Distributional characteristics and regional variation of hounsfield units value across whole spinal vertebral bodies: a cross-sectional study based on 200 objects and 6600 vertebras measurement

Distributional characteristics and regional variation of hounsfield units value across whole spinal vertebral bodies: a cross-sectional study based on 200 objects and 6600 vertebras measurement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Distributional characteristics and regional variation of hounsfield units value across whole spinal vertebral bodies: a cross-sectional study based on 200 objects and 6600 vertebras measurement Lei Qi, Yuxuan Yang, Biteng Xu, Gaoya Yu, Haozhi Yu, Liang Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7326976/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To describe and analyze the distribution characteristics of hounsfield units (HU) value from computerized tomography (CT) scan across whole spine. Methods: Consecutive adult subjects undergoing cervical, thoracic, lumbar spine CT and DEXA scanning between January 2020 and June 2024 were screened in the study. The CT-HU value of vertebras was respectively measured from C2-L5.The distribution characteristics and reginal heterogeneity of HU value were analyzed. The correlation between HU value of C2-L5 and T-score of lumbar vertebras were also evaluated. Results: There were 200 subjects with 6600 vertebras enrolled in the study with the mean age of 63.7±12.6 years including 92 male and 108 female. There were no significant differences of CT-HU value between axial, sagittal and coronal planes for the same vertebra. HU value showed a downward trend from cervical to thoracic and lumbar spine. HU value of all vertebras in osteoporosis group was significantly lower than normal and osteopenia groups. HU value of all vertebras was significant higher in male than female and the mean HU values gradually decreased with age. L3 T-score has the highest correlation with HU value of C2-L5 vertebra and the HU value of thoracic vertebras has the highest correlation with L3 T-score, followed by cervical and lumbar vertebras. Conclusion: The CT-HU value has distinct distribution characteristics for different part of spine and the reginal variation from C2 to L5 share certain trends and rules. Despite of significant variation, vertebral CT-HU value has intrinsic correlation with bone mineral density for individuals. hounsfield units spine computerized tomography vertebral Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Nowadays, the gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DEXA) recommended by the World Health Organization[ 1 ]. As a two-dimensional measurement, DEXA only measures density/area and its calculations include the cortical bone and the posterior elements. T-score of DEXA can be overestimated due to degenerative bony spurs and facet hypertrophy in an aging population, which sometimes make DEXA less sensitive to osteoporosis screening[ 2 ]. The utilization of Hounsfield units (HU) value from computerized tomography (CT) scan in screening osteoporosis in the lumbar spine has been widely reported. There were significant positive correlations of HU value with bone mineral density (BMD) and T-score [ 3 ]. CT-HU value is measured in the cancellous area of the vertebral body, which makes it less affected by degenerative changes[ 4 ]. More importantly, HU value can be attained prospectively or retrospectively from all clinical CT exams, which could provide an opportunity to screen BMD at no additional radiation exposure and little cost when CT have been ordered for other indications[ 5 ]. Based on these advantages, the CT-HU value has been regarded as an important tool to evaluate the BMD and to aid in early opportunistic screening for osteoporosis. Nowadays, most studies on CT-HU value measurement focused on lumbar spine and research on cervical and thoracic spine is limited and DEXA could not provide the T-score of cervical and thoracic spine. To the best of our knowledge, no studies of CT-HU value measurement and analysis of whole spine in the same population has been conducted until now. The purpose of this study to describe the distribution and characteristics of CT-HU value from cervical, thoracic to lumbar spine, and analyze the correlation between HU value and lumbar T-score. Materials and Methods The study was approved by the ethics committee of local hospital. Consecutive adult subjects (≥ 18 years old) undergoing cervical, thoracic, lumbar spine CT and DEXA scanning within 3 months due to degenerative spine pathology or physical examination at our hospital between January 2021 and June 2024 were screened for eligibility in the current study. The exclusion criteria included general autoimmune or metabolism diseases, spine deformity, spine tumor, infectious spondylitis, previous spinal instrumentation or fusion surgery. CT-HU value measurement method All imaging was performed using a 64-row and 128-slice multidetector CT scanner (Siemens, Germany). The CT parameters included a slice thickness of 0.6 mm, a tube voltage of 120kV, and a tube current of 156mA. The study was restricted to native scans without a contrast medium. HU value measurement was performed using Philips EasyVision Picture Archiving and Communication System (PACS). The field of view was adapted to the individual anatomy. Two-dimensional reconstructions were obtained in the coronal and sagittal planes. CT-HU value was measured by placing a click-and-drag circle region of interest (ROI) within vertebral trabecular bone, which was made as large as possible while avoiding avoid cortical bone, the posterior venous plexus, bone islands, compressed bone, and other heterogeneous areas (Figure.1). The measurements were taken by a single rater, who was blinded to the DXA results. The deformed vertebras, vertebras with serious degenerative changes, and any apparent sclerotic levels that might affect trabecular HU measurements were excluded. HU value was recorded in the axial, sagittal and coronal plane from C2-L5. For axial plane, HU value was measured at three levels within the vertebral body: immediately caudal to the superior end plate, mid-body, and cranial to the inferior end plate (Figure.1A-C). For sagittal and coronal plane, the mid-sagittal (Figure.1D-E) and mid-coronal plane (Figure.1F-H) was respectively selected to measure HU value. Statistics Continuous variables were recorded as mean ± standard deviation, and categorical variables were expressed as frequency or percentages. An independent t test was used to analyze the difference of continuous variables. χ2 test and Fisher exact test were used to examine the differences among categorical variables. A paired t test was used to analyze the difference of HU values between different slices and planes for a vertebra. Analysis of variance (ANOVA) was performed to analyze the difference of HU values between different levels and subgroups. Correlation values of HU with age and with T-score using Pearson correlation coefficient (weak: 0-0.39, moderate: 0.40–0.59, strong: 0.60-1.0). Mean and 95% confidence intervals were calculated of cases with T-score divided into three groups (normal, osteopenia, and osteoporosis). In addition, the receiver operating characteristic (ROC) curve was used to assess areas under the curve (AUC, with 95% confidence interval), as well as optimal cutoff points, and calculate sensitivity and specificity for osteoporosis. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software, Version 22.0 (IBM Corp., NY, USA). The statistical significance was set at P < 0.05. Results Population sample There were 200 subjects enrolled in the study with the mean age of 63.7 ± 12.6 years (range: 40–79 years), including 92 male (mean age: 62.1 ± 14.2 years ) and 108 female (mean age: 65.2 ± 10.6 years). According to the T-score of DEXA and subgrouping, there were 68 cases in normal group (T-score≥-1.0), 72 cases in osteopenia (-1.0>T-score>-2.5) and 60 cases in osteoporosis (T-score≤-2.5) group. All cases were divided into three subgroups by age, including 30 cases of age ≤ 45y, 58 cases of 45<age ≤ 60y, 84 cases of 6075y. Distribution and reginal variation of HU value from C2-L5 The HU value for the same vertebra was respectively measured in the axial, sagittal and coronal plane from C2-L5. There were no significant differences of HU value between 3 different axial slices and sagittal, coronal planes for the same vertebra (P>0.05) (Figure.2). So, the HU value of sagittal plane was selected for following analysis because of its easily assessment. As for the different parts of spine, the HU value of vertebra showed a downward trend from cervical to thoracic and lumbar spine, with significant difference between the cervical, thoracic and lumbar spine (P = 0.000). The decrease amplitude was greater in cervical than thoracic and lumbar spine. For the cervical spine form C2 to C7, HU value of C2 was the highest, followed by C4, C3, C5, C6 and C7. For the thoracic spine, despite the downward trend form T1 to T12, there were no significant difference. For the lumbar spine, L3 has the lowest HU value but without significant difference with other levels from L1 to L5. Subgroups analysis The trend of HU value from C2-L5 was also respectively described for BMD normal, osteopenia and osteoporosis subgroups (Figure.3A). For osteoporosis group, HU value of all vertebras from C2-L5 was significantly lower than normal and osteopenia groups (P = 0.000). The HU value in the three subgroups showed the similar whole trend from cervical, thoracic to lumbar spine. However, the decrease amplitude from cervical to thoracic spine was significantly greater in osteoporosis group. As for the gender, the HU value of all vertebras was significant higher in male than female cases (P = 0.000), but with the similar trend from C2-L5 (Figure.3B). As for the age, it was observed that the mean HU value gradually decreased with age with significant difference (P = 0.000), except the difference between cases of 6075y (P = 0.463) (Figure.3C). Correlation of HU and T-score The correlation between HU value of C2-L5 vertebra and T-score of L1-L4 and total lumbar vertebras were present in Figure.4A. L3 T-score has the highest correlation with HU value of C2-L5 vertebra. As for the different parts of spine, the HU value of thoracic vertebras has the highest correlation with L3 T-score, followed by cervical and lumbar vertebras. For the detailed vertebras, HU value of C4 (r = 0.72), T7 (r = 0.83) and L3 (r = 0.69) has the highest correlation with L3 T-score, which were selected as the representative vertebra for cervical, thoracic and lumbar spine. As for the correlation of HU value with T-score in cases of different BMD, the correlation was lower in osteoporosis than osteopenia and normal BMD groups for cervical (C4), thoracic (T7) and lumbar (L3) spine (Figure.4B). ROC analysis for osteoporosis Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic accuracy of HU for identifying individuals with osteoporosis. The area under the curve (AUC) was calculated respectively from C2 to L2. The results showed that C4 (AUC, 0.78), T7 (AUC, 0.96) and L3 (AUC, 0.85) were the highest ROC among the cervical, thoracic and lumbar spine respectively (Figure.5). In addition, a screening HU value of 334 for C4, 160 for T7 and 112 for L3 was selected to diagnose osteoporosis. Discussion Accurate assessment of BMD is very important for diagnosis of osteoporosis and related clinical work. Despite of as the gold standard for evaluating BMD, DEAX has some limitations for widely application. Previous studies have revealed that the T-score tended to be higher than the actual BMD in degenerative patients and older patients or patients having degenerative lumbar scoliosis[ 6 ]. CT-HU value only measures the trabecular portion of the vertebra, and has been regarded as accurate and reliable alternate method of assessing BMD[ 7 ]. Most of the HU value research focused on the lumbar vertebras and fewer studies measured the HU value for the whole spine on consecutive population. Base on 200 objects and 6600 vertebras measurement, the characteristics and distributional trend of HU value from C2-L5 were analyzed in the current study. As for the same vertebra, it was found that HU value was similar between axial, sagittal and coronal planes for normal vertebras, which was constant with previous reports [ 8 – 10 ]. As for whether the HU value of different vertebras or different parts different significantly? It was found that the HU value showed the downward trend from cervical to lumbar spine in the study, which was consistent with previous studies. Cervical spine has proportionally more cortical bone than the rest of the spine and biomechanical analysis found a continuous increase in density with progression from lumbar toward cervical vertebrae. Marinova et al measured the CT-HU value at the thoracic and lumbar spine (T1, T6, T12, L1–L5) in 234 patients and found that HU values were highest at T1 and T6, lowest at L1–L3[ 10 ]. Yoganandan et al found the decrease in trabecular BMD from rostral to caudal along the entire spine[ 11 ]. Weishaupt et al[ 12 ] found the trabecular BMD of the cervical spine to be significantly higher compared to the thoracic and lumbar spine in a QCT study of 50 healthy volunteers. As for the cervical spine, the current study revealed that cervical HU value vary by vertebral level and HU value of C2 was the highest (C2 > C4 > C3 > C5 > C6 > C7), which was consistent with previous reports[ 13 ]. Anderst et al[ 14 ] revealed that average BMD of C3 and C6 was significantly less than C4 and C5, and C7 was the lowest. Stephan et al[ 15 ] measured the QCT of C1-T1 vertebras in 194 patients and found that BMD was highest in C4 and decreased in the caudal direction. For the thoracic spine, despite the downward tendency of HU value form T1 to T12, there were no significant difference. As we all known, age has negative relationship with BMD and previous studies have revealed that mean HU value displayed a tendency to decrease with age[ 16 ], which was also verified in the current study. Lee et al[ 17 ] found that mean HU values decreased consistently by decade, ranging from a mean of 175.0 HU in the 5th decade to 51.8 HU in the 9th decade of life. Kobes et al[ 18 ] revealed that mean BMD decreased linearly with 2.4 HU per year of age. As for whether the HU value correlated with gender, the current study found that HU values were significantly higher in male than female in all vertebras from C2 to L5. Zhang et al found that HU of the lumbar spine in men aged 40–59 years was significantly higher than that in women[ 19 ]. The significant positive correlations of HU value with BMD and T-score of DEXA have been reported and verified in many studies[ 20 ]. Despite the positive correlation was verified, correlation coefficients reported were obviously different among various studies. Zhang et al reported that the HU value of the L1–L4 were positively correlated with the T-scores of L1–L4 (r = 0.349)[ 19 ]. In Lee’s study, the correlation coefficients between HU value and T-score were for the L1-4 vertebrae were 0.673, 0.794, 0.766, and 0.713, respectively[ 17 ]. Choi et al[ 21 ] reported that the correlation was higher in the non-degenerative group (r = 0.701, 0.709, 0.709, 0.649 and 0.734 for L1, L2, L3, L4, L1-4) than degenerative group (r = 0.300, 0.457, 0.433, 0.447 and 0.398). In the current study, the correlation of HU value of C2-L5 with T-score were evaluated respectively and the correlation varied greatly from cervical to lumbar spine. Among the T-score of L1-L4, L3 T-score has the highest correlation with HU value of C2-L5 vertebra (r:0.53–0.83). The HU value of thoracic vertebras has the highest correlation with L3 T-score than cervical and lumbar vertebras. For the detailed vertebras, C4 (r = 0.72), T7 (r = 0.83) and L3 (r = 0.69) has the highest correlation with L3 T-score. HU value has been proven to be a feasible tool to assess bone quality and identify osteoporosis opportunistically with reasonable sensitivity and specificity[ 22 ]. Berger-Groch et al reported that 100% sensitivity to detect osteoporosis was reached in patients with HU<62 in L4, with HU<58 in L5 and with HU<68 in S1[ 23 ]. Schreiber[ 16 ] and Lee[ 17 ] reported the mean HU values for normal, osteopenic, and osteoporotic subjects were 133.0, 100.8, 78.5 and 120.8, 78.8 and 54.7 respectively. A meta-analysis including 9 studies in 2021 found that HU is a clinically useful tool to aide in the diagnosis of osteoporosis with the threshold of 135 HU[ 24 ]. In the current study, the threshold of HU values of different part of spine were also calculated to evaluate osteoporosis with HU value of 334 for C4, 160 for T7 and 112 for L3. We do not suggest that CT-HU be used instead of DEXA for the assessment of BMD, although we believe that HU may provide valuable additional information for those individuals who undergo CT scan for other reasons and those who cannot take DEXA exam. This study also has several limitations. The cross-sectional design of our analysis limits our level of evidence. In addition, sample size of 200 subjects from a single center was not enough for comprehensively analyze the detailed distribution pattern of CT-HU value. So, further multi-center cohort studies with large sample are needed to better analyze the clinical significance of CT-HU value. Conclusion Through the current cross-sectional CT-HU value measurement of 6600 vertebras, the distinct distributional characteristics and regional variation of HU value for the whole spine were described. Despite of significant variation of CT-HU from C2 to L5, there were certain trends and rules with intrinsic correlation of bone mineral density for individuals. Knowledge of CT-HU variation from cervical to thoracic and lumbar spine will be helpful for us to make proper decision and strategy for spine surgery. Declarations Author Contribution (1) Conception and design: Liang Wang and Lei Qi; (2) Acquisition and analysis of data: Yuxuan Yang, Biteng Xu, Gaoya Yu, Haozhi Yu; (3)Figure preparation: Lei Qi, Yuxuan Yang and Liang Wang; (4) Drafting and revising the article: Lei Qi, Yuxuan Yang and Liang Wang; (5) Final approval of the version to be published: Liang Wang, Lei Qi References Batur P (2024) Osteoporosis Update: Screening and Treatment Recommendations. J Womens Health (Larchmt) 33:269–272. 10.1089/jwh.2023.0816 Girdler SJ, Lindsey MH, Sebastian AS, Nassr A (2024) Osteoporosis Evaluation and Management in Spine Surgery. J Am Acad Orthop Surg 32:e909–e918. 10.5435/JAAOS-D-24-00311 Wang H, Zou D, Sun Z, Wang L, Ding W, Li W (2020) Hounsfield Unit for Assessing Vertebral Bone Quality and Asymmetrical Vertebral Degeneration in Degenerative Lumbar Scoliosis. 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Eur Spine J 29:1098–1104. 10.1007/s00586-020-06292-z Ahern DP, McDonnell JM, Riffault M, Evans S, Wagner SC, Vaccaro AR, Hoey DA, Butler JS (2021) A meta-analysis of the diagnostic accuracy of Hounsfield units on computed topography relative to dual-energy X-ray absorptiometry for the diagnosis of osteoporosis in the spine surgery population. Spine J 21:1738–1749. 10.1016/j.spinee.2021.03.008 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7326976","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502269954,"identity":"a7ad7daf-5186-4e05-8059-548590f8c4fe","order_by":0,"name":"Lei Qi","email":"","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Qi","suffix":""},{"id":502269956,"identity":"d5cbcd45-fa16-4cc6-a447-59f0c0a0789a","order_by":1,"name":"Yuxuan Yang","email":"","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Yuxuan","middleName":"","lastName":"Yang","suffix":""},{"id":502269957,"identity":"22c39b68-db94-40fc-81ef-96adc23ad6db","order_by":2,"name":"Biteng Xu","email":"","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Biteng","middleName":"","lastName":"Xu","suffix":""},{"id":502269960,"identity":"ce116881-4fc7-4fb2-86c5-2b2cc9c2e48f","order_by":3,"name":"Gaoya Yu","email":"","orcid":"","institution":"School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Gaoya","middleName":"","lastName":"Yu","suffix":""},{"id":502269963,"identity":"fca11d85-e06b-456a-8d1d-d6436700dba0","order_by":4,"name":"Haozhi Yu","email":"","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Haozhi","middleName":"","lastName":"Yu","suffix":""},{"id":502269965,"identity":"e05e111a-7b49-4ded-97e0-a88c3f0514c7","order_by":5,"name":"Liang Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACduaGA1Am4wMGNhCdQEALMyNcC7MB0VpgTDYJorQYHGZsPPBzR21i/+z2a5U/yg4z8LPnGDD83IFXS8PB3jPHE2fcOVN2m+fcYQbJnjcGjL1ncGsxA2o5wNt2LLfhRk7abca2wwwGN3IMmBnb8Gs5+BeoZT5QS+FPoBZ7YrQc5m2ryd1wI/0YAy/IFgkCWuxBWmTbDtRvvJHDLM1zLp1H4syzgoO9eLRItjcf/vi2rc5Y7kb6w48/yqzl+NuTNz74iUcLFBwGYh4DEIsHRBwgqIGBoQ6I2R8QoXAUjIJRMApGIgAAn9ZbZ0Qj4UUAAAAASUVORK5CYII=","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":true,"prefix":"","firstName":"Liang","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-08-08 11:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7326976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7326976/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89679482,"identity":"b0b81bca-8ba2-408d-94bc-0510addc1fe9","added_by":"auto","created_at":"2025-08-22 14:21:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1962806,"visible":true,"origin":"","legend":"\u003cp\u003eMethod of CT-HU value measurement. A-C: CT-HU value of axial plane was measured at three levels within the vertebral body: immediately caudal to the superior end plate, mid-body, and cranial to the inferior end plate. D-E: CT-HU value of mid-sagittal plane was measured from C2-L5. F-H: CT-HU value of mid-coronal plane was measured from C2-L5.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7326976/v1/cc399af6ba45f2ae18d8e865.jpg"},{"id":89680239,"identity":"1a8313f9-b762-4c42-850e-728555fe80fa","added_by":"auto","created_at":"2025-08-22 14:29:08","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":498146,"visible":true,"origin":"","legend":"\u003cp\u003eThe box-plot of CT-HU value from C2-L5 showed there was no significant difference of CT-HU value between coronal, sagittal and axial planes for the same vertebra with a downward trend from cervical to thoracic and lumbar spine.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7326976/v1/b43eebc86a7b46c9150a914d.jpg"},{"id":89680242,"identity":"4007e733-1ba4-4392-9d71-a18f7e16b2ee","added_by":"auto","created_at":"2025-08-22 14:29:08","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1110835,"visible":true,"origin":"","legend":"\u003cp\u003eThe line chart of CT-HU value for the different subgroups. A: There was significant difference of CT-HU value between normal BMD, osteopenia and osteoporosis groups. B: CT-HU value was significant higher in male than female cases. C. CT-HU value gradually decreased with age.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7326976/v1/6da990bcef57b202803d1c2f.jpg"},{"id":89679489,"identity":"f55d2e37-1ff0-4c59-b053-da664faece3d","added_by":"auto","created_at":"2025-08-22 14:21:09","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":4142656,"visible":true,"origin":"","legend":"\u003cp\u003eThe correlation analysis between CT-HU value and T-score. A: The heat map showed the correlation analysis between CT-HU value of C2-L5 and T-score of L1-L4. The values in the lower left part of the graph represent correlations, and correspondingly, the closer the shape of the upper right part was to the round and the lighter color, the less correlation they had. B: The scatter plot showed the pearson correlation of HU value of C4, T7, L3 with T-score of L3 in normal BMD, osteopenia and osteoporosis groups.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7326976/v1/cba62b546679fad386a82d02.jpg"},{"id":89680244,"identity":"1be832f0-445a-4e66-9e7e-c1b67a2523e4","added_by":"auto","created_at":"2025-08-22 14:29:09","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":322504,"visible":true,"origin":"","legend":"\u003cp\u003eThe ROC curves assessing performance of CT-HU value to identify subjects with osteoporosis as diagnosed by T-score. 334 HU of C4 was 0.49% specific and 61.7% sensitive, 160.5HU of T7 was 49% specific and 87.9% sensitive and 112.5HU of L3 was 66% specific and 74.8% sensitive for osteoporosis.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7326976/v1/60859c760cbc157b8328f3f0.jpg"},{"id":99314407,"identity":"1be04e4b-3bb0-4850-a588-53f27b023687","added_by":"auto","created_at":"2025-12-31 16:21:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8501752,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7326976/v1/0b19711d-a067-4f72-88d3-82a3dfe43c0a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Distributional characteristics and regional variation of hounsfield units value across whole spinal vertebral bodies: a cross-sectional study based on 200 objects and 6600 vertebras measurement","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNowadays, the gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DEXA) recommended by the World Health Organization[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As a two-dimensional measurement, DEXA only measures density/area and its calculations include the cortical bone and the posterior elements. T-score of DEXA can be overestimated due to degenerative bony spurs and facet hypertrophy in an aging population, which sometimes make DEXA less sensitive to osteoporosis screening[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe utilization of Hounsfield units (HU) value from computerized tomography (CT) scan in screening osteoporosis in the lumbar spine has been widely reported. There were significant positive correlations of HU value with bone mineral density (BMD) and T-score [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. CT-HU value is measured in the cancellous area of the vertebral body, which makes it less affected by degenerative changes[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. More importantly, HU value can be attained prospectively or retrospectively from all clinical CT exams, which could provide an opportunity to screen BMD at no additional radiation exposure and little cost when CT have been ordered for other indications[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Based on these advantages, the CT-HU value has been regarded as an important tool to evaluate the BMD and to aid in early opportunistic screening for osteoporosis.\u003c/p\u003e\u003cp\u003eNowadays, most studies on CT-HU value measurement focused on lumbar spine and research on cervical and thoracic spine is limited and DEXA could not provide the T-score of cervical and thoracic spine. To the best of our knowledge, no studies of CT-HU value measurement and analysis of whole spine in the same population has been conducted until now. The purpose of this study to describe the distribution and characteristics of CT-HU value from cervical, thoracic to lumbar spine, and analyze the correlation between HU value and lumbar T-score.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e The study was approved by the ethics committee of local hospital. Consecutive adult subjects (\u0026ge;\u0026thinsp;18 years old) undergoing cervical, thoracic, lumbar spine CT and DEXA scanning within 3 months due to degenerative spine pathology or physical examination at our hospital between January 2021 and June 2024 were screened for eligibility in the current study. The exclusion criteria included general autoimmune or metabolism diseases, spine deformity, spine tumor, infectious spondylitis, previous spinal instrumentation or fusion surgery.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eCT-HU value measurement method\u003c/h2\u003e\u003cp\u003eAll imaging was performed using a 64-row and 128-slice multidetector CT scanner (Siemens, Germany). The CT parameters included a slice thickness of 0.6 mm, a tube voltage of 120kV, and a tube current of 156mA. The study was restricted to native scans without a contrast medium. HU value measurement was performed using Philips EasyVision Picture Archiving and Communication System (PACS). The field of view was adapted to the individual anatomy. Two-dimensional reconstructions were obtained in the coronal and sagittal planes. CT-HU value was measured by placing a click-and-drag circle region of interest (ROI) within vertebral trabecular bone, which was made as large as possible while avoiding avoid cortical bone, the posterior venous plexus, bone islands, compressed bone, and other heterogeneous areas (Figure.1). The measurements were taken by a single rater, who was blinded to the DXA results. The deformed vertebras, vertebras with serious degenerative changes, and any apparent sclerotic levels that might affect trabecular HU measurements were excluded.\u003c/p\u003e\u003cp\u003eHU value was recorded in the axial, sagittal and coronal plane from C2-L5. For axial plane, HU value was measured at three levels within the vertebral body: immediately caudal to the superior end plate, mid-body, and cranial to the inferior end plate (Figure.1A-C). For sagittal and coronal plane, the mid-sagittal (Figure.1D-E) and mid-coronal plane (Figure.1F-H) was respectively selected to measure HU value.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eContinuous variables were recorded as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and categorical variables were expressed as frequency or percentages. An independent t test was used to analyze the difference of continuous variables. χ2 test and Fisher exact test were used to examine the differences among categorical variables. A paired t test was used to analyze the difference of HU values between different slices and planes for a vertebra. Analysis of variance (ANOVA) was performed to analyze the difference of HU values between different levels and subgroups. Correlation values of HU with age and with T-score using Pearson correlation coefficient (weak: 0-0.39, moderate: 0.40\u0026ndash;0.59, strong: 0.60-1.0). Mean and 95% confidence intervals were calculated of cases with T-score divided into three groups (normal, osteopenia, and osteoporosis). In addition, the receiver operating characteristic (ROC) curve was used to assess areas under the curve (AUC, with 95% confidence interval), as well as optimal cutoff points, and calculate sensitivity and specificity for osteoporosis. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software, Version 22.0 (IBM Corp., NY, USA). The statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003ePopulation sample\u003c/h2\u003e\u003cp\u003eThere were 200 subjects enrolled in the study with the mean age of 63.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6 years (range: 40\u0026ndash;79 years), including 92 male (mean age: 62.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 years ) and 108 female (mean age: 65.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6 years). According to the T-score of DEXA and subgrouping, there were 68 cases in normal group (T-score\u0026ge;-1.0), 72 cases in osteopenia (-1.0\u0026gt;T-score\u0026gt;-2.5) and 60 cases in osteoporosis (T-score\u0026le;-2.5) group. All cases were divided into three subgroups by age, including 30 cases of age\u0026thinsp;\u0026le;\u0026thinsp;45y, 58 cases of 45\u0026lt;age\u0026thinsp;\u0026le;\u0026thinsp;60y, 84 cases of 60\u0026lt;age\u0026thinsp;\u0026le;\u0026thinsp;75y, and 28 cases of age\u0026gt;75y.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDistribution and reginal variation of HU value from C2-L5\u003c/h3\u003e\n\u003cp\u003eThe HU value for the same vertebra was respectively measured in the axial, sagittal and coronal plane from C2-L5. There were no significant differences of HU value between 3 different axial slices and sagittal, coronal planes for the same vertebra (P\u0026gt;0.05) (Figure.2). So, the HU value of sagittal plane was selected for following analysis because of its easily assessment. As for the different parts of spine, the HU value of vertebra showed a downward trend from cervical to thoracic and lumbar spine, with significant difference between the cervical, thoracic and lumbar spine (P\u0026thinsp;=\u0026thinsp;0.000). The decrease amplitude was greater in cervical than thoracic and lumbar spine. For the cervical spine form C2 to C7, HU value of C2 was the highest, followed by C4, C3, C5, C6 and C7. For the thoracic spine, despite the downward trend form T1 to T12, there were no significant difference. For the lumbar spine, L3 has the lowest HU value but without significant difference with other levels from L1 to L5.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSubgroups analysis\u003c/h2\u003e\u003cp\u003eThe trend of HU value from C2-L5 was also respectively described for BMD normal, osteopenia and osteoporosis subgroups (Figure.3A). For osteoporosis group, HU value of all vertebras from C2-L5 was significantly lower than normal and osteopenia groups (P\u0026thinsp;=\u0026thinsp;0.000). The HU value in the three subgroups showed the similar whole trend from cervical, thoracic to lumbar spine. However, the decrease amplitude from cervical to thoracic spine was significantly greater in osteoporosis group.\u003c/p\u003e\u003cp\u003eAs for the gender, the HU value of all vertebras was significant higher in male than female cases (P\u0026thinsp;=\u0026thinsp;0.000), but with the similar trend from C2-L5 (Figure.3B). As for the age, it was observed that the mean HU value gradually decreased with age with significant difference (P\u0026thinsp;=\u0026thinsp;0.000), except the difference between cases of 60\u0026lt;age\u0026thinsp;\u0026le;\u0026thinsp;75y and cases of age\u0026gt;75y (P\u0026thinsp;=\u0026thinsp;0.463) (Figure.3C).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCorrelation of HU and T-score\u003c/h3\u003e\n\u003cp\u003eThe correlation between HU value of C2-L5 vertebra and T-score of L1-L4 and total lumbar vertebras were present in Figure.4A. L3 T-score has the highest correlation with HU value of C2-L5 vertebra. As for the different parts of spine, the HU value of thoracic vertebras has the highest correlation with L3 T-score, followed by cervical and lumbar vertebras. For the detailed vertebras, HU value of C4 (r\u0026thinsp;=\u0026thinsp;0.72), T7 (r\u0026thinsp;=\u0026thinsp;0.83) and L3 (r\u0026thinsp;=\u0026thinsp;0.69) has the highest correlation with L3 T-score, which were selected as the representative vertebra for cervical, thoracic and lumbar spine. As for the correlation of HU value with T-score in cases of different BMD, the correlation was lower in osteoporosis than osteopenia and normal BMD groups for cervical (C4), thoracic (T7) and lumbar (L3) spine (Figure.4B).\u003c/p\u003e\n\u003ch3\u003eROC analysis for osteoporosis\u003c/h3\u003e\n\u003cp\u003eReceiver operating characteristic (ROC) analysis was performed to assess the diagnostic accuracy of HU for identifying individuals with osteoporosis. The area under the curve (AUC) was calculated respectively from C2 to L2. The results showed that C4 (AUC, 0.78), T7 (AUC, 0.96) and L3 (AUC, 0.85) were the highest ROC among the cervical, thoracic and lumbar spine respectively (Figure.5). In addition, a screening HU value of 334 for C4, 160 for T7 and 112 for L3 was selected to diagnose osteoporosis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccurate assessment of BMD is very important for diagnosis of osteoporosis and related clinical work. Despite of as the gold standard for evaluating BMD, DEAX has some limitations for widely application. Previous studies have revealed that the T-score tended to be higher than the actual BMD in degenerative patients and older patients or patients having degenerative lumbar scoliosis[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. CT-HU value only measures the trabecular portion of the vertebra, and has been regarded as accurate and reliable alternate method of assessing BMD[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost of the HU value research focused on the lumbar vertebras and fewer studies measured the HU value for the whole spine on consecutive population. Base on 200 objects and 6600 vertebras measurement, the characteristics and distributional trend of HU value from C2-L5 were analyzed in the current study. As for the same vertebra, it was found that HU value was similar between axial, sagittal and coronal planes for normal vertebras, which was constant with previous reports [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs for whether the HU value of different vertebras or different parts different significantly? It was found that the HU value showed the downward trend from cervical to lumbar spine in the study, which was consistent with previous studies. Cervical spine has proportionally more cortical bone than the rest of the spine and biomechanical analysis found a continuous increase in density with progression from lumbar toward cervical vertebrae. Marinova et al measured the CT-HU value at the thoracic and lumbar spine (T1, T6, T12, L1\u0026ndash;L5) in 234 patients and found that HU values were highest at T1 and T6, lowest at L1\u0026ndash;L3[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Yoganandan et al found the decrease in trabecular BMD from rostral to caudal along the entire spine[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Weishaupt et al[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] found the trabecular BMD of the cervical spine to be significantly higher compared to the thoracic and lumbar spine in a QCT study of 50 healthy volunteers.\u003c/p\u003e\u003cp\u003eAs for the cervical spine, the current study revealed that cervical HU value vary by vertebral level and HU value of C2 was the highest (C2\u0026thinsp;\u0026gt;\u0026thinsp;C4\u0026thinsp;\u0026gt;\u0026thinsp;C3\u0026thinsp;\u0026gt;\u0026thinsp;C5\u0026thinsp;\u0026gt;\u0026thinsp;C6\u0026thinsp;\u0026gt;\u0026thinsp;C7), which was consistent with previous reports[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Anderst et al[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] revealed that average BMD of C3 and C6 was significantly less than C4 and C5, and C7 was the lowest. Stephan et al[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] measured the QCT of C1-T1 vertebras in 194 patients and found that BMD was highest in C4 and decreased in the caudal direction. For the thoracic spine, despite the downward tendency of HU value form T1 to T12, there were no significant difference.\u003c/p\u003e\u003cp\u003eAs we all known, age has negative relationship with BMD and previous studies have revealed that mean HU value displayed a tendency to decrease with age[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which was also verified in the current study. Lee et al[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] found that mean HU values decreased consistently by decade, ranging from a mean of 175.0 HU in the 5th decade to 51.8 HU in the 9th decade of life. Kobes et al[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] revealed that mean BMD decreased linearly with 2.4 HU per year of age. As for whether the HU value correlated with gender, the current study found that HU values were significantly higher in male than female in all vertebras from C2 to L5. Zhang et al found that HU of the lumbar spine in men aged 40\u0026ndash;59 years was significantly higher than that in women[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe significant positive correlations of HU value with BMD and T-score of DEXA have been reported and verified in many studies[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Despite the positive correlation was verified, correlation coefficients reported were obviously different among various studies. Zhang et al reported that the HU value of the L1\u0026ndash;L4 were positively correlated with the T-scores of L1\u0026ndash;L4 (r\u0026thinsp;=\u0026thinsp;0.349)[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In Lee\u0026rsquo;s study, the correlation coefficients between HU value and T-score were for the L1-4 vertebrae were 0.673, 0.794, 0.766, and 0.713, respectively[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Choi et al[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] reported that the correlation was higher in the non-degenerative group (r\u0026thinsp;=\u0026thinsp;0.701, 0.709, 0.709, 0.649 and 0.734 for L1, L2, L3, L4, L1-4) than degenerative group (r\u0026thinsp;=\u0026thinsp;0.300, 0.457, 0.433, 0.447 and 0.398). In the current study, the correlation of HU value of C2-L5 with T-score were evaluated respectively and the correlation varied greatly from cervical to lumbar spine. Among the T-score of L1-L4, L3 T-score has the highest correlation with HU value of C2-L5 vertebra (r:0.53\u0026ndash;0.83). The HU value of thoracic vertebras has the highest correlation with L3 T-score than cervical and lumbar vertebras. For the detailed vertebras, C4 (r\u0026thinsp;=\u0026thinsp;0.72), T7 (r\u0026thinsp;=\u0026thinsp;0.83) and L3 (r\u0026thinsp;=\u0026thinsp;0.69) has the highest correlation with L3 T-score.\u003c/p\u003e\u003cp\u003eHU value has been proven to be a feasible tool to assess bone quality and identify osteoporosis opportunistically with reasonable sensitivity and specificity[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Berger-Groch et al reported that 100% sensitivity to detect osteoporosis was reached in patients with HU\u0026lt;62 in L4, with HU\u0026lt;58 in L5 and with HU\u0026lt;68 in S1[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Schreiber[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Lee[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] reported the mean HU values for normal, osteopenic, and osteoporotic subjects were 133.0, 100.8, 78.5 and 120.8, 78.8 and 54.7 respectively. A meta-analysis including 9 studies in 2021 found that HU is a clinically useful tool to aide in the diagnosis of osteoporosis with the threshold of 135 HU[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In the current study, the threshold of HU values of different part of spine were also calculated to evaluate osteoporosis with HU value of 334 for C4, 160 for T7 and 112 for L3.\u003c/p\u003e\u003cp\u003eWe do not suggest that CT-HU be used instead of DEXA for the assessment of BMD, although we believe that HU may provide valuable additional information for those individuals who undergo CT scan for other reasons and those who cannot take DEXA exam. This study also has several limitations. The cross-sectional design of our analysis limits our level of evidence. In addition, sample size of 200 subjects from a single center was not enough for comprehensively analyze the detailed distribution pattern of CT-HU value. So, further multi-center cohort studies with large sample are needed to better analyze the clinical significance of CT-HU value.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThrough the current cross-sectional CT-HU value measurement of 6600 vertebras, the distinct distributional characteristics and regional variation of HU value for the whole spine were described. Despite of significant variation of CT-HU from C2 to L5, there were certain trends and rules with intrinsic correlation of bone mineral density for individuals. Knowledge of CT-HU variation from cervical to thoracic and lumbar spine will be helpful for us to make proper decision and strategy for spine surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e(1) Conception and design: Liang Wang and Lei Qi; (2) Acquisition and analysis of data: Yuxuan Yang, Biteng Xu, Gaoya Yu, Haozhi Yu; (3)Figure preparation: Lei Qi, Yuxuan Yang and Liang Wang; (4) Drafting and revising the article: Lei Qi, Yuxuan Yang and Liang Wang; (5) Final approval of the version to be published: Liang Wang, Lei Qi\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBatur P (2024) Osteoporosis Update: Screening and Treatment Recommendations. 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Spine J 21:1738\u0026ndash;1749. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.spinee.2021.03.008\u003c/span\u003e\u003cspan address=\"10.1016/j.spinee.2021.03.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hounsfield units, spine, computerized tomography, vertebral","lastPublishedDoi":"10.21203/rs.3.rs-7326976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7326976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo describe and analyze the distribution characteristics of hounsfield units (HU) value from computerized tomography (CT) scan across whole spine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eConsecutive adult subjects undergoing cervical, thoracic, lumbar spine CT and DEXA scanning between January 2020 and June 2024 were screened in the study. The CT-HU value of vertebras was respectively measured from C2-L5.The distribution characteristics and reginal heterogeneity of HU value were analyzed. The correlation between HU value of C2-L5 and T-score of lumbar vertebras were also evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere were 200 subjects with 6600 vertebras enrolled in the study with the mean age of 63.7±12.6 years including 92 male and 108 female. There were no significant differences of CT-HU value between axial, sagittal and coronal planes for the same vertebra. HU value showed a downward trend from cervical to thoracic and lumbar spine. HU value of all vertebras in osteoporosis group was significantly lower than normal and osteopenia groups. HU value of all vertebras was significant higher in male than female and the mean HU values gradually decreased with age. L3 T-score has the highest correlation with HU value of C2-L5 vertebra and the HU value of thoracic vertebras has the highest correlation with L3 T-score, followed by cervical and lumbar vertebras.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe CT-HU value has distinct distribution characteristics for different part of spine and the reginal variation from C2 to L5 share certain trends and rules. Despite of significant variation, vertebral CT-HU value has intrinsic correlation with bone mineral density for individuals.\u003c/p\u003e","manuscriptTitle":"Distributional characteristics and regional variation of hounsfield units value across whole spinal vertebral bodies: a cross-sectional study based on 200 objects and 6600 vertebras measurement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-22 14:21:04","doi":"10.21203/rs.3.rs-7326976/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52ca6006-c918-4373-8f82-861e1ccc84d8","owner":[],"postedDate":"August 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T01:53:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-22 14:21:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7326976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7326976","identity":"rs-7326976","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}