Hänninen Nina E, Voss Antti, Hartikainen Suvi, Nissinen Tomi, Rautio Pentti, Sund Reijo, Väänänen Sami P
Imaging Center, Kuopio University Hospital, Wellbeing Services County of North Savo, Finland; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
Imaging Center, Kuopio University Hospital, Wellbeing Services County of North Savo, Finland; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
Bone. 2025 Oct;199:117564. doi: 10.1016/j.bone.2025.117564. Epub 2025 Jun 17.
Dual-energy X-ray absorptiometry (DXA) is a valuable tool for measuring bone mineral density (BMD). Conventional skeletal projection images for BMD assessment include the hip and the posterior-anterior (PA) lumbar spine DXA scans. However, the PA view suffers from the pileup of anatomical structures which are not present in the lateral view. This study aimed to evaluate the significance of lateral projection in measuring BMD. We acquired a dataset covering over 10,000 patients with the lateral projection included in the routine clinical DXA examination together with PA lumbar spine and femur projections. Age-related BMD decrease was more pronounced in the lateral lumbar spine and femur than in the PA lumbar spine. To elaborate on this difference, we estimated aortic calcification score from lateral spine DXA images and detected degeneration and scoliosis from PA lumbar spine images using neural networks. Multivariate linear regression analysis suggested that aortic calcification increased BMD in PA spine, but in lateral spine and femur, the expected decline in BMD was observed. The spinal degeneration was related to higher BMD in all sites, with the largest effect on PA spine BMD. Scoliosis increased BMD on lateral spine but was associated with decreased BMD in PA spine and at femur. Lateral lumbar spine DXA helped to reveal sources for the artificially elevated BMD and provided better insight into age-related decrease in vertebral bone mineral density than the PA scan. Lateral projection should therefore be considered more in clinical practice, as it enhances the reliability of lumbar spine BMD measurement.
双能X线吸收法（DXA）是测量骨密度（BMD）的一种重要工具。用于BMD评估的传统骨骼投影图像包括髋部和后前位（PA）腰椎DXA扫描。然而，PA位视图存在侧位视图中不存在的解剖结构叠加问题。本研究旨在评估侧位投影在测量BMD中的意义。我们获取了一个数据集，涵盖超过10000例患者，其常规临床DXA检查包括侧位投影以及PA腰椎和股骨投影。与年龄相关的BMD降低在腰椎侧位和股骨比在PA腰椎更明显。为了详细说明这种差异，我们从腰椎侧位DXA图像估计主动脉钙化评分，并使用神经网络从PA腰椎图像检测退变和脊柱侧弯。多变量线性回归分析表明，主动脉钙化增加了PA脊柱的BMD，但在腰椎侧位和股骨，观察到BMD预期下降。脊柱退变与所有部位较高的BMD相关，对PA脊柱BMD影响最大。脊柱侧弯增加了腰椎侧位的BMD，但与PA脊柱和股骨的BMD降低相关。腰椎侧位DXA有助于揭示BMD人为升高的来源，并比PA扫描更深入地了解与年龄相关的椎体骨密度降低。因此，在临床实践中应更多地考虑侧位投影，因为它提高了腰椎BMD测量的可靠性。
