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Opportunistic osteoporosis screening using multiphase abdominal CT: reliable proximal femur BMD assessment with AI-assisted segmentation
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DOI：10.3389/fmed.2026.1886437.png)
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Abstract
En 中文
ObjectivesTo evaluate the agreement and classification concordance of artificial intelligence (AI)-assisted proximal femur bone mineral density (BMD) assessment using multiphase contrast-enhanced abdominal computed tomography (CT); with unenhanced CT-derived quantitative computed tomography (QCT) serving as the reference standard.MethodsThis retrospective study included 429 patients (mean age; 60.48 ± 12.30 years) who underwent a standardized five-phase abdominal CT protocol; comprising unenhanced; arterial; portal venous; late venous; and excretory phases. A commercially available AI-based QCT workstation was used for semi-automatic proximal femur segmentation and volumetric BMD (vBMD) and T-score calculation. Repeated-measures ANOVA and Bland-Altman analysis were performed to assess inter-phase differences and agreement. Classification concordance was evaluated using the unenhanced CT-derived QCT results as the reference standard.ResultsThe study cohort comprised 378 osteoporotic patients and 51 non-osteoporotic patients; categorized according to unenhanced CT-derived T-score reference values. Results from repeated-measures ANOVA indicated significant phase-related variations in T-scores and vBMD (both P < 0.001). Subsequent post-hoc comparisons revealed that T-scores and vBMD in the arterial and portal venous phases were consistent with the unenhanced phase; whereas modest yet statistically significant deviations were observed in the late venous and excretory phases. Bland-Altman analyses showed minimal mean bias across arterial; portal venous; and excretory phases; however; the late venous phase exhibited broader limits of agreement (LoA). Classification concordance compared to the unenhanced reference was consistently high across all phases; ranging from 98.14 to 99.53%. Additionally; intraobserver reproducibility remained excellent; with ICC values between 0.964 and 0.996.ConclusionAI-assisted proximal femur BMD assessment on contrast-enhanced abdominal CT showed high agreement and classification concordance with unenhanced CT-derived QCT. The arterial and portal venous phases were particularly suitable for opportunistic osteoporosis screening; although external validation against DXA or independent QCT remains necessary.
Keywords:
osteoporosis
contrast-enhanced CT
proximal femur
quantitative CT
opportunistic screening
artificial intelligence segmentation
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