Opportunistic Bone Health Assessment Using Contrast-Enhanced Abdominal CT - A DXA-Referenced Analysis in Liver Transplant Recipients

Sep 30, 2026

Objective: investigate the relationship between CT-derived Hounsfield Unit (HU) measurements and dual-energy X-ray absorptiometry (DXA), and assess whether contrast-enhanced abdominal CT can serve as a complementary bone-health assessment tool in liver transplant recipients. Methods: retrospective study of adult recipients who underwent contrast-enhanced abdominal CT and DXA within three months; HU from lumbar spine (L1–L4) and femoral neck on venous-phase CT compared with DXA T-scores as the reference. Results: 259 recipients; lumbar spine DXA showed normal, osteopenic, and osteoporotic groups. HU decreased with worsening DXA category and correlated with T-scores. HU diagnostic performance for osteoporosis was fair (AUC up to 0.751). Conclusion: contrast-enhanced abdominal CT provides rapid ancillary information but should not replace DXA.

LanguageEnglish

CategoryHealthcare

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Abstract

Objective and Methods

Results

Conclusion

Introduction

Background and Pathophysiology

DXA as Reference Standard

Article Opportunistic Bone Health Assessment Using ContrastEnhanced Abdominal CT: A DXA-Referenced Analysis in Liver Transplant Recipients Nurullah Dag 1, *, Hilal Er Ulubaba 1, Sevgi Tasolar 1, Mehmet Candur 1 and Sami Akbulut 2 Academic Editors: Antonio Jesús Láinez-Ramos-Bossini and Fernando Ruiz Santiago Received: 17 November 2025 Revised: 17 December 2025 Accepted: 18 December 2025 Published: 22 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Radiology, Faculty of Medicine, Inonu University, Malatya 44280, Türkiye; [hilal.er@inonu.edu.tr](hilal.er@inonu.edu.tr) (H.E.U.); [sevgi.tasolar@inonu.edu.tr](sevgi.tasolar@inonu.edu.tr) (S.T.); [mehmet.candur@inonu.edu.tr](mehmet.candur@inonu.edu.tr) (M.C.) 2 Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya 44280, Türkiye; [akbulutsami@gmail.com](akbulutsami@gmail.com) * [Correspondence: nurullah.dag@inonu.edu.tr](Correspondence: nurullah.dag@inonu.edu.tr) Abstract Objective: This study aimed to investigate the relationship between computed tomography (CT)-derived Hounsfield Unit (HU) measurements and dual-energy X-ray absorptiometry (DXA) and to evaluate the feasibility of using contrast-enhanced abdominal CT as a complementary tool in the assessment of bone health in liver transplant recipients. Methods: This retrospective descriptive and analytical study included adult liver transplant recipients who underwent both contrast-enhanced abdominal CT and DXA within a three-month interval. HU measurements were obtained from sagittal and axial reformatted images atthe lumbar spine (L1–L4) and femoral neck. All CT examinations were performed using a standardized venous-phase protocol. DXA-derived T-scores from the lumbar spine and femur served as the reference standard. Correlation analyses and receiver operating characteristic (ROC) curves were used to evaluate associations between HU values and BMD, as well as the diagnostic performance of HU in identifying low bone density. Results: A total of 259 recipients (mean age 55.7 ± 14.4 years; 62.9% male) were included. Based on lumbar spine DXA, 17.8% had normal BMD, 36.7% were osteopenic, and 45.5% were osteoporotic. CT-derived HU values at both the lumbar spine and femoral neck were significantly lower in patients with reduced BMD and showed a graded decline across worsening DXA categories. HU values demonstrated positive correlations with corresponding T-scores. Diagnostic performance for detecting osteoporosis was fair, with AUCs of 0.700 (sagittal), 0.698 (axial), and 0.751 (femoral) . Conclusion: Contrast-enhanced abdominal CT provides useful ancillary information for opportunistic bone health assessment. CT-derived HU values offer a rapid and cost-effective complementary tool but should not replace DXA in the diagnostic evaluation of osteoporosis Keywords: liver transplantation; bone health; computed tomography; Hounsfield unit; dual-energy X-ray absorptiometry 1. Introduction Since the first successful liver transplantation (LT) performed by Starzl et al. [1] in 1967, LT has evolved into an established, life-saving therapeutic option not only for patients with end-stage liver disease and hepatic malignancies, but also for selected cases of acute liver failure and a broad spectrum of pediatric metabolic disorders [2,3] . Advances in surgical techniques, perioperative management, and modern immunosuppressive regimens have collectively contributed to the marked improvement in post-transplant survival, enabling substantial gains in graft function, long-term outcomes, and overall patient prognosis [4,5] . As post-transplant survival continues to improve, the prevention, early detection, and effective management of long-term complications have become increasingly critica

FAQs

What was the main objective of the study?

To examine the relationship between CT-derived Hounsfield Unit (HU) measurements and DXA, and to evaluate the feasibility of using contrast-enhanced abdominal CT as a complementary tool for bone-health assessment in liver transplant recipients.

How were CT and DXA measurements obtained and compared?

Adult liver transplant recipients underwent both contrast-enhanced abdominal CT and DXA within a three-month interval. HU values were measured from the lumbar spine (L1–L4) and femoral neck on standardized venous-phase CT, and DXA T-scores served as the reference standard.

What did the results show about HU performance for identifying low bone density?

CT-derived HU values were lower in patients with reduced BMD and showed a graded decline across worsening DXA categories, with positive correlations to corresponding T-scores. Diagnostic performance for osteoporosis was fair, with AUC values up to 0.751.

Sep 30, 2026

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