Phantomless Computed Tomography-Based Quantitative Bone Mineral Density Assessment: A Literature Review

The global surge in aging populations has intensified osteoporosis challenges, necessitating improved diagnostic methods. While dual X-ray absorptiometry (DXA) is the conventional standard in assessing bone mineral density (BMD), the exploration of quantitative computed tomography (QCT) has been proposed, particularly phantomless techniques. Challenges in single-energy CT, emphasizing internal calibration standards like subcutaneous fat, are discussed. Advances in PL-QCT, notably with automatic region of interest (ROI) selection, show improved accuracy. Dual-energy CT (DECT) introduces new dimensions for musculoskeletal analysis. Despite advancements, challenges persist, including interindividual variability and patient-specific factors. Evolving single-energy CT and DECT techniques show promise in refining BMD assessment and osteoporosis diagnosis, enhancing patient care. Continued research and integration into clinical practice are vital for realizing these advancements' full benefits. In this review, we evaluate and summarize current evidence on the feasibility and different approaches to achieve analysis of BMD with phantomless QCT.