{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:38:16Z","timestamp":1786527496961,"version":"build-2736575974"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the agreement and classification concordance of artificial intelligence (AI)-assisted proximal femur bone mineral density (BMD) assessment using multiphase contrast-enhanced abdominal computed tomography (CT), with unenhanced CT-derived quantitative computed tomography (QCT) serving as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 429 patients (mean age, 60.48 \u00b1 12.30 years) who underwent a standardized five-phase abdominal CT protocol, comprising unenhanced, arterial, portal venous, late venous, and excretory phases. A commercially available AI-based QCT workstation was used for semi-automatic proximal femur segmentation and volumetric BMD (vBMD) and T-score calculation. Repeated-measures ANOVA and Bland-Altman analysis were performed to assess inter-phase differences and agreement. Classification concordance was evaluated using the unenhanced CT-derived QCT results as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study cohort comprised 378 osteoporotic patients and 51 non-osteoporotic patients, categorized according to unenhanced CT-derived T-score reference values. Results from repeated-measures ANOVA indicated significant phase-related variations in T-scores and vBMD (both\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Subsequent\n                      <jats:italic>post-hoc<\/jats:italic>\n                      comparisons revealed that T-scores and vBMD in the arterial and portal venous phases were consistent with the unenhanced phase, whereas modest yet statistically significant deviations were observed in the late venous and excretory phases. Bland-Altman analyses showed minimal mean bias across arterial, portal venous, and excretory phases; however, the late venous phase exhibited broader limits of agreement (LoA). Classification concordance compared to the unenhanced reference was consistently high across all phases, ranging from 98.14 to 99.53%. Additionally, intraobserver reproducibility remained excellent, with ICC values between 0.964 and 0.996.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AI-assisted proximal femur BMD assessment on contrast-enhanced abdominal CT showed high agreement and classification concordance with unenhanced CT-derived QCT. The arterial and portal venous phases were particularly suitable for opportunistic osteoporosis screening, although external validation against DXA or independent QCT remains necessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1886437","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:10:20Z","timestamp":1786525820000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Opportunistic osteoporosis screening using multiphase abdominal CT: reliable proximal femur BMD assessment with AI-assisted segmentation"],"prefix":"10.3389","volume":"13","author":[{"given":"Fenghuan","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Chinese Medicine","place":["Guangdong Province, Zhuhai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Xu","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Qujing Central Hospital of Yunnan Province, Yunnan Province","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Chinese Medicine","place":["Guangdong Province, Zhuhai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Chinese Medicine","place":["Guangdong Province, Zhuhai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rulin","family":"Xu","sequence":"additional","affiliation":[{"name":"Canon Medical Systems China Co Ltd, Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqiang","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Chinese Medicine","place":["Guangdong Province, Zhuhai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiarong","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of MR, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1093\/bmb\/ldaa005","article-title":"The epidemiology of osteoporosis","volume":"133","author":"Clynes","year":"2020","journal-title":"Br Med Bull."},{"key":"B2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1007\/s11657-023-01244-8","article-title":"Addressing gaps in osteoporosis screening in Kuwait using opportunistic quantitative computer tomography (QCT): a retrospective study","volume":"18","author":"Qadan","year":"2023","journal-title":"Arch Osteoporos."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-024-06912-6","article-title":"Updated practice guideline for dual-energy X-ray absorptiometry (DXA)","author":"Slart","year":"2024","journal-title":"Eur J Nucl Med Mol Imaging."},{"key":"B4","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.bone.2012.10.036","article-title":"High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis","volume":"52","author":"Graeff","year":"2013","journal-title":"Bone."},{"key":"B5","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1186\/s12877-023-03963-6","article-title":"Quantitative CT screening improved lumbar BMD evaluation in older patients compared to dual-energy X-ray absorptiometry","volume":"23","author":"Lin","year":"2023","journal-title":"BMC Geriatr."},{"key":"B6","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.jocd.2015.06.012","article-title":"Clinical use of quantitative computed tomography (QCT) of the hip in the management of osteoporosis in adults: the 2015 ISCD official positions-Part I","volume":"18","author":"Engelke","year":"2015","journal-title":"J Clin Densitom."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1016\/j.acra.2023.08.030","article-title":"Combining deep learning and radiomics for automated, objective, comprehensive bone mineral density assessment from low-dose chest computed tomography","volume":"31","author":"Wang","year":"2023","journal-title":"Acad Radiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"4792","DOI":"10.21037\/qims-24-59","article-title":"Opportunistic use of chest low-dose computed tomography (LDCT) imaging for low bone mineral density and osteoporosis screening: cutoff thresholds for the attenuation values of the lower thoracic and upper lumbar vertebrae","volume":"14","author":"Pan","year":"2024","journal-title":"Quant Imaging Med Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.mric.2021.05.002","article-title":"Computed tomography techniques, protocols, advancements, and future directions in liver diseases","volume":"29","author":"Kulkarni","year":"2021","journal-title":"Magn Reson Imaging Clin N Am."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.2214\/AJR.06.1006","article-title":"Volumetric quantitative CT of the spine and hip derived from contrast-enhanced MDCT: conversion factors","volume":"188","author":"Bauer","year":"2007","journal-title":"AJR Am J Roentgenol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"28378","DOI":"10.1038\/s41598-024-79985-w","article-title":"Effect of contrast media on CT bone density assessment: comparative analysis of low-dose chest CT and abdominopelvic CT","volume":"14","author":"Ahn","year":"2024","journal-title":"Sci Rep."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1887","DOI":"10.1007\/s00256-025-04892-8","article-title":"Opportunistic screening for osteoporosis: validation study for L1 bone density measurements using contrast-enhanced chest and abdominal CTs","volume":"54","author":"Hanly","year":"2025","journal-title":"Skeletal Radiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"20220196","DOI":"10.1259\/bjr.20220196","article-title":"Iterative reconstruction vs. deep learning image reconstruction: comparison of image quality and diagnostic accuracy of arterial stenosis in low-dose lower extremity CT angiography","volume":"95","author":"Qu","year":"2022","journal-title":"Br J Radiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.2214\/AJR.07.2154","article-title":"Eliminating unenhanced CT when evaluating abdominal neoplasms in children. AJR Am J Roentgenol","volume":"189","author":"da Costa e Silva","year":"2007"},{"key":"B15","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3390\/diagnostics16010029","article-title":"Opportunistic bone health assessment using contrast-enhanced abdominal CT: a DXA-referenced analysis in liver transplant recipients","volume":"16","author":"Dag","year":"2025","journal-title":"Diagnostics."},{"key":"B16","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1007\/s00431-026-06794-w","article-title":"Opportunistic assessment of bone mineral density using computed tomography in pediatric liver transplant recipients","volume":"185","author":"Dag","year":"2026","journal-title":"Eur J Pediatr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1186\/s13018-023-04174-w","article-title":"Performance of iCare quantitative computed tomography in bone mineral density assessment of the hip and vertebral bodies in European spine phantom","volume":"18","author":"Liu","year":"2023","journal-title":"J Orthop Surg Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1148\/radiol.211561","article-title":"Value-added opportunistic CT screening: state of the art","volume":"303","author":"Pickhardt","year":"2022","journal-title":"Radiology."},{"key":"B19","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s41747-021-00259-5","article-title":"The impact of imaging time and contrast agent dose on screening for osteoporosis with contrast-enhanced CT","volume":"6","author":"Woisetschl\u00e4ger","year":"2022","journal-title":"Eur Radiol Exp."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.2214\/AJR.16.16387","article-title":"Influence of IV contrast administration on CT measures of muscle and bone attenuation: implications for sarcopenia and osteoporosis evaluation","volume":"207","author":"Boutin","year":"2016","journal-title":"AJR Am J Roentgenol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0241012","DOI":"10.1371\/journal.pone.0241012","article-title":"Reliability of 3D image analysis and influence of contrast medium administration on measurement of Hounsfield unit values of the proximal femur","volume":"15","author":"Lee","year":"2020","journal-title":"PLoS ONE."},{"key":"B22","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s00330-014-3408-2","article-title":"Intravenous contrast injection significantly affects bone mineral density measured on CT","volume":"25","author":"Pompe","year":"2015","journal-title":"Eur Radiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s00198-015-3224-9","article-title":"Effect of IV contrast on lumbar trabecular attenuation at routine abdominal CT: correlation with DXA and implications for opportunistic osteoporosis screening","volume":"27","author":"Pickhardt","year":"2016","journal-title":"Osteoporos Int."},{"key":"B24","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.bone.2016.10.020","article-title":"Focal osteoporosis defects play a key role in hip fracture","volume":"94","author":"Poole","year":"2017","journal-title":"Bone."},{"key":"B25","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.semarthrit.2017.09.011","article-title":"Methods for segmentation of rheumatoid arthritis bone erosions in high-resolution peripheral quantitative computed tomography (HR-pQCT)","volume":"47","author":"Figueiredo","year":"2017","journal-title":"Semin Arthritis Rheum."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1886437\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:10:21Z","timestamp":1786525821000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1886437\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":25,"alternative-id":["10.3389\/fmed.2026.1886437"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1886437","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"1886437"}}