Simulating Dual-Energy X-Ray Absorptiometry in CT Using Deep-Learning Segmentation Cascade

Arun Krishnaraj*, Spencer Barrett, Orna Bregman-Amitai, Michael Cohen-Sfady, Amir Bar, David Chettrit, Mila Orlovsky, Eldad Elnekave

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Osteoporosis is an underdiagnosed condition despite effective screening modalities. Dual-energy x-ray absorptiometry (DEXA) screening, although recommended in clinical guidelines, remains markedly underutilized. In contrast to DEXA, CT utilization is high and presents a valuable data source for opportunistic osteoporosis screening. The purpose of this study was to describe a method to simulate lumbar DEXA scores from routinely acquired CT studies using a machine-learning algorithm. Methods: Between January 2010 and September 2014, 610 CT studies of the abdomen and pelvis were used to develop spinal column and L1 to L4 multiclass segmentation. DEXA simulation training and validation used 1,843 pairs of CT studies accompanied by DEXA results obtained within a 6-month interval from the same individual. Machine learning–based regression was used to determine correlation between calculated grade (on the basis of vertebrae L1-L4) and DEXA t score. Results: Analysis of the t score equivalent, generated by the algorithm, revealed true positives in 1,144 patients, false positives in 92 patients, true negatives in 245 patients, and false negatives in 212 patients, resulting in an accuracy of 82%. Sensitivity for the detection of osteoporosis or osteopenia was 84.4% (95% confidence interval, 82.3%-86.2%), and specificity was 72.7% (95% confidence interval, 67.7%-77.2%). Conclusions: The presented algorithm can identify osteoporosis and osteopenia with a high degree of accuracy (82%) and a small proportion of false positives. Efforts to cull greater information using machine-learning algorithms from pre-existing data have the potential to have a marked impact on population health efforts such as bone mineral density screening for osteoporosis, in which gaps in screening currently exist.

Original languageEnglish
Pages (from-to)1473-1479
Number of pages7
JournalJournal of the American College of Radiology
Issue number10
StatePublished - Oct 2019
Externally publishedYes


  • DEXA
  • machine learning
  • osteoporosis
  • population health
  • segmentation cascade


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