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. 2025 Nov;34(11):4984-4997.
doi: 10.1007/s00586-025-08923-9. Epub 2025 May 21.

Diagnostic model for distinguishing fresh or old osteoporotic vertebral compression fractures based on modified computed tomography window: a retrospective cohort study

Shichu Wang  1   2   3 , Zhenghan Han  1   2   3   4 , Yiting Lei  1   2   3 , Wenjun Liu  1   2   3 , Tianji Huang  1   2   3 , Bo Liu  5   6   7
Affiliations

Diagnostic model for distinguishing fresh or old osteoporotic vertebral compression fractures based on modified computed tomography window: a retrospective cohort study

Shichu Wang et al. Eur Spine J. 2025 Nov.

Abstract

Purpose: To develop and validate a Computed Tomography (CT) -based nomogram for distinguishing fresh from old osteoporotic vertebral compression fractures (OVCFs), with magnetic resonance imaging (MRI) as the reference standard.

Methods: In this retrospective study, OVCF patients from The First Affiliated Hospital of Chongqing Medical University (August 2022-December 2023) were analyzed. Modified CT window parameters (width: 400; level: 200) were applied to quantify vertebral features, including CT values, height reduction, endplate integrity, trabecular sparsity, Schmorl's nodes, and high-density shadows. Predictive variables were selected via univariate and multivariate logistic regression, followed by nomogram construction. Model performance was assessed using receiver operating characteristic (ROC) curves (area under the curve, AUC), calibration plots, Hosmer-Lemeshow testing, and decision curve analysis (DCA). 10-fold cross-validation was used to evaluate the generalization performance of the model.

Results: The nomogram incorporated seven imaging biomarkers, achieving AUCs of 0.941 (training cohort) and 0.974 (validation cohort). The calibration accuracy was assessed using the Hosmer-Lemeshow test (χ²=3.30, P = 0.95). DCA demonstrating significant clinical utility across probability thresholds. In cross-validation, the mean AUC on the validation sets was 0.911 ± 0.080 (mean ± standard deviation).

Conclusion: The proposed CT-based nomogram achieved adequate performance in identifying fresh and old OVCFs.

Keywords: Acute lower back pain; CT value; Diagnostic model; Modified CT window technique; Osteoporotic vertebral compression fractures.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval from the institutional review board of the First Affiliated Hospital of Chongqing Medical University was obtained (K2023-131) and all patients signed informed consent forms. This study was conducted in accordance with the World Medical Association Declaration of Helsinki.Our study has passed the review of the Chinese Clinical Trial Registry, with the registration number ChiCTR2400083010. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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