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We investigated the reliability of HU measurements in adolescent idiopathic scoliosis (AIS), particularly addressing the impact of spinal tilt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed lumbar CT images of 11- to 19-year-old AIS patients who underwent posterior spinal fusion (July 2007\u2013March 2024). HU values and lumbar tilt were measured at L1, L3, and L5. Reliability was assessed using intra-rater (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200936), inter-rater (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200930), and equivalence datasets (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200962) comparing standard pelvis-parallel images versus images reconstructed parallel to the vertebral body.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both intra-rater (ICC(1,1)\u2009&gt;\u20090.95) and inter-rater (ICC(2,1)\u2009&gt;\u20090.80) reliability were excellent. Measurements from standard pelvis-parallel images and reconstructed images showed stable overall equivalence (ICC(3,1)\u2009=\u20090.96). However, the percentage of cases with an HU value difference of 20 or more was 11.3% when the lumbar tilt angle was 10 degrees or greater, compared to 5.6% when the tilt angle was below 9 degrees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analyses for AIS patients showed that vertebral HU measurements are reliable when using vertebral-parallel reconstructed images but standard pelvis-parallel images lose reliability with significant tilt. While our findings do not promote routine CT usage, our validated methodology provides a baseline technique that could potentially be applied to complex, high-risk cases where osteoporosis is prevalent and critical for surgical planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01509-5","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:37:29Z","timestamp":1784565449000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Opportunistic bone mineral density assessment in pediatric scoliosis: validating Hounsfield unit measurement from lumbar CT images"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4495-1134","authenticated-orcid":false,"given":"Kosei","family":"Nagata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Nakajima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Nakarai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Urayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Komatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Nakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Oshima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakae","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Inui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Saita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Taniguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"1509_CR1","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.jocd.2014.01.004","volume":"17","author":"N Bishop","year":"2014","unstructured":"Bishop N, Arundel P, Clark E, Dimitri P, Farr J, Jones G, Makitie O, Munns CF, Shaw N, International Society of Clinical D (2014) Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2013 pediatric official positions. 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The manuscript submitted does not contain information about medical device (s)\/drug (s).","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"\u201cAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (institutional review board of the Clinical Research Support Center of the University of Tokyo Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.The data that support the findings of this study are not publicly available but are available from the corresponding author upon reasonable request.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}