Low-Dose Chest CT–Based 3D Osteoporosis Assessment: Insights into Vertebral Microarchitecture

Background Annual screening chest low-dose CT (LDCT) exams contain detailed bone anatomical information. There is a need for a simplified three-dimensional (3D) method to perform practical, passive, accurate, reproducible, and rapid osteoporosis screening from these data. Purpose To develop a simplified 3D method for osteoporosis screening from vertebral trabecular and cortical architecture using screening chest LDCT data, and to analyze bone microarchitecture according to shape, parameters, age, and gender. Materials and Methods Twenty-two subjects underwent screening chest LDCT. 3D vertebral histological images were reconstructed from LDCT data using interactive direct transparency thresholding volume rendering algorithms. Trabecular and cortical bone parameters were measured and compared with values from the literature. Age, gender, and each parameter’s relationships were analyzed using linear regression. Results Reconstructed 3D images of trabecular and cortical microstructures closely matched prior literature. Parameter values were generally larger in males, although Tb.Th and Tb.Sp showed no significant gender difference. Tb.Th, Tb.Sp, and Ct.Th declined faster with age in females than males, while postmenopausal leads to a reduction in Tb.N Conclusions Screening chest LDCT (~ 1.5 mSv) can provide superior vertebral imaging compared to lumbar spine radiography, revealing both trabecular and cortical architecture. This simplified 3D technique allows assessment of macro- and microstructural bone status, supporting osteoporosis diagnosis and management.