Reanalysis precision of 3D quantitative computed tomography (QCT) of the spine

Purpose: To evaluate the precision of 3D QCT of the spine. Methods: Interoperator analysis reproducibility of two different 3D QCT analysis systems (QCTPro from Mindways Software Inc and MIAF-Spine from the Institute of Medical Physics, University of Erlangen) was evaluated in 29 postmenopausal women. For each analysis system four different trained operators analyzed all scans independently. Results of the vertebrae L1 and L2 were averaged. With QCTPro BMD of the central trabecular elliptical VOI was analyzed. With MIAF-Spine integral, trabecular and cortical BMD, BMC and Volume were analyzed in the total vertebral body, the elliptical cylinder and the Osteo VOIs that were further subdivided into superior, mid and inferior subVOIs, each. Results: Precision errors (%CV(rms)) for the central trabecular VOI that is also used in the traditional single slice QCT techniques were 1.7 +/- 2.2% and 0.6 +/- 0.6% for QCTPro and MIAF-Spine, respectively. For MIAF-Spine integral BMD precision errors were lowest in the total and mid Osteo subVOIs (0.5 +/- 0.5%). Trabecular BMD precision errors were lowest in the mid subVOIs (0.6 +/- 0.6%). For trabecular BMD there were no differences among the total vertebral body, elliptical cylinder and Osteo VOIs. Cortical BMD precision errors were lowest in the mid total vertebral body subVOI (2.1 +/- 1.9%) and slightly higher in the mid of the Osteo subVOI. Precision errors in the superior and inferior subVOIs were typically 50% to 100% higher compared to the mid subVOIs. Discussion: Compared to QCTPro MIAF-Spine uses an automated 3D segmentation and an anatomic vertebral coordinate system to position a variety of analysis VOIs. This results in better precision than the more manually assisted analysis used by QCTPro. In-vivo precision errors will be approximately 0.5% higher compared to the analysis precision errors reported here (13). The results demonstrate that with 3D QCT in-vivo precision errors of about 1%-1.5% for trabecular and 2.5% to 3% for cortical bone can be obtained in postmenopausal women. (C) 2008 Elsevier Inc. All rights reserved.