{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T12:02:45Z","timestamp":1786708965102,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T00:00:00Z","timestamp":1728259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Cystic fibrosis bone disease (CFBD) is a common comorbidity in adult people with cystic fibrosis (pwCF), resulting in an increased risk of bone fractures. This study evaluated the capacity of artificial intelligence (AI)-assisted low-dose chest CT (LDCT) opportunistic screening for detecting low bone mineral density (BMD) in adult pwCF. Methods: In this retrospective single-center study, 65 adult pwCF (mean age 30.1 \u00b1 7.5 years) underwent dual-energy X-ray absorptiometry (DXA) of the lumbar vertebrae L1 to L4 to determine BMD and corresponding z-scores and completed LDCTs of the chest within three months as part of routine clinical care. A fully automated CT-based AI algorithm measured the attenuation values (Hounsfield units [HU]) of the thoracic vertebrae Th9\u2013Th12 and first lumbar vertebra L1. The ability of the algorithm to diagnose CFBD was assessed using receiver operating characteristic (ROC) curves. Results: HU values of Th9 to L1 and DXA-derived BMD and the corresponding z-scores of L1 to L4 showed a strong correlation (all p &lt; 0.05). The area under the curve (AUC) for diagnosing low BMD was highest for L1 (0.796; p = 0.001) and Th11 (0.835; p &lt; 0.001), resulting in a specificity of 84.9% at a sensitivity level of 75%. The HU threshold values for distinguishing normal from low BMD were &lt;197 (L1) and &lt;212 (Th11), respectively. Conclusions: Routine LDCT of the chest with the fully automated AI-guided determination of thoracic and lumbar vertebral attenuation values is a valuable tool for predicting low BMD in adult pwCF, with the best results for Th11 and L1. However, further studies are required to define clear threshold values.<\/jats:p>","DOI":"10.3390\/jcm13195961","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T10:58:32Z","timestamp":1728298712000},"page":"5961","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Opportunistic Screening for Low Bone Mineral Density in Adults with Cystic Fibrosis Using Low-Dose Computed Tomography of the Chest with Artificial Intelligence"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1259-8911","authenticated-orcid":false,"given":"Matthias","family":"Welsner","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Navel","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering and Applied Natural Sciences, Westphalian University of Applied Sciences, 45897 Gelsenkirchen, Germany"},{"name":"Institute for Artificial Intelligence in Medicine, University Medicine Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Hosch","sequence":"additional","affiliation":[{"name":"Institute for Artificial Intelligence in Medicine, University Medicine Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rathsmann","sequence":"additional","affiliation":[{"name":"Department of Radiology, St. Josef Hospital Werden, University Medicine Essen, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Stehling","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children\u2019s Hospital, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivagurunathan","family":"Sutharsan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svenja","family":"Strassburg","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4603-6602","authenticated-orcid":false,"given":"Dirk","family":"Westh\u00f6lter","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Taube","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2997-0740","authenticated-orcid":false,"given":"Sebastian","family":"Zensen","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6331-7679","authenticated-orcid":false,"given":"Benedikt M.","family":"Schaarschmidt","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Forsting","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5811-7100","authenticated-orcid":false,"given":"Felix","family":"Nensa","sequence":"additional","affiliation":[{"name":"Institute for Artificial Intelligence in Medicine, University Medicine Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0719-2207","authenticated-orcid":false,"given":"Mathias","family":"Holtkamp","sequence":"additional","affiliation":[{"name":"Institute for Artificial Intelligence in Medicine, University Medicine Essen, 45147 Essen, Germany"},{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4843-5911","authenticated-orcid":false,"given":"Johannes","family":"Haubold","sequence":"additional","affiliation":[{"name":"Institute for Artificial Intelligence in Medicine, University Medicine Essen, 45147 Essen, Germany"},{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5376-3154","authenticated-orcid":false,"given":"Luca","family":"Salh\u00f6fer","sequence":"additional","affiliation":[{"name":"Institute for Artificial Intelligence in Medicine, University Medicine Essen, 45147 Essen, Germany"},{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7455-8590","authenticated-orcid":false,"given":"Marcel","family":"Opitz","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1038\/s41572-024-00538-6","article-title":"Cystic fibrosis","volume":"10","author":"Mall","year":"2024","journal-title":"Nat. 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