Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal women

Abstract Objective Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mineral density (BMD) and structural deterioration, resulting in increased fracture risk. Early diagnosis is crucial to prevent fractures and improve patient outcomes. This study investigates the diagnosti...

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Main Authors: Sara Rafieizadeh, Sima Lari, Mohammad Mahdi Maleki, Abbas Shokri, Leili Tapak
Format: Article
Language:English
Published: BMC 2025-06-01
Series:BMC Medical Imaging
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Online Access:https://doi.org/10.1186/s12880-025-01739-5
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author Sara Rafieizadeh
Sima Lari
Mohammad Mahdi Maleki
Abbas Shokri
Leili Tapak
author_facet Sara Rafieizadeh
Sima Lari
Mohammad Mahdi Maleki
Abbas Shokri
Leili Tapak
author_sort Sara Rafieizadeh
collection DOAJ
description Abstract Objective Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mineral density (BMD) and structural deterioration, resulting in increased fracture risk. Early diagnosis is crucial to prevent fractures and improve patient outcomes. This study investigates the diagnostic utility of morphometric and cortical indices derived from cone-beam computed tomography (CBCT) for identifying osteoporotic postmenopausal women who were candidates for dental implant therapy, with dual-energy X-ray absorptiometry (DXA) used as the reference standard. Materials and methods This cross-sectional study included 71 postmenopausal women, aged 50–79 years, who underwent CBCT imaging at the Oral and Maxillofacial Radiology Department of Hamadan University of Medical Sciences between 2022 and 2024. Participants with systemic conditions affecting bone metabolism were excluded. The morphometric indices—Computed Tomography Mandibular Index (CTMI), Computed Tomography Index Superior (CTI(S)), Computed Tomography Index Inferior (CTI(I)), and Computed Tomography Cortical Index (CTCI)—were measured at the mental foramen and antegonial regions using OnDemand3D Dental software. Bone mineral density (BMD) was assessed by DXA scans of the lumbar spine and femoral neck. In addition to traditional statistical analyses (Pearson’s correlation and one-way ANOVA with LSD test), a multilayer perceptron (MLP) neural network model was employed to evaluate the diagnostic power of CBCT indices. Results DXA results based on the femoral neck T-scores categorized 38 patients as normal, 32 as osteopenic, and one as osteoporotic, while lumbar spine T-scores identified 38 normal, 22 osteopenic, and 11 osteoporotic patients. Significant differences (p < 0.05) were observed in most CBCT-derived indices, with the CTMI index demonstrating the most marked variation, especially between normal and osteoporotic groups (p < 0.001). Moreover, significant positive correlations were found between the CBCT indices and DXA T-scores across the lumbar spine, femoral neck, and total hip regions. The neural network model achieved an overall diagnostic accuracy of 75%, with the highest predictive importance attributed to antegonial CTCI and CTMI indices. Conclusion This study highlights the significant correlation between CBCT-derived radiomorphometric indices such as CTMI, CTI(S), CTI(I), and CTCI at the mental foramen and antegonial regions and bone mineral density (BMD) in postmenopausal women. CBCT, particularly the CTMI index in the antegonial region, offers a cost-effective, non-invasive method for early osteoporosis detection, providing a valuable alternative to traditional screening methods.
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spelling doaj-art-bd85b1310a18467eb351ddcd56ad2fba2025-08-20T03:26:43ZengBMCBMC Medical Imaging1471-23422025-06-0125111210.1186/s12880-025-01739-5Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal womenSara Rafieizadeh0Sima Lari1Mohammad Mahdi Maleki2Abbas Shokri3Leili Tapak4Dental Implants Research Centre, Department of Oral and Maxillofacial Radiology, Dental School, Hamadan University of Medical SciencesDepartment of Oral and Maxillofacial Radiology, Dental School, Shahid Beheshti University of Medical SciencesStudent Research Committee, Hamadan, University of Medical SciencesDental Implants Research Centre, Department of Oral and Maxillofacial Radiology, Dental School, Hamadan University of Medical SciencesDepartment of Biostatistics, Hamadan University of Medical SciencesAbstract Objective Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mineral density (BMD) and structural deterioration, resulting in increased fracture risk. Early diagnosis is crucial to prevent fractures and improve patient outcomes. This study investigates the diagnostic utility of morphometric and cortical indices derived from cone-beam computed tomography (CBCT) for identifying osteoporotic postmenopausal women who were candidates for dental implant therapy, with dual-energy X-ray absorptiometry (DXA) used as the reference standard. Materials and methods This cross-sectional study included 71 postmenopausal women, aged 50–79 years, who underwent CBCT imaging at the Oral and Maxillofacial Radiology Department of Hamadan University of Medical Sciences between 2022 and 2024. Participants with systemic conditions affecting bone metabolism were excluded. The morphometric indices—Computed Tomography Mandibular Index (CTMI), Computed Tomography Index Superior (CTI(S)), Computed Tomography Index Inferior (CTI(I)), and Computed Tomography Cortical Index (CTCI)—were measured at the mental foramen and antegonial regions using OnDemand3D Dental software. Bone mineral density (BMD) was assessed by DXA scans of the lumbar spine and femoral neck. In addition to traditional statistical analyses (Pearson’s correlation and one-way ANOVA with LSD test), a multilayer perceptron (MLP) neural network model was employed to evaluate the diagnostic power of CBCT indices. Results DXA results based on the femoral neck T-scores categorized 38 patients as normal, 32 as osteopenic, and one as osteoporotic, while lumbar spine T-scores identified 38 normal, 22 osteopenic, and 11 osteoporotic patients. Significant differences (p < 0.05) were observed in most CBCT-derived indices, with the CTMI index demonstrating the most marked variation, especially between normal and osteoporotic groups (p < 0.001). Moreover, significant positive correlations were found between the CBCT indices and DXA T-scores across the lumbar spine, femoral neck, and total hip regions. The neural network model achieved an overall diagnostic accuracy of 75%, with the highest predictive importance attributed to antegonial CTCI and CTMI indices. Conclusion This study highlights the significant correlation between CBCT-derived radiomorphometric indices such as CTMI, CTI(S), CTI(I), and CTCI at the mental foramen and antegonial regions and bone mineral density (BMD) in postmenopausal women. CBCT, particularly the CTMI index in the antegonial region, offers a cost-effective, non-invasive method for early osteoporosis detection, providing a valuable alternative to traditional screening methods.https://doi.org/10.1186/s12880-025-01739-5Cone-beam computed tomography (CBCT)Bone mineral density (BMD)Radiomorphometric indicesOsteoporosis screeningPostmenopausal womens
spellingShingle Sara Rafieizadeh
Sima Lari
Mohammad Mahdi Maleki
Abbas Shokri
Leili Tapak
Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal women
BMC Medical Imaging
Cone-beam computed tomography (CBCT)
Bone mineral density (BMD)
Radiomorphometric indices
Osteoporosis screening
Postmenopausal womens
title Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal women
title_full Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal women
title_fullStr Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal women
title_full_unstemmed Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal women
title_short Investigation of the correlation between radiomorphometric indices in cone-beam computed tomography images and dual X-ray absorptiometry bone density test results in postmenopausal women
title_sort investigation of the correlation between radiomorphometric indices in cone beam computed tomography images and dual x ray absorptiometry bone density test results in postmenopausal women
topic Cone-beam computed tomography (CBCT)
Bone mineral density (BMD)
Radiomorphometric indices
Osteoporosis screening
Postmenopausal womens
url https://doi.org/10.1186/s12880-025-01739-5
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