[Influence of bone marrow fat on the determination of bone mineral content by QCT]

Single-energy quantitative CT (SEQCT) is thought to be suitable for long-term observation of changes in bone mineral content in individual patients. However, in patients with osteoporosis, an increase in bone marrow fat cannot be ignored. The relationship between bone marrow fat and bone mineral density (BMD) at different tube voltages of 80 kV and 120 kV was investigated using a set of solution phantoms that we devised, and was also studied in healthy volunteers. On the basis of the results obtained using the solution phantoms, the influence of bone marrow fat accounted for a decrease of 8.9 mg/cm3 in BMD value at 80 kV and of 10.8 mg/cm3 at 120 kV in the presence of 10 vol% fat. These findings suggested that the influence of fat was less at a lower tube voltage. The formulas used to estimate the true bone mineral and fat contents from the BMD values at low and high tube voltages were derived by eliminating the influence of beam hardening. Using these formulas, we studied healthy volunteers, and found that the difference between the true BMD value and the BMD value calibrated for beam hardening averaged 17.8 mg/cm3 at 80 kV and 22.6 mg/cm3 at 120 kV. Moreover, the estimated concentration of bone marrow fat in the volunteers averaged 25.0 vol%. In conclusion, because SEQCT performed at a low tube voltage is less influenced by bone marrow fat, it should be selected for assessment of the clinical response to therapy and for studying sequential changes. However, in patients with a low bone mineral content indicated by SEQCT, it would be worthwhile trying to estimate both true mineral and fat contents in bone using the formulas obtained in this study in order to differentiate decrease in bone mineral from interference by bone marrow fat.