CT Hounsfield unit and histogram analysis for differentiation of recent versus remote vertebral compression fractures

The purpose of this study was to analyze the intraosseous tissue changes in recent vertebral compression fractures (VCFs) and to differentiate recent from remote VCFs using CT Hounsfield unit histogram analysis (HUHA).

65 patients with T11 to L3 VCFs were included. HUHA of 2 vertebral bodies (VBs)- a fractured VB and the closest lower-level unaffected VB-was done. The mean Hounsfield unit (HU) value and HU proportions of 5 ranges (HU ≤ 0, 0 < HU ≤ 50, 50 < HU ≤ 100, 100 < HU ≤ 150, and HU > 150) were obtained. Then, ΔHU value and ΔHU proportion were calculated by subtracting the values from the two vertebrae. Finally, the obtained values were compared between the recent and remote VCF groups and subjected to ROC curve analysis.

In recent VCF group, the ΔHU proportion (HU ≤ 0) corresponding to normal fatty marrow was lower (-0.17 vs 0.01) and the ΔHU proportion (HU > 150) representing trabecular bone was higher (0.23 vs 0.04) than in remote VCF group (p < 0.001). In the differentiation of recent from remote VCF, the ΔHU value and ΔHU proportion (HU > 150) showed high area under the curve (AUC, 0.939 and 0.912, respectively).

CT HUHA demonstrated both trabecular bone and bone marrow changes in recent VCFs, and showed high diagnostic performance in differentiating between recent and remote VCFs.

With its vendor neutral applicability, CT HUHA can be used for the differentiation of recent and remote VCFs.