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Dillenseger JP, Gillet R, Louis M, Bach J, Sieffert C, Meylheuc L, Palpacuer C, Bierry G, Garnon J, Blum A. Quantitative and qualitative evaluation of three MSCT for high resolution bone imaging. Eur J Radiol 2024; 173:111394. [PMID: 38428256 DOI: 10.1016/j.ejrad.2024.111394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/09/2023] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Strategies for achieving high resolution varies between manufacturers. In CT, the helical mode with narrow collimation has long been considered as the gold standard for high-resolution imaging. More recently, incremental modes with small dexels and focal spot, have been developed but have not been compared with helical acquisitions under optimal conditions. The aim of this work is to compare the high-resolution acquisition strategies currently proposed by recent MSCT. METHODS Three CT systems were compared. A phantom was used to evaluate geometric accuracy, uniformity, scan slice geometry, and spatial resolution. Human dry bones were used to test different protocols on real bone architecture. A blind visual analysis was conducted by trained CT users for classifying the different acquisitions (p-values). RESULTS All systems give satisfactory results in terms of geometric accuracy and uniformity. The in-plane MTF at 5% were respectively 13.4, 15.9 and 18.1 lp/cm. Dry-bones evaluation confirms that acquisition#3 is considered as the best. CONCLUSIONS The incremental acquisition coupled with à small focal spot, and a high-sampling detector, overpasses the reference of low-pitch helical acquisitions for high-resolution imaging. Cortical bone, bony vessels, and tumoral matrix analysis are the very next challenges that will have to be managed to improve normal and pathologic bone imaging thanks to the availability UHR-CT systems.
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Affiliation(s)
- Jean-Philippe Dillenseger
- ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France; Pole d'imagerie médicale, Hôpitaux universitaire de Strasbourg, Strasbourg, France.
| | - Romain Gillet
- Service D'imagerie Guilloz, CHRU Nancy, Nancy, France; IADI - U1254, Inserm, Université de Lorraine, Nancy, France
| | | | - Justin Bach
- Pole d'imagerie médicale, Hôpitaux universitaire de Strasbourg, Strasbourg, France.
| | - Cléa Sieffert
- ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France.
| | - Laurence Meylheuc
- ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France.
| | - Clément Palpacuer
- Clinical research department, Groupe Hospitalier Mulhouse et Sud Alsace, Mulhouse, France.
| | - Guillaume Bierry
- ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France; Pole d'imagerie médicale, Hôpitaux universitaire de Strasbourg, Strasbourg, France.
| | - Julien Garnon
- ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France; Pole d'imagerie médicale, Hôpitaux universitaire de Strasbourg, Strasbourg, France.
| | - Alain Blum
- Service D'imagerie Guilloz, CHRU Nancy, Nancy, France; IADI - U1254, Inserm, Université de Lorraine, Nancy, France.
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Mondal S, MacManus DB, Banche-Niclot F, Vitale-Brovarone C, Fiorilli S, McCarthy HO, Dunne N. Finite element analysis of vertebroplasty in the osteoporotic T11-L1 vertebral body: Effects of bone cement formulation. J Biomed Mater Res B Appl Biomater 2024; 112:e35359. [PMID: 38247244 DOI: 10.1002/jbm.b.35359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Vertebral compression fractures are one of the most severe clinical consequences of osteoporosis and the most common fragility fracture afflicting 570 and 1070 out of 100,000 men and women worldwide, respectively. Vertebroplasty (VP), a minimally invasive surgical procedure that involves the percutaneous injection of bone cement, is one of the most efficacious methods to stabilise osteoporotic vertebral compression fractures. However, postoperative fracture has been observed in up to 30% of patients following VP. Therefore, this study aims to investigate the effect of different injectable bone cement formulations on the stress distribution within the vertebrae and intervertebral discs due to VP and consequently recommend the optimal cement formulation. To achieve this, a 3D finite element (FE) model of the T11-L1 vertebral body was developed from computed tomography scan data of the spine. Osteoporotic bone was modeled by reducing the Young's modulus by 20% in the cortical bone and 74% in cancellous bone. The FE model was subjected to different physiological movements, such as extension, flexion, bending, and compression. The osteoporotic model caused a reduction in the average von Mises stress compared with the normal model in the T12 cancellous bone and an increment in the average von Mises stress value at the T12 cortical bone. The effects of VP using different formulations of a novel injectable bone cement were modeled by replacing a region of T12 cancellous bone with the materials. Due to the injection of the bone cement at the T12 vertebra, the average von Mises stresses on cancellous bone increased and slightly decreased on the cortical bone under all loading conditions. The novel class of bone cements investigated herein demonstrated an effective restoration of stress distribution to physiological levels within treated vertebrae, which could offer a potential superior alternative for VP surgery as their anti-osteoclastogenic properties could further enhance the appeal of their fracture treatment and may contribute to improved patient recovery and long-term well-being.
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Affiliation(s)
- Subrata Mondal
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
| | - David B MacManus
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- BRAIN Lab, School of Mechanical & Materials Engineering, University College Dublin, Dublin 4, Ireland
| | | | | | - Sonia Fiorilli
- Department of Applied Science and Technology, Politecnico di Torino, Turin, Italy
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7 BL, UK
| | - Nicholas Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Centre for Medical Engineering Research, Dublin City University, Dublin 9, Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, Dublin 2, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, Dublin 9, Ireland
- Biodesign Europe, Dublin City University, Dublin 9, Ireland
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Gillet R, Boubaker F, Hossu G, Thay A, Gillet P, Blum A, Teixeira PAG. Computed Tomography Bone Imaging: Pushing the Boundaries in Clinical Practice. Semin Musculoskelet Radiol 2023; 27:397-410. [PMID: 37748463 DOI: 10.1055/s-0043-1768451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Bone microarchitecture has several clinical implications over and above estimating bone strength. Computed tomography (CT) analysis mainly uses high-resolution peripheral quantitative CT and micro-CT, research imaging techniques, most often limited to peripheral skeleton assessment. Ultra-high-resolution (UHR) CT and photon-counting detector CT, two commercially available techniques, provide images that can approach the spatial resolution of the trabeculae, bringing bone microarchitecture analysis into clinical practice and improving depiction of bone vascularization, tumor matrix, and cortical and periosteal bone. This review presents bone microarchitecture anatomy, principles of analysis, reference measurements, and an update on the performance and potential clinical applications of these new CT techniques. We also share our clinical experience and technical considerations using an UHR-CT device.
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Affiliation(s)
- Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
| | - Fatma Boubaker
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
| | | | | | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
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Midthun P, Kirkhus E, Østerås BH, Høiness PR, England A, Johansen S. Metal artifact reduction on musculoskeletal CT: a phantom and clinical study. Eur Radiol Exp 2023; 7:46. [PMID: 37524994 PMCID: PMC10390408 DOI: 10.1186/s41747-023-00354-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/10/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Artifacts caused by metal implants are challenging when undertaking computed tomography (CT). Dedicated algorithms have shown promising results although with limitations. Tin filtration (Sn) in combination with high tube voltage also shows promise but with limitations. There is a need to examine these limitations in more detail. The purpose of this study was to investigate the impact of different metal artefact reduction (MAR) algorithms, tin filtration, and ultra-high-resolution (UHR) scanning, alone or in different combinations in both phantom and clinical settings. METHODS An ethically approved clinical and phantom study was conducted. A modified Catphan® phantom with titanium and stainless-steel inserts was scanned with six different MAR protocols with tube voltage ranging from 80 to 150 kVp. Other scan parameters were kept identical. The differences (∆) in mean HU and standard deviation (SD) in images, with and without metal, were measured and compared. In the clinical study, three independent readers performed visual image quality assessments on eight different protocols using retrospectively acquired images. RESULTS Iterative MAR had the lowest ∆HU and ∆SD in the phantom study. For images of the forearm, the soft tissue noise for Sn-based 150-kVp UHR protocol with was significantly higher (p = 0.037) than for single-energy MAR protocols. All Sn-based 150-kVp protocols were rated significantly higher (p < 0.046 than the single-energy MAR protocols in the visual assessment. CONCLUSIONS All Sn-based 150-kVp UHR protocols showed similar objective MAR in the phantom study, and higher objective MAR and significantly improved visual image quality than single-energy MAR. RELEVANCE STATEMENT Images with less metal artifacts and higher visual image quality may be more clinically optimal in CT examination of musculoskeletal patients with metal implants. KEY POINTS • Metal artifact reduction algorithms and Sn filter combined with high kVp reduce artifacts. • Metal artifact reduction algorithms introduce new artifacts in certain metals. • Sn-based protocols alone may be considered as low metal artifact protocols.
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Affiliation(s)
- Petter Midthun
- Health Faculty, Oslo Metropolitan University, Pilestredet 48, 0130, Oslo, Norway
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva Kirkhus
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Bjørn Helge Østerås
- Department of Physics and Image Analysis, Oslo University Hospital, Oslo, Norway
| | | | - Andrew England
- School of Medicine, University College Cork, Cork, England
| | - Safora Johansen
- Health Faculty, Oslo Metropolitan University, Pilestredet 48, 0130, Oslo, Norway.
- Department of Cancer Treatment, Oslo University Hospital, Oslo, Norway.
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Guha I, Zhang X, Rajapakse CS, Chang G, Saha PK. Finite element analysis of trabecular bone microstructure using CT imaging and continuum mechanical modelling. Med Phys 2022; 49:3886-3899. [PMID: 35319784 PMCID: PMC9325403 DOI: 10.1002/mp.15629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Osteoporosis is a bone disease associated with enhanced bone loss, microstructural degeneration, and fracture‐risk. Finite element (FE) modeling is used to estimate trabecular bone (Tb) modulus from high‐resolution three‐dimensional (3‐D) imaging modalities including micro‐computed tomography (CT), magnetic resonance imaging (MRI), and high‐resolution peripheral quantitative CT (HR‐pQCT). This paper validates an application of voxel‐based continuum finite element analysis (FEA) to predict Tb modulus from clinical CT imaging under a condition similar to in vivo imaging by comparing with measures derived by micro‐CT and experimental approaches. Method Voxel‐based continuum FEA methods for CT imaging were implemented using linear and nonlinear models and applied on distal tibial scans under a condition similar to in vivo imaging. First, tibial axis in a CT scan was aligned with the coordinate z‐axis at 150 μm isotropic voxels. FEA was applied on an upright cylindrical volume of interests (VOI) with its axis coinciding with the tibial bone axis. Voxel volume, edge, and vertex elements and their connectivity were defined as per the isotropic image grid. A calibration phantom was used to calibrate CT numbers in Hounsfield unit to bone mineral density (BMD) values, which was then converted into calcium hydroxyapatite (CHA) density. Mechanical properties at each voxel volume element was defined using its ash‐density defined on CT‐derived CHA density. For FEA, the bottom surface of the cylindrical VOI was fixed and a constant displacement was applied along the z‐direction at each vertex element on the top surface to simulate a physical axial compressive loading condition. Finally, a Poisson's ratio of 0.3 was applied, and Tb modulus (MPa) was computed as the ratio of average von Mises stress (MPa) of volume elements on the top surface and the applied displacement. FEA parameters including mesh element size, substep number, and different tolerance values were optimized. Results CT‐derived Tb modulus values using continuum FEA showed high linear correlation with the micro‐CT‐derived reference values (r ∈ [0.87 0.90]) as well as experimentally measured values (r ∈ [0.80 0.87]). Linear correlation of computed modulus with their reference values using continuum FEA with linear modeling was comparable with that obtained by nonlinear modeling. Nonlinear continuum FEA‐based modulus values (mean of 1087.2 MPa) showed greater difference from their reference values (mean of 1498.9 MPa using micro‐CT‐based FEA) as compared with linear continuum methods. High repeat CT scan reproducibility (intra‐class correlation [ICC] = 0.98) was observed for computed modulus values using both linear and nonlinear continuum FEA. It was observed that high stress regions coincide with Tb microstructure as fuzzily characterized by BMD values. Distributions of von Mises stress over Tb microstructure and marrow regions were significantly different (p < 10–8). Conclusion Voxel‐based continuum FEA offers surrogate measures of Tb modulus from CT imaging under a condition similar to in vivo imaging that alleviates the need for segmentation of Tb and marrow regions, while accounting for bone distribution at the microstructural level. This relaxation of binary segmentation will extend the scope of FEA application to assess mechanical properties of bone microstructure at relatively low‐resolution imaging.
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Affiliation(s)
- Indranil Guha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gregory Chang
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, 52242, USA.,Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
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