Regions of interest in opportunistic computed tomography-based screening for osteoporosis: impact on short-term in vivo precision

Park et al. evaluated the short-term precision of various regions of interest (ROI) for opportunistic CT-based osteoporosis screening, using AVIEW, an advanced deep-learning software. In a study involving 73 patients, attenuation differences were analyzed across 54 ROI configurations on L1 vertebra CT scans. Results showed that large, elliptical ROIs on 1- or 3-mm slice-thickness images at the mid-level provided the highest diagnostic precision (RMSSD: 12.4–12.5 HU) and accuracy (AUROC: 0.90). The study identified optimal ROI placement to improve diagnostic precision and recommended thin-slice imaging when feasible. Patient-level factors such as age or body size showed no significant impact. While this work establishes a foundational approach for precise CT-based screening, limitations include the single-center design and exclusion of sagittal and coronal planes. Future studies should validate findings across broader populations and explore additional imaging configurations. The use of AVIEW software highlights its potential in advancing osteoporosis diagnostics.