million people worldwide. Early detection and treatment are important, as several classes of drugs are effective at reducing the risk of fractures that exact a devasting toll on victims. A National Osteoporosis Foundation report last year found that nearly 20 percent of Medicare fee-for-service beneficiaries died within 12 months of a new osteoporotic fracture.

Bone mineral density (BMD) tests can diagnose osteoporosis, but the number of people who get these tests is suboptimal.

"Osteoporosis is a prevalent, under-diagnosed and treatable disease associated with increased morbidity and mortality," said study lead author Josephine Therkildsen, M.D., from Herning Hospital, Hospital Unit West, in Herning, Denmark. "Effective anti-osteoporotic treatment exists and so, identifying individuals with greater fracture rate who may benefit from such treatment is imperative."

Therkildsen and colleagues recently looked at cardiac CT, a test done to assess heart health, as an opportunistic way to screen for osteoporosis. Because the cardiac CT scan also visualizes the thoracic vertebrae, the bones that form the vertebral spine in the upper trunk, it is relatively easy to add a BMD test to the procedure.

The study involved 1,487 participants who underwent cardiac CT for evaluation of heart disease. Participants also had BMD testing of three thoracic vertebrae using quantitative CT software.

Of the 1,487 people in the study, 179, or 12%, had very low BMD. During follow-up of just over three years on average, 80 of the participants, or 5.3%, were diagnosed with a fracture. The fracture was osteoporosis-related in 31 of the 80 people.

The association between a very low BMD and a higher rate of fracture strongly suggests that thoracic spine BMD may be used to guide osteoporosis preventive measures and treatment decisions, the study authors said.

Adding BMD testing to cardiac CT is feasible and applicable in a clinical setting, according to Therkildsen. It does not add time to the exam and doesn't expose the patient to any additional radiation. In fact, Therkildsen said, technological advances over time have reduced the radiation dose given at cardiac CT. BMD measurements can be made using existing non-enhanced CT images as long as a suitable calibration system is ensured, scanner stability is continuously monitored and systematic imaging acquisition techniques are implemented.

"We believe that opportunistic BMD testing using routine CT scans can be done with little change to normal clinical practice and with the benefit of identifying individuals with a greater fracture rate," Therkildsen said.

Although the researchers used cardiac CT images in the study, in theory any CT images that include a view of relevant bone structures could be used for measuring BMD. The development of fully automated software for BMD measurements further enhances the adaptability and convenience of this approach.

Additional research will help pin down the optimal BMD cut-off values for treatment while providing more data on fracture risk based on gender and areas of the body. The impact of clinical risk factors in combination with BMD measured from CT scans for the assessment of fracture risk would also benefit further study.

"Our research group is dedicated to extend the research in this field, as we believe it should be added to clinical practice," Therkildsen said.

For more information: www.rsna.org

Related Content

An example of a CT coronary artery calcium scoring exam showing how each vessel segment is scored to assess a patient's risk for a future heart attack. Example is from Philips Healthcare.

An example of a CT coronary artery calcium scoring exam showing how each vessel segment is scored to assess a patient's risk for a future heart attack. Example is from Philips Healthcare.

News | Cardiac Imaging | September 25, 2020
September 25, 2020 — A study out of University Hospitals (UH) found that removing the cost barrier for coronary arter
Rafael Rivero, M.D., Global Head of Medical Affairs at MSI, said: "The importance of MyoStrain cannot be understated because of the test's immense clinical value and ability to quantify intramyocardial dysfunction across 48 segments of the heart. In a six-heartbeat MRI scan, MyoStrain arms physicians with novel clinical information about a patient's heart health."
News | Cardiac Imaging | August 11, 2020
August 11, 2020 — Myocardial Solutions, Inc. and United Imaging, Inc.
Cardiac MR can offer data above and beyond anatomical imaging, which is the main reason why this system was installed at Baylor Scott White Heart Hospital in Dallas. The system is a dedicated heart MRI scanner.

Cardiac MR can offer data above and beyond anatomical imaging, which is the main reason why this system was installed at Baylor Scott White Heart Hospital in Dallas. The system is a dedicated heart MRI scanner.

News | Cardiac Imaging | June 29, 2020
June 29, 2020 — A type of smart magnetic r...
New Multimodality Cardiac Imaging Guidelines for Competitive Athletes Created. ASE SCCT and SCMR recommendations for imaging, screening atheletes.
News | Cardiac Imaging | May 11, 2020
May 11, 2020 – Competitive athletes are a rapidly growing population worldwide.
Figure 4 for the study. Images of a 65-year-old man (patient 6). (a) Cardiac MRI perfusion shows perfusion deficit of anterior/anterolateral wall attributed to left anterior descending artery/left circumflex artery (*). (b) CT coronary angiography. (c) Coronary angiography, left anterior oblique projection with caudal angulation. (d) Three-dimensional image fusion helped refine diagnosis: perfusion deficits (*) were most likely caused by narrow first diagonal branch and its first, stented side branch (arrow

Figure 4 for the study. Images of a 65-year-old man (patient 6). (a) Cardiac MRI perfusion shows perfusion deficit of anterior/anterolateral wall attributed to left anterior descending artery/left circumflex artery (*). (b) CT coronary angiography. (c) Coronary angiography, left anterior oblique projection with caudal angulation. (d) Three-dimensional image fusion helped refine diagnosis: perfusion deficits (*) were most likely caused by narrow first diagonal branch and its first, stented side branch (arrowhead). Retrospectively, denoted lesion could also be found at CT coronary angiography and coronary angiography (arrowheads in b and c, respectively). CT FFR = CT-derived fractional flow reserve, LGE = late gadolinium enhancement. Image courtesy of RSNA, Radiology.

News | Cardiac Imaging | May 04, 2020
May 4, 2020 – A new technique that combines computed tomography (CT) and magnetic resonance imaging MRI can bolster c
An example of a coronary computed tomography angiography (CCTA) exam. The CIAO study looked at patients who have a problem of blood flow limitation and chest pain symptoms in the absence of a 50 percent or more artery narrowing, known as ischemia with no obstructive CAD, or INOCA.

An example of a coronary computed tomography angiography (CCTA) exam. The CIAO study looked at patients who have a problem of blood flow limitation and chest pain symptoms in the absence of a 50 percent or more artery narrowing, known as ischemia with no obstructive CAD, or INOCA.

News | Cardiac Imaging | April 03, 2020
April 3, 2020 — Patients who experience chest pain and have abnormal results on a cardiac stress test but who do not
Schematic depiction of the automated process for assessing fat, muscle, liver, aortic calcification, and bone from original abdominal CT scan data

Figure 1: Depiction of the fully automated CT biomarkers tools used in this study. (A) Schematic depiction of the automated process for assessing fat, muscle, liver, aortic calcification, and bone from original abdominal CT scan data. (B) Case example in an asymptomatic 52-year-old man undergoing CT for colorectal cancer screening. At the time of CT screening, he had a body-mass index of 27·3 and Framingham risk score of 5% (low risk). However, several CT-based metabolic markers were indicative of underlying disease. Multivariate Cox model prediction based on these three CT-based results put the risk of cardiovascular event at 19% within 2 years, at 40% within 5 years, and at 67% within 10 years, and the risk of death at 4% within 2 years, 11% within 5 years, and 27% within 10 years. At longitudinal clinical follow-up, the patient suffered an acute myocardial infarction 3 years after this initial CT and died 12 years after CT at the age of 64 years. (C) Contrast-enhanced CT performed 7 months before death for minor trauma was interpreted as negative but does show significant progression of vascular calcification, visceral fat, and hepatic steatosis. HU=Hounsfield units.

News | Cardiac Imaging | March 06, 2020
March 6, 2020 — Researchers at the National Institutes of Health a