ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
Simplified sagittal slice HU measurement as a practical alternative to conventional axial HU in opportunistic osteoporosis screening.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Development and evaluation of a simple CT-based DXA triage score for osteoporosis in candidates for lumbar spine surgery.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Article
- Diagnostic performance of lumbar computed tomography Hounsfield unit thresholds for osteoporosis and osteopenia: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Review
- Opportunistic osteoporosis screening using CT-based Hounsfield units: a machine learning approach for preoperative spine surgery planning.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- The association between bone density evaluated on CT or MRI versus the gold standard dual-energy X-ray absorptiometry (DEXA) in the lumbar spine and hip: a meta-analysis.Brain & spine · 2026Review
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5 authors.
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Abstract
purposeOpportunistic assessment of bone quality using CT-derived Hounsfield Unit (HU) values has gained attention as an alternative to DXA-based osteoporosis screening. However, conventional axial HU measurements are time-consuming and operator-dependent. A simplified sagittal HU measurement method may provide a more practical approach, although its clinical validity has yet to be fully established. This study aimed to evaluate the correlation between HU values obtained from simplified sagittal and conventional axial slices and determine their respective diagnostic performance in identifying osteoporosis.
methodsWe retrospectively analyzed 162 patients aged ≥ 50 years who underwent both lumbar spine CT and DXA scans. HU values were measured using both conventional axial slices (Ax L1-4 Ave HU) and a simplified sagittal slice method (Sg L1-4 Ave HU). Spearman's rank correlation was calculated to assess the association between each HU measurement and the lowest T-score (Low-T score). Agreement between the two methods was evaluated using Bland-Altman analysis, and the predictive performance for diagnosing osteoporosis (Low T-score ≤ - 2.5) was assessed by ROC curve analysis. Vertebra-specific differences between axial and sagittal HU values were also analyzed.
resultsSg L1-4 Ave HU showed a moderate correlation with Low T-score (ρ = 0.476), comparable to Ax L1-4 Ave HU (ρ = 0.493). The Bland-Altman analysis revealed a mean difference of - 4.08 HU between Sg and Ax measurements, with most differences falling within the 95% limits of agreement. Axial HU values were consistently higher than sagittal HU values across all lumbar levels, particularly at L1 and L4. The AUC for predicting osteoporosis was 0.692 for Sg L1-4 Ave HU and 0.707 for Ax L1-4 Ave HU. Based on Youden's index, the optimal cutoff values were 94.0 HU for sagittal and 99.5 HU for axial measurements.
conclusionsSimplified sagittal HU measurements demonstrated good agreement with conventional axial measurements and exhibited similar diagnostic accuracy in identifying osteoporosis. Given their efficiency and consistency, sagittal HU values may serve as a practical and reproducible alternative for CT-based opportunistic bone quality assessment, especially in routine clinical settings or where DXA is unavailable.
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