Comparison of reconstruction kernel and monochromatic energy pairs used in dual energy CT imaging of the proximal humerus.

Dual-energy computed tomography (DECT) enables improved volumetric bone mineral density (vBMD) assessment by accounting for marrow alterations associated with aging, disease, and injury. However, DECT reconstruction kernels and monochromatic energy pair combinations may influence vBMD measurements and finite element model (FEM)-estimated bone stiffness. This study investigated the effects of reconstruction kernel and DECT energy pair combinations on proximal humeral vBMD and FEM-estimated stiffness in cadaveric specimens. Fourteen cadaveric shoulders from seven specimens were scanned bilaterally using DECT with a K2HPO4 calibration phantom. Images were reconstructed using standard (STD) and bone-sharpening (BONE) kernels. Simulated monochromatic images at 40, 90, and 140 keV were combined into 40/90, 40/140, and 90/140 keV energy pairs. Volumetric BMD was extracted from the humeral shaft diaphysis and anatomic neck using custom Python scripts and 3D Slicer software. Image-based FEMs were generated to estimate bone stiffness. Results were analyzed using repeated-measures analysis of variance (RM-ANOVA). In the cortical-dense humeral diaphysis, energy pair combinations had the greatest variation. Mean diaphyseal vBMD increased from 332.08 ± 102.54 mgK2HPO4/cc (40/90 keV BONE) to 406.84 ± 130.15 mgK2HPO4/cc (90/140 keV BONE), while FEM stiffness increased from 180.30 ± 47.07 kN/mm to 223.30 ± 63.91 kN/mm. Significant differences were observed across reconstruction conditions and energy pair combinations. In contrast, trabecular-rich anatomic neck regions demonstrated minimal variation in vBMD and FEM stiffness across energy pairs and kernels. These findings indicate that DECT energy pairs and reconstruction kernel substantially influence cortical bone assessments, particularly when using the 90/140 keV energy pair, while trabecular-rich regions remain comparatively unaffected.