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Peer-reviewedCC BY 4.0PLOS One

Spectral CT electron density for evaluation of lumbar intervertebral disk degeneration

  • Masanori Nakajo1
  • Tsubasa Nakano2
  • Tomohito Hasegawa3
  • Kiyohisa Kamimura4
  • Koji Takumi5
  • Hiroaki Nagano6
  • Masatoyo Nakajo
  • Hiroyuki Tominaga
  • Mutsukazu Hayashi
  • Takashi Iwanaga
  • Fumiko Kanzaki
  • Eran Langzam
3 more authors
  • Graeme Campbell
  • Ko Higuchi
  • Takashi Yoshiura
6 affiliations
  1. 1Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
  2. 2Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
  3. 3Department of Radiological Technology, Kagoshima University Hospital, Kagoshima, Japan
  4. 4CT Clinical Science, Philips Healthcare, Haifa, Israel
  5. 5CT Clinical Science, Philips GmbH Market DACH, Hamburg, Germany
  6. 6CT Clinical Science, Philips Japan, Tokyo, Japan
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Abstract

Objective: This study aimed to investigate the ability of spectral CT parameters to evaluate lumbar intervertebral disk degeneration (LIDD). Summary of background data: LIDD is the most prevalent cause of low back pain. However, the usefulness of spectral CT for LIDD evaluation remains unclear. Methods: This retrospective study included consecutive patients who underwent spectral CT and Magnetic resonance imaging for spinal disease examination from February 2018 to June 2021 on a single center. The conventional polyenergetic 120-kVp computed tomography value (CTconv), electron density (ED), and effective atomic number (Zeff) were measured in the annulus fibrosus (AF) and nucleus pulposus (NP) in each disk. Additionally, differences in each spectral CT parameter were obtained between the anterior AF and NP and between the posterior AF and NP. These parametric values were correlated with modified Pfirrmann grade (mPG) using Spearman’s rank correlation coefficients. The receiver operating characteristic curve analysis was used to assess diagnostic performances for differentiating between normal and degenerative disks. Results: Three hundred thirty-eight lumbar intervertebral disks of 100 patients were analyzed. The CTconv and ED were negatively correlated with mPG in AF (ρ = −0.29 to −0.36) and positively correlated with mPG in NP (ρ = 0.16–0.45), whereas Zeff in NP was negatively correlated with mPG (ρ = −0.29 to −0.38). The ED differences between the anterior AF and NP and between the posterior AF and NP were strongly correlated with mPG (ρ = −0.71 and −0.64, respectively) and demonstrated high diagnostic performances in differentiating between normal and degenerative disks (area under the receiver operating characteristic curve values = 0.92 and 0.88, respectively). Conclusion: Spectral CT parameters, particularly ED, can diagnose lumbar intervertebral disk degeneration.

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Cite

BibTeXRIS
BibTeX
@article{nakajo2026spectral,
  title = {{Spectral CT electron density for evaluation of lumbar intervertebral disk degeneration}},
  author = {Masanori Nakajo and Tsubasa Nakano and Tomohito Hasegawa and Kiyohisa Kamimura and Koji Takumi and Hiroaki Nagano and Masatoyo Nakajo and Hiroyuki Tominaga and Mutsukazu Hayashi and Takashi Iwanaga and Fumiko Kanzaki and Eran Langzam and Graeme Campbell and Ko Higuchi and Takashi Yoshiura},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357658},
  url = {https://doi.org/10.1371/journal.pone.0357658},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Spectral CT electron density for evaluation of lumbar intervertebral disk degeneration
AU  - Masanori Nakajo
AU  - Tsubasa Nakano
AU  - Tomohito Hasegawa
AU  - Kiyohisa Kamimura
AU  - Koji Takumi
AU  - Hiroaki Nagano
AU  - Masatoyo Nakajo
AU  - Hiroyuki Tominaga
AU  - Mutsukazu Hayashi
AU  - Takashi Iwanaga
AU  - Fumiko Kanzaki
AU  - Eran Langzam
AU  - Graeme Campbell
AU  - Ko Higuchi
AU  - Takashi Yoshiura
PY  - 2026
DA  - 2026/09/01
JO  - PLOS One
DO  - 10.1371/journal.pone.0357658
UR  - https://doi.org/10.1371/journal.pone.0357658
AB  - Objective: This study aimed to investigate the ability of spectral CT parameters to evaluate lumbar intervertebral disk degeneration (LIDD). Summary of background data: LIDD is the most prevalent cause of low back pain. However, the usefulness of spectral CT for LIDD evaluation remains unclear. Methods: This retrospective study included consecutive patients who underwent spectral CT and Magnetic resonance imaging for spinal disease examination from February 2018 to June 2021 on a single center. The conventional polyenergetic 120-kVp computed tomography value (CTconv), electron density (ED), and effective atomic number (Zeff) were measured in the annulus fibrosus (AF) and nucleus pulposus (NP) in each disk. Additionally, differences in each spectral CT parameter were obtained between the anterior AF and NP and between the posterior AF and NP. These parametric values were correlated with modified Pfirrmann grade (mPG) using Spearman’s rank correlation coefficients. The receiver operating characteristic curve analysis was used to assess diagnostic performances for differentiating between normal and degenerative disks. Results: Three hundred thirty-eight lumbar intervertebral disks of 100 patients were analyzed. The CTconv and ED were negatively correlated with mPG in AF (ρ = −0.29 to −0.36) and positively correlated with mPG in NP (ρ = 0.16–0.45), whereas Zeff in NP was negatively correlated with mPG (ρ = −0.29 to −0.38). The ED differences between the anterior AF and NP and between the posterior AF and NP were strongly correlated with mPG (ρ = −0.71 and −0.64, respectively) and demonstrated high diagnostic performances in differentiating between normal and degenerative disks (area under the receiver operating characteristic curve values = 0.92 and 0.88, respectively). Conclusion: Spectral CT parameters, particularly ED, can diagnose lumbar intervertebral disk degeneration.
SN  - 1932-6203
ER  -