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Microstructural and histomorphological features of osteophytes in late-stage human knee osteoarthritis with varus deformity. Joint Bone Spine 2022; 89:105353. [DOI: 10.1016/j.jbspin.2022.105353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/30/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022]
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Castro-Mollo M, Gera S, Ruiz-Martinez M, Feola M, Gumerova A, Planoutene M, Clementelli C, Sangkhae V, Casu C, Kim SM, Ostland V, Han H, Nemeth E, Fleming R, Rivella S, Lizneva D, Yuen T, Zaidi M, Ginzburg Y. The hepcidin regulator erythroferrone is a new member of the erythropoiesis-iron-bone circuitry. eLife 2021; 10:e68217. [PMID: 34002695 PMCID: PMC8205482 DOI: 10.7554/elife.68217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 01/19/2023] Open
Abstract
Background Erythroblast erythroferrone (ERFE) secretion inhibits hepcidin expression by sequestering several bone morphogenetic protein (BMP) family members to increase iron availability for erythropoiesis. Methods To address whether ERFE functions also in bone and whether the mechanism of ERFE action in bone involves BMPs, we utilize the Erfe-/- mouse model as well as β-thalassemic (Hbbth3/+) mice with systemic loss of ERFE expression. In additional, we employ comprehensive skeletal phenotyping analyses as well as functional assays in vitro to address mechanistically the function of ERFE in bone. Results We report that ERFE expression in osteoblasts is higher compared with erythroblasts, is independent of erythropoietin, and functional in suppressing hepatocyte hepcidin expression. Erfe-/- mice display low-bone-mass arising from increased bone resorption despite a concomitant increase in bone formation. Consistently, Erfe-/- osteoblasts exhibit enhanced mineralization, Sost and Rankl expression, and BMP-mediated signaling ex vivo. The ERFE effect on osteoclasts is mediated through increased osteoblastic RANKL and sclerostin expression, increasing osteoclastogenesis in Erfe-/- mice. Importantly, Erfe loss in Hbbth3/+mice, a disease model with increased ERFE expression, triggers profound osteoclastic bone resorption and bone loss. Conclusions Together, ERFE exerts an osteoprotective effect by modulating BMP signaling in osteoblasts, decreasing RANKL production to limit osteoclastogenesis, and prevents excessive bone loss during expanded erythropoiesis in β-thalassemia. Funding YZG acknowledges the support of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (R01 DK107670 to YZG and DK095112 to RF, SR, and YZG). MZ acknowledges the support of the National Institute on Aging (U19 AG60917) and NIDDK (R01 DK113627). TY acknowledges the support of the National Institute on Aging (R01 AG71870). SR acknowledges the support of NIDDK (R01 DK090554) and Commonwealth Universal Research Enhancement (CURE) Program Pennsylvania.
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Affiliation(s)
- Melanie Castro-Mollo
- Division of Hematology Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Sakshi Gera
- The Mount Sinai Bone Program, Departments of Medicine and Pharmacological Sciences, and Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Marc Ruiz-Martinez
- Division of Hematology Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Maria Feola
- Division of Hematology Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Anisa Gumerova
- The Mount Sinai Bone Program, Departments of Medicine and Pharmacological Sciences, and Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Marina Planoutene
- Division of Hematology Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Cara Clementelli
- Division of Hematology Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Veena Sangkhae
- Center for Iron Disorders, University of California, Los Angeles (UCLA)Los AngelesUnited States
| | - Carla Casu
- Department of Pediatrics, Division of Hematology, and Penn Center for Musculoskeletal Disorders, Children’s Hospital of Philadelphia (CHOP), University of Pennsylvania, Perelman School of MedicinePhiladelphiaUnited States
| | - Se-Min Kim
- The Mount Sinai Bone Program, Departments of Medicine and Pharmacological Sciences, and Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | | | - Huiling Han
- Intrinsic Lifesciences, LLCLaJollaUnited States
| | - Elizabeta Nemeth
- Center for Iron Disorders, University of California, Los Angeles (UCLA)Los AngelesUnited States
| | - Robert Fleming
- Department of Pediatrics, Saint Louis University School of MedicineSt LouisUnited States
| | - Stefano Rivella
- Department of Pediatrics, Division of Hematology, and Penn Center for Musculoskeletal Disorders, Children’s Hospital of Philadelphia (CHOP), University of Pennsylvania, Perelman School of MedicinePhiladelphiaUnited States
| | - Daria Lizneva
- The Mount Sinai Bone Program, Departments of Medicine and Pharmacological Sciences, and Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Tony Yuen
- The Mount Sinai Bone Program, Departments of Medicine and Pharmacological Sciences, and Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Mone Zaidi
- The Mount Sinai Bone Program, Departments of Medicine and Pharmacological Sciences, and Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Yelena Ginzburg
- Division of Hematology Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
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Arsan B, Yalcin-Ülker GM, Meral DG, Erdem TL. Is there any predictive bone parameter for implant stability in 2-dimensional and 3-dimensional radiologic images? Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:371-379. [PMID: 32891573 DOI: 10.1016/j.oooo.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/26/2020] [Accepted: 08/07/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This ex vivo study aimed to compare radiomorphometric parameters between 2-dimensional (2-D) and 3-dimensional (3-D) radiographs and evaluate the influence of preoperative radiologic bone parameters on the clinical outcomes of implant stability. STUDY DESIGN Implant recipient sites in fresh bovine blocks were evaluated on panoramic radiographs for gray value (GV), fractal dimension (FD), number of connected trabeculae (Co), and density of connected trabeculae (CoD). Cone beam computed tomography (CBCT) scans were evaluated for trabecular thickness (TbTh), cortical thickness (CTh), degree of anisotropy (DA), FD, and Co. Insertion torque (IT) and implant stability quotient (ISQ) were measured. RESULTS GV was significantly correlated with all parameters in 2-D and 3-D images except FD in 2-D and Co in 3-D, and with all surgical parameters (P ≤ .029). Co and CoD values on panoramic radiographs had significant correlation with TbTh, CTh, and DA values on CBCT images (P < .001). All 2-D parameters and TbTh and CTh in the CBCT data were significantly correlated with IT only (P ≤ .047). Only GV was correlated with ISQ measurements (P ≤ .029). CONCLUSIONS GV, Co, and CoD values on panoramic radiographs reflect the architecture of trabecular bone and the thickness of cortical bone, and might help predict implant stability in clinical situations.
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Affiliation(s)
- Belde Arsan
- Assistant Professor, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey.
| | - Gül Merve Yalcin-Ülker
- Assistant Professor, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Istanbul Okan University, Istanbul
| | - Deniz Gökce Meral
- Professor, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Istanbul Okan University, Istanbul
| | - Tamer Lütfi Erdem
- Professor, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Beykent University, Istanbul
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Coupry A, Rony L, Ducellier F, Hubert L, Chappard D. Texture analysis of trabecular bone around RM-Pressfit cementless acetabulum in a series of 46 patients during a 5 year period. Orthop Traumatol Surg Res 2019; 105:1283-1287. [PMID: 31477444 DOI: 10.1016/j.otsr.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless total hip arthroplasty (THA) is a common procedure producing excellent clinical results. Their long-term survival is nevertheless burdened by loosening of the acetabular part caused by changes in the distribution of strains around the cup. In this context the RM-Pressfit® cup has been developed, resulting in a more harmonious distribution of the strains. HYPOTHESIS Texture analysis of X-ray films can evaluate the evolution of trabecular bone micro-architecture during the five years following THA with a RM-Pressfit® cup. MATERIAL AND METHOD A monocentric series of 46 hips was reviewed regularly within five years post- surgery. Radiographic evaluation of the operated hip was done on frontal digitized radiographs of the pelvis to follow evolution of bone micro-architecture in the #2 zone of De Lee and Charnley. Texture analysis using fractal algorithms was done at D0, 6 months, 1, 2 and 5 years post-THA. The fractal methods used included the skyscrapers and the dynamic blanket methods with 3 different structuring elements (a cross, a horizontal and a vertical vector). RESULTS The RM-Pressfit® caused significant changes in the distribution of strains around the acetabulum that preserved the bone volume over a 5-year period post-surgery. This corresponds to an improvement of the trabecular micro-architecture around the acetabular cups. CONCLUSION A statistically significant increase in the four fractal dimensions considered corresponded to an improved trabecular bone micro-architecture revealed by texture analysis, a non-invasive method that can be used on digitized X-ray images. LEVEL OF EVIDENCE IIIb, Case control study, retrospective design.
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Affiliation(s)
- Augustin Coupry
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France
| | - Louis Rony
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | | | - Laurent Hubert
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | - Daniel Chappard
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France.
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Fauch L, Palander A, Dekker H, Schulten EA, Koistinen A, Kullaa A, Keinänen M. Narrowband-autofluorescence imaging for bone analysis. BIOMEDICAL OPTICS EXPRESS 2019; 10:2367-2382. [PMID: 31149377 PMCID: PMC6524578 DOI: 10.1364/boe.10.002367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
We present a new autofluorescence-imaging method for bone analysis. This method, based on the autofluorescence of bone, provides color images in microscopic scale. The color images are created from three monochrome images acquired with optimal excitation- and emission-wavelengths combinations. The choice of these combinations were determined from the study of two-dimensional distributions of bone-features-bispectral autofluorescence in the visible- and ultraviolet-spectral range. We demonstrate that main-bone features visualized with MG-staining method can also be visualized in the autofluorescence-color image. Furthermore, the autofluorescence-color image presents features hardly distinguished in a histological-bone section.
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Affiliation(s)
- Laure Fauch
- SIB Labs, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- Co-first authors with equal contribution
- Co-first authors with equal contribution
| | - Anni Palander
- Institute of Dentistry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- Co-first authors with equal contribution
| | - Hannah Dekker
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije Universiteit VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, Amsterdam, The Netherlands
| | - Engelbert Ajm Schulten
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije Universiteit VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, Amsterdam, The Netherlands
| | - Arto Koistinen
- SIB Labs, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Arja Kullaa
- SIB Labs, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- Institute of Dentistry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- Research Group of Oral Health Sciences, Faculty of Medicine, P.O. Box 8000, 90014 Oulu, Finland
| | - Markku Keinänen
- Department of Environmental and Biological Sciences, University of Eastern Finland, P.O. Box 111, 80100 Joensuu, Finland
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Kahn A, Kün-Darbois JD, Bertin H, Corre P, Chappard D. Mandibular bone effects of botulinum toxin injections in masticatory muscles in adult. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:100-108. [PMID: 31227452 DOI: 10.1016/j.oooo.2019.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/29/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Botulinum toxin (BTX) is injected into masticatory muscles to treat various conditions. Animal studies have demonstrated bone loss at the condylar and alveolar regions of the mandible after BTX injection into masticatory muscles. The aim of the present study was to investigate mandibular bone changes in patients who received BTX injections in masticatory muscles. STUDY DESIGN Twelve adult patients who received BTX injections into masticatory muscles were included in this study. Cone beam computed tomography (CBCT) was performed before and 12 months after the injection. The condylar and alveolar regions of the mandible were analyzed by using texture analysis of the CBCT images with the run length method. Condylar cortical thickness was measured, and 3-dimensional analysis of the mandible was also performed. Six patients who did not receive BTX injections were used as controls. RESULTS A run length parameter (gray level nonuniformity) was found to be increased in condylar and alveolar bones. A significant cortical thinning was found at the anterior portion of the right condyle. Three-dimensional analysis showed significant changes in the condylar bone and at the digastric fossa. No changes in mandibular angles were found. CONCLUSIONS This study identified mandibular bone changes in adult patients who received BTX injection into masticatory muscles.
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Affiliation(s)
- Alexis Kahn
- Department of Oral and Maxillofacial surgery, Chu d'Angers, Angers, Cedex, France; Department of Oral and Maxillofacial surgery, Chu de Nantes, Nantes, Cedex 1, France
| | - Jean-Daniel Kün-Darbois
- Department of Oral and Maxillofacial surgery, Chu d'Angers, Angers, Cedex, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, UNIV Angers, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Chu d'Angers, Angers, Cedex, France
| | - Helios Bertin
- Department of Oral and Maxillofacial surgery, Chu de Nantes, Nantes, Cedex 1, France
| | - Pierre Corre
- Department of Oral and Maxillofacial surgery, Chu de Nantes, Nantes, Cedex 1, France
| | - Daniel Chappard
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, UNIV Angers, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Chu d'Angers, Angers, Cedex, France.
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Silva LM, Venâncio JF, Loures ADO, Lopes DGDF, Dechichi P, Rabelo GD. Efeito do Diabetes Mellitus tipo I na organização espacial das trabéculas ósseas: análise por meio do processo de esqueletonização. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introdução: Diabetes mellitus é uma doença metabólica que afeta vários órgãos-alvo, incluindo os ossos. OBJETIVO: Avaliar pelo método de esqueletonização o efeito do Diabetes mellitus tipo I (DM1) na microarquitetura de osso esponjoso. Material e Métodos: Quatorze ratos Wistar foram divididos em: Saudável (S, n=7) e Diabético (D, n=7). O DM1 foi induzido por meio de injeção endovenosa de estreptozotocina no grupo D, sendo a confirmação da condição realizada por checagem do nível glicêmico. Os animais foram sacrificados após 35 dias da indução no grupo D, juntamente com os do grupo S. As epífises femorais foram seccionadas, removidas, desmineralizadas e incluídas em parafina. Dois cortes (5 µm) foram obtidos, corados em Hematoxilina e Eosina, e analisados ao Microscópio de Luz. Foi realizada a delimitação interativa das trabéculas ósseas, seguido pelo processo de binarização utilizando threshold global, feita por dois operadores distintos. Depois, foi realizado o processo de esqueletonização para acesso às características das trabéculas e da rede de interconexão entre elas. Os parâmetros avaliados foram: Área óssea em micrômetros quadrados (B.Ar), Índice de Modelo estrutural (SMI), Dimensão Fractal (FD), Número de trabéculas (Tb.N), Número de ramos (B.N), Número total de junções (Junc.N), Média de pontos terminais (End.p), Média de extensão de cada ramo (R.Le) e Número de junções triplas (Triple.points.N). Resultados: Houve diferença significante apenas no parâmetro SMI para os diferentes operadores (p<0,0001), sendo o mesmo retirado da análise entre diabetes vs saudável. Houve diferença significante na quantidade óssea, sendo maior no grupo S (0,46±0,09) comparado ao grupo D (0,41±0,07) (p=0,0082). Os demais parâmetros não mostraram diferença significante. Conclusão: Conclui-se que a área óssea no grupo saudável é maior em comparação ao DM1. Dentro das limitações deste estudo, parece que a distribuição espacial das trabéculas e suas características de interconexão não são alteradas no diabetes.
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Muehlematter UJ, Mannil M, Becker AS, Vokinger KN, Finkenstaedt T, Osterhoff G, Fischer MA, Guggenberger R. Vertebral body insufficiency fractures: detection of vertebrae at risk on standard CT images using texture analysis and machine learning. Eur Radiol 2018; 29:2207-2217. [PMID: 30519934 DOI: 10.1007/s00330-018-5846-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/30/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of bone texture analysis (TA) combined with machine learning (ML) algorithms in standard CT scans to identify patients with vertebrae at risk for insufficiency fractures. MATERIALS AND METHODS Standard CT scans of 58 patients with insufficiency fractures of the spine, performed between 2006 and 2013, were analyzed retrospectively. Every included patient had at least two CT scans. Intact vertebrae in a first scan that either fractured ("unstable") or remained intact ("stable") in the consecutive scan were manually segmented on mid-sagittal reformations. TA features for all vertebrae were extracted using open-source software (MaZda). In a paired control study, all vertebrae of the study cohort "cases" and matched controls were classified using ROC analysis of Hounsfield unit (HU) measurements and supervised ML techniques. In a within-subject vertebra comparison, vertebrae of the cases were classified into "unstable" and "stable" using identical techniques. RESULTS One hundred twenty vertebrae were included. Classification of cases/controls using ROC analysis of HU measurements showed an AUC of 0.83 (95% confidence interval [CI], 0.77-0.88), and ML-based classification showed an AUC of 0.97 (CI, 0.97-0.98). Classification of unstable/stable vertebrae using ROC analysis showed an AUC of 0.52 (CI, 0.42-0.63), and ML-based classification showed an AUC of 0.64 (CI, 0.61-0.67). CONCLUSION TA combined with ML allows to identifying patients who will suffer from vertebral insufficiency fractures in standard CT scans with high accuracy. However, identification of single vertebra at risk remains challenging. KEY POINTS • Bone texture analysis combined with machine learning allows to identify patients at risk for vertebral body insufficiency fractures on standard CT scans with high accuracy. • Compared to mere Hounsfield unit measurements on CT scans, application of bone texture analysis combined with machine learning improve fracture risk prediction. • This analysis has the potential to identify vertebrae at risk for insufficiency fracture and may thus increase diagnostic value of standard CT scans.
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Affiliation(s)
- Urs J Muehlematter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Manoj Mannil
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Kerstin N Vokinger
- University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Georg Osterhoff
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Michael A Fischer
- Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Li W, Hirvasniemi J, Guo X, Saarakkala S, Lammi MJ, Qu C. Comparison of bone texture between normal individuals and patients with Kashin-Beck disease from plain radiographs in knee. Sci Rep 2018; 8:17510. [PMID: 30504816 PMCID: PMC6269488 DOI: 10.1038/s41598-018-35552-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/07/2018] [Indexed: 11/23/2022] Open
Abstract
To compare tibial bone texture between Kashin-Beck disease (KBD) patients and normal individuals from plain radiographs using an advanced image analysis. Plain knee radiographs were obtained from KBD patients (n = 49) and age-matched healthy controls (n = 98). KBD were graded with diagnostic criteria WS/T 207-2010. The textural values related to bone structure from medial and lateral tibial subchondral and trabecular bones were evaluated using entropy of Laplacian-based image (ELap), entropy of local binary patterns (ELBP), homogeneity indices (HI) of local angles (HIMean, HIPerp and HIParal), and fractal dimensions from horizontal (FDHor) and vertical (FDVer) structures. KBD patients were shorter in height and lighter in weight, and their tibial width was wider than controls. Anatomical angle of KBD patients showed more genu valgus. Total KBD patients and subgroups had higher ELap, HIMean, HIPerp and HIParal in detected tibial subchondral and trabecular bones than controls, except ELap in lateral subchondral bone. ELBP, FDHor and FDVer from the detected tibial bone in KBD patients and subgroups were lower than controls, except FDVer in lateral trabecular bone. Our results indicate that micro-scale in bone texture in KBD-affected knees can be quantitatively examined from plain radiographs using an advanced image analysis.
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Affiliation(s)
- Wenrong Li
- Department of Medical Imaging, The First Affiliated Hospital of Xi´an Jiaotong University, 277 West Yanta Road, Xi´an Shaanxi, 710061, P. R. China.,School of Public Health, Xi´an Jiaotong University Health Science Center, Xi´an, P. R. China
| | - Jukka Hirvasniemi
- Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Xiong Guo
- School of Public Health, Xi´an Jiaotong University Health Science Center, Xi´an, P. R. China.
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Mikko J Lammi
- School of Public Health, Xi´an Jiaotong University Health Science Center, Xi´an, P. R. China.,Department of Integrative Molecular Biology, Umeå University, 90187, Umeå, Sweden
| | - Chengjuan Qu
- Department of Integrative Molecular Biology, Umeå University, 90187, Umeå, Sweden.
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Castejón D, Alba-Tercedor J, Rotllant G, Ribes E, Durfort M, Guerao G. Micro-computed tomography and histology to explore internal morphology in decapod larvae. Sci Rep 2018; 8:14399. [PMID: 30258199 PMCID: PMC6158171 DOI: 10.1038/s41598-018-32709-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/10/2018] [Indexed: 01/15/2023] Open
Abstract
Traditionally, the internal morphology of crustacean larvae has been studied using destructive techniques such as dissection and microscopy. The present study combines advances in micro-computed tomography (micro-CT) and histology to study the internal morphology of decapod larvae, using the common spider crab (Maja brachydactyla Balss, 1922) as a model and resolving the individual limitations of these techniques. The synergy of micro-CT and histology allows the organs to be easily identified, revealing simultaneously the gross morphology (shape, size, and location) and histological organization (tissue arrangement and cell identification). Micro-CT shows mainly the exoskeleton, musculature, digestive and nervous systems, and secondarily the circulatory and respiratory systems, while histology distinguishes several cell types and confirms the organ identity. Micro-CT resolves a discrepancy in the literature regarding the nervous system of crab larvae. The major changes occur in the metamorphosis to the megalopa stage, specifically the formation of the gastric mill, the shortening of the abdominal nerve cord, the curving of the abdomen beneath the cephalothorax, and the development of functional pereiopods, pleopods, and lamellate gills. The combination of micro-CT and histology provides better results than either one alone.
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Affiliation(s)
- Diego Castejón
- Institut de Ciències del Mar (ICM-CSIC), Passeig Marítim de la Barceloneta 37-49, 08003, Barcelona, Spain.
| | - Javier Alba-Tercedor
- Departamento de Zoología, Facultad de Ciencias, Universidad de Granada, Campus de Fuente Nueva s/n, 18071, Granada, Spain.
| | - Guiomar Rotllant
- Institut de Ciències del Mar (ICM-CSIC), Passeig Marítim de la Barceloneta 37-49, 08003, Barcelona, Spain
| | - Enric Ribes
- Unitat de Biologia Cel·lular, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Diagonal 645, 08028, Barcelona, Spain
| | - Mercè Durfort
- Unitat de Biologia Cel·lular, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Diagonal 645, 08028, Barcelona, Spain
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11
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Behrooz A, Kask P, Meganck J, Kempner J. Automated Quantitative Bone Analysis in In Vivo X-ray Micro-Computed Tomography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1955-1965. [PMID: 28600241 DOI: 10.1109/tmi.2017.2712571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Measurement and analysis of bone morphometry in 3D micro-computed tomography volumes using automated image processing and analysis improve the accuracy, consistency, reproducibility, and speed of preclinical osteological research studies. Automating segmentation and separation of individual bones in 3D micro-computed tomography volumes of murine models presents significant challenges considering partial volume effects and joints with thin spacing, i.e., 50 to [Formula: see text]. In this paper, novel hybrid splitting filters are presented to overcome the challenge of automated bone separation. This is achieved by enhancing joint contrast using rotationally invariant second-derivative operators. These filters generate split components that seed marker-controlled watershed segmentation. In addition, these filters can be used to separate metaphysis and epiphysis in long bones, e.g., femur, and remove the metaphyseal growth plate from the detected bone mask in morphometric measurements. Moreover, for slice-by-slice stereological measurements of long bones, particularly curved bones, such as tibia, the accuracy of the analysis can be improved if the planar measurements are guided to follow the longitudinal direction of the bone. In this paper, an approach is presented for characterizing the bone medial axis using morphological thinning and centerline operations. Building upon the medial axis, a novel framework is presented to automatically guide stereological measurements of long bones and enhance measurement accuracy and consistency. These image processing and analysis approaches are combined in an automated streamlined software workflow and applied to a range of in vivo micro-computed tomography studies for validation.
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12
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Roberts BC, Thewlis D, Solomon LB, Mercer G, Reynolds KJ, Perilli E. Systematic mapping of the subchondral bone 3D microarchitecture in the human tibial plateau: Variations with joint alignment. J Orthop Res 2017; 35:1927-1941. [PMID: 27891668 DOI: 10.1002/jor.23474] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 10/28/2016] [Indexed: 02/04/2023]
Abstract
Tibial subchondral bone plays an important role in knee osteoarthritis (OA). Microarchitectural characterization of subchondral bone plate (SBP), underlying subchondral trabecular bone (STB) and relationships between these compartments, however, is limited. The aim of this study was to characterize the spatial distribution of SBP thickness, SBP porosity and STB microarchitecture, and relationships among them, in OA tibiae of varying joint alignment. Twenty-five tibial plateaus from end-stage knee-OA patients, with varus (n = 17) or non-varus (n = 8) alignment were micro-CT scanned (17 μm/voxel). SBP and STB microarchitecture was quantified via a systematic mapping in 22 volumes of interest per knee (11 medial, 11 lateral). Significant within-condylar and between-condylar (medial vs. lateral) differences (p < 0.05) were found. In varus, STB bone volume fraction (BV/TV) was consistently high throughout the medial condyle, whereas in non-varus, medially, it was more heterogeneously distributed. Regions of high SBP thickness were co-located with regions of high STB BV/TV underneath. In varus, BV/TV was significantly higher medially than laterally, however, not so in non-varus. Moreover, region-specific significant associations between the SBP thickness and SBP porosity and the underlying STB microarchitecture were detected, which in general were not captured when considering the values averaged for each condyle. As subchondral bone changes reflect responses to local mechanical and biochemical factors within the joint, our results suggest that joint alignment influences both the medial-to-lateral and the within-condyle distribution of force across the tibia, generating corresponding local bony responses (adaptation) of both the subchondral bone plate and underlying subchondral trabecular bone microarchitecture. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1927-1941, 2017.
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Affiliation(s)
- Bryant C Roberts
- The Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - Dominic Thewlis
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Graham Mercer
- Department of Orthopaedic Surgery, Repatriation General Hospital, Daws Park, South Australia, Australia
| | - Karen J Reynolds
- The Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - Egon Perilli
- The Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
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13
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Deguette C, Ramond-Roquin A, Rougé-Maillart C. Relationships between age and microarchitectural descriptors of iliac trabecular bone determined by microCT. Morphologie 2017; 101:64-70. [PMID: 28495330 DOI: 10.1016/j.morpho.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 11/18/2022]
Abstract
AIM Estimation of age at death is a major issue in anthropology. The main anthropological histological methods propose studying the architecture of cortical bone. In bone histomorphometry, researches on metabolic bone diseases have provided normative tables for trabecular bone volume (BV/TV) according to age and gender of individuals on trans-iliac bone biopsies. We have used microCT, a non-destructive tool for measuring bone volume and trabecular descriptors to compare the French tables to a series of forensic anthropological population and if the two iliac bones could be used interchangeably. METHODOLOGY Coxal bone of a personal forensic collection whose age and gender were known (DNA identification) were used. Bone samples, centered on the same area than bone biopsy. MicroCT (pixel size: 36μm) was used to measure BV/TV and morphometric trabecular parameters of microarchitecture. An adjusted Z-score was calculated for BV/TV to compare with normative tables and a right/left comparison of trabecular parameters was provided. RESULTS Twenty-seven iliac bones, which 20 forming 10 complete pelvises, aged between 24 and 73y.o. (average of 47.7 y.o.) were used. All adjusted Z-score were within normal values. There was a strong positive correlation between right and left sides for Tb.Th, Tb.N and Tb.Sp, but an insignificant correlation was obtained for BV/TV. CONCLUSION Normative tables between age and BV/TV are valid and therefore usable in anthropology. They may represent an alternative to determine the age at death. Nevertheless, it requires a precise technique that could be a drawback in current practice.
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Affiliation(s)
- C Deguette
- Urgences médico-judiciaires, hôpital Hôtel-Dieu, hôpitaux universitaires Paris centre, AP-HP, 1, place du Parvis-Notre-Dame, 75004 Paris, France.
| | - A Ramond-Roquin
- Département de médecine générale, université d'Angers, LUNAM université, 1, rue Haute-de-Reculée, 49045 Angers cedex 01, France; Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), département de medicine, UA santé publique France, université d'Angers, LUNAM université, 1, rue Haute-de-Reculée, 49045 Angers cedex 01, France
| | - C Rougé-Maillart
- Service de médecine légale, LUNAM université, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
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14
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Blery P, Pilet P, Bossche AV, Thery A, Guicheux J, Amouriq Y, Espitalier F, Mathieu N, Weiss P. Vascular imaging with contrast agent in hard and soft tissues using microcomputed-tomography. J Microsc 2015; 262:40-9. [PMID: 27002484 DOI: 10.1111/jmi.12339] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Abstract
Vascularization is essential for many tissues and is a main requisite for various tissue-engineering strategies. Different techniques are used for highlighting vasculature, in vivo and ex vivo, in 2-D or 3-D including histological staining, immunohistochemistry, radiography, angiography, microscopy, computed tomography (CT) or micro-CT, both stand-alone and synchrotron system. Vascularization can be studied with or without a contrast agent. This paper presents the results obtained with the latest Skyscan micro-CT (Skyscan 1272, Bruker, Belgium) following barium sulphate injection replacing the bloodstream in comparison with results obtained with a Skyscan In Vivo 1076. Different hard and soft tissues were perfused with contrast agent and were harvested. Samples were analysed using both forms of micro-CT, and improved results were shown using this new micro-CT. This study highlights the vasculature using micro-CT methods. The results obtained with the Skyscan 1272 are clearly defined compared to results obtained with Skyscan 1076. In particular, this instrument highlights the high number of small vessels, which were not seen before at lower resolution. This new micro-CT opens broader possibilities in detection and characterization of the 3-D vascular tree to assess vascular tissue engineering strategies.
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Affiliation(s)
- P Blery
- Inserm U791, LIOAD, Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France.,Faculté de chirurgie dentaire, Université de Nantes, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France
| | - P Pilet
- Inserm U791, LIOAD, Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France
| | - A Vanden- Bossche
- Inserm U1059, Laboratoire de Biologie intégrative du Tissu Osseux, Faculté de Médecine, 15 rue Ambroise Paré, 42023 Saint-Etienne cedex
| | - A Thery
- Inserm U791, LIOAD, Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France.,Service d'ORL et de chirurgie cervico-faciale, CHU Hôtel Dieu, 1 place Alexis Ricordeau, 44042 Nantes Cedex 1, France
| | - J Guicheux
- Inserm U791, LIOAD, Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France
| | - Y Amouriq
- Inserm U791, LIOAD, Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France.,Faculté de chirurgie dentaire, Université de Nantes, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France
| | - F Espitalier
- Inserm U791, LIOAD, Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France.,Service d'ORL et de chirurgie cervico-faciale, CHU Hôtel Dieu, 1 place Alexis Ricordeau, 44042 Nantes Cedex 1, France
| | - N Mathieu
- IRSN Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PRP-HOM/SRBE/LR2I, 31 avenue de la division Leclerc BP17, 92260 Fontenay aux roses, France
| | - P Weiss
- Inserm U791, LIOAD, Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France.,Faculté de chirurgie dentaire, Université de Nantes, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France
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15
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Hirvasniemi J, Thevenot J, Kokkonen HT, Finnilä MA, Venäläinen MS, Jämsä T, Korhonen RK, Töyräs J, Saarakkala S. Correlation of Subchondral Bone Density and Structure from Plain Radiographs with Micro Computed Tomography Ex Vivo. Ann Biomed Eng 2015; 44:1698-709. [PMID: 26369637 PMCID: PMC4696139 DOI: 10.1007/s10439-015-1452-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/04/2015] [Indexed: 12/01/2022]
Abstract
Osteoarthritis causes changes in the subchondral bone structure and composition. Plain radiography is a cheap, fast, and widely available imaging method. Bone tissue can be well seen from plain radiograph, which however is only a 2D projection of the actual 3D structure. Therefore, the aim was to investigate the relationship between bone density- and structure-related parameters from 2D plain radiograph and 3D bone parameters assessed from micro computed tomography (µCT) ex vivo. Right tibiae from eleven cadavers without any diagnosed joint disease were imaged using radiography and with µCT. Bone density- and structure-related parameters were calculated from four different locations from the radiographs of proximal tibia and compared with the volumetric bone microarchitecture from the corresponding regions. Bone density from the plain radiograph was significantly related with the bone volume fraction (r = 0.86; n = 44; p < 0.01). Mean homogeneity index for orientation of local binary patterns (HIangle,mean) and fractal dimension of vertical structures (FDVer) were related (p < 0.01) with connectivity density (HIangle,mean: r = −0.73, FDVer: r = 0.69) and trabecular separation (HIangle,mean: r = 0.73, FDVer: r = −0.70) when all ROIs were pooled together (n = 44). Bone density and structure in tibia from standard clinically available 2D radiographs are significantly correlated with true 3D microstructure of bone.
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Affiliation(s)
- Jukka Hirvasniemi
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland. .,Infotech Oulu, University of Oulu, Oulu, Finland.
| | - Jérôme Thevenot
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Harri T Kokkonen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Mikko A Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko S Venäläinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Jämsä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Rami K Korhonen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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16
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Chappard D, Stancu IC. Porosity imaged by a vector projection algorithm correlates with fractal dimension measured on 3D models obtained by microCT. J Microsc 2014; 258:24-30. [PMID: 25556606 DOI: 10.1111/jmi.12212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/02/2014] [Indexed: 11/28/2022]
Abstract
Porosity is an important factor to consider in a large variety of materials. Porosity can be visualized in bone or 3D synthetic biomaterials by microcomputed tomography (microCT). Blocks of porous poly(2-hydroxyethyl methacrylate) were prepared with polystyrene beads of different diameter (500, 850, 1160 and 1560 μm) and analysed by microCT. On each 2D binarized microCT section, pixels of the pores which belong to the same image column received the same pseudo-colour according to a look up table. The same colour was applied on the same column of a frontal plane image which was constructed line by line from all images of the microCT stack. The fractal dimension Df of the frontal plane image was measured as well as the descriptors of the 3D models (porosity, 3D fractal dimension D3D, thickness, density and separation of material walls. Porosity, thickness Df and D3D increased with the size of the porogen beads. A linear correlation was observed between Df and D3D. This method provides quantitative and qualitative analysis of porosity on a single frontal plane image of a porous object.
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Affiliation(s)
- Daniel Chappard
- GEROM Groupe Etudes Remodelage Osseux et bioMatériaux - LHEA, IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, LUNAM Université, 49933 Angers, Cedex, France
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17
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The contribution of Micro-CT to the evaluation of trabecular bone at the posterior part of the auricular surface in men. Int J Legal Med 2014; 132:1231-1239. [PMID: 25538015 DOI: 10.1007/s00414-014-1139-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
AIM Using multi-slice computed tomography (MSCT), Barrier et al. described the disappearance at the posterior auricular surface of a "central line" (CL) and "juxtalinear cells" (JLCs) belonging to a trabecular bundle, and a trabecular density gradient around the CL that decreased with age. The aim of our study was to use micro-CT to test these findings, referring to the concept of Ascadi and Nemeskeri. METHODOLOGY The coxal bones of fifteen males were used; age was known. CLs were identified on MSCT-sections using Barrier's method (64 detectors, 0.6 mm slice thickness, 0.1 mm overlap) with two different software programs (Synapse®, Amira®). Then, CLs were researched on microCT slices (pixel size: 36 μm). Three volumes of interest were defined (around, above, and below CL), and 3D morphometric parameters of the trabecular microarchitecture (particularly BV/TV and DA) were calculated. Two-tailed statistical analyses were performed attempting to correlate these parameters with age at death. RESULTS CLs and JLCs were observed on micro-CT slices, but with moderate agreement between both imaging techniques. Their presence was not correlated with the age of the subjects. Around the CL, BV/TV decreased significantly with age; DA was negatively correlated with BV/TV and had a tendency to increase with age. Between areas above and below the CL, there was a BV/TV gradient and both BV/TVs decreased in parallel with age. CONCLUSION Our findings regarding the contribution of micro-CT to the evaluation of trabecular bone could be a promising research approach for application in a larger study population.
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Demais V, Audrain C, Mabilleau G, Chappard D, Baslé MF. Diversity of bone matrix adhesion proteins modulates osteoblast attachment and organization of actin cytoskeleton. Morphologie 2014; 98:53-64. [PMID: 24735942 DOI: 10.1016/j.morpho.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 02/12/2014] [Indexed: 06/03/2023]
Abstract
Interaction of cells with extracellular matrix is an essential event for differentiation, proliferation and activity of osteoblasts. In bone, binding of osteoblasts to bone matrix is required to determine specific activities of the cells and to synthesize matrix bone proteins. Integrins are the major cell receptors involved in the cell linkage to matrix proteins such as fibronectin, type I collagen and vitronectin, via the RGD-sequences. In this study, cultures of osteoblast-like cells (Saos-2) were done on coated glass coverslips in various culture conditions: DMEM alone or DMEM supplemented with poly-L-lysine (PL), fetal calf serum (FCS), fibronectin (FN), vitronectin (VN) and type I collagen (Col-I). The aim of the study was to determine the specific effect of these bone matrix proteins on cell adherence and morphology and on the cytoskeleton status. Morphological characteristics of cultured cells were studied using scanning electron microscopy and image analysis. The heterogeneity of cytoskeleton was studied using fractal analysis (skyscrapers and blanket algorithms) after specific preparation of cells to expose the cytoskeleton. FAK and MAPK signaling pathways were studied by western blotting in these various culture conditions. Results demonstrated that cell adhesion was reduced with PL and VN after 240 min. After 60 min of adhesion, cytoskeleton organization was enhanced with FN, VN and Col-I. No difference in FAK phosphorylation was observed but MAPK phosphorylation was modulated by specific adhesion on extracellular proteins. These results indicate that culture conditions modulate cell adhesion, cytoskeleton organization and intracellular protein pathways according to extracellular proteins present for adhesion.
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Affiliation(s)
- V Demais
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France
| | - C Audrain
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France; Service commun d'imageries et d'analyses microscopiques (SCIAM), IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France
| | - G Mabilleau
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France; Service commun d'imageries et d'analyses microscopiques (SCIAM), IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France
| | - D Chappard
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France; Service commun d'imageries et d'analyses microscopiques (SCIAM), IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France.
| | - M F Baslé
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France; Service commun d'imageries et d'analyses microscopiques (SCIAM), IRIS-IBS (institut de biologie en santé), LUNAM université, CHU d'Angers, 49933 Angers cedex, France
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Thevenot J, Hirvasniemi J, Pulkkinen P, Määttä M, Korpelainen R, Saarakkala S, Jämsä T. Assessment of risk of femoral neck fracture with radiographic texture parameters: a retrospective study. Radiology 2014; 272:184-91. [PMID: 24620912 DOI: 10.1148/radiol.14131390] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate whether femoral neck fracture can be predicted retrospectively on the basis of clinical radiographs by using the combined analysis of bone geometry, textural analysis of trabecular bone, and bone mineral density (BMD). MATERIALS AND METHODS Formal ethics committee approval was obtained for the study, and all participants gave informed written consent. Pelvic radiographs and proximal femur BMD measurements were obtained in 53 women aged 79-82 years in 2006. By 2012, 10 of these patients had experienced a low-impact femoral neck fracture. A Laplacian-based semiautomatic custom algorithm was applied to the radiographs to calculate the texture parameters along the trabecular fibers in the lower neck area for all subjects. Intra- and interobserver reproducibility was calculated by using the root mean square average coefficient of variation to evaluate the robustness of the method. RESULTS The best predictors of hip fracture were entropy (P = .007; reproducibility coefficient of variation < 1%), the neck-shaft angle (NSA) (P = .017), and the BMD (P = .13). For prediction of fracture, the area under the receiver operating characteristic curve was 0.753 for entropy, 0.608 for femoral neck BMD, and 0.698 for NSA. The area increased to 0.816 when entropy and NSA were combined and to 0.902 when entropy, NSA, and BMD were combined. CONCLUSION Textural analysis of pelvic radiographs enables discrimination of patients at risk for femoral neck fracture, and our results show the potential of this conventional imaging method to yield better prediction than that achieved with dual-energy x-ray absorptiometry-based BMD. The combination of the entropy parameter with NSA and BMD can further enhance predictive accuracy.
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Affiliation(s)
- Jérôme Thevenot
- From the Department of Medical Technology (J.T., J.H., P.P., M.M., R.K., S.S., T.J.) and Institute of Health Sciences (R.K.), University of Oulu, PO Box 5000, Oulu 90014, Finland; Department of Sports and Exercise Medicine, Oulu Deaconess Institute, Oulu, Finland (R.K.); Institute of Health Sciences (R.K.) and Department of Diagnostic Radiology (S.S., T.J.), Medical Research Center Oulu, Oulu University Hospital and University of Oulu (J.T., J.H., P.P., M.M., R.K., S.S., T.J.)
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20
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Thevenot J, Hirvasniemi J, Finnilä M, Pulkkinen P, Kuhn V, Link T, Eckstein F, Jämsä T, Saarakkala S. Trabecular homogeneity index derived from plain radiograph to evaluate bone quality. J Bone Miner Res 2013; 28:2584-91. [PMID: 23677814 DOI: 10.1002/jbmr.1987] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/06/2022]
Abstract
Radiographic texture analysis has been developed lately to improve the assessment of bone architecture as a determinant of bone quality. We validate here an algorithm for the evaluation of trabecular homogeneity index (HI) in the proximal femur from hip radiographs, with a focus on the impact of the principal compressive system of the trabecular bone, and evaluate its correlation with femoral strength, bone mineral density (BMD), and volumetric trabecular structure parameters. A semiautomatic custom-made algorithm was applied to calculate the HI in the femoral neck and trochanteric areas from radiographs of 178 femoral bone specimens (mean age 79.3 ± 10.4 years). Corresponding neck region was selected in CT scans to calculate volumetric parameters of trabecular structure. The site-specific BMDs were assessed from dual-energy X-ray absorptiometry (DXA), and the femoral strength was experimentally tested in side-impact configuration. Regression analysis was performed between the HI and biomechanical femoral strength, BMD, and volumetric parameters. The correlation between HI and failure load was R(2) = 0.50; this result was improved to R(2) = 0.58 for cervical fractures alone. The discrimination of bones with high risk of fractures (load <3000 N) was similar for HI and BMD (AUC = 0.87). Regression analysis between the HIs versus site-specific BMDs yielded R(2) = 0.66 in neck area, R(2) = 0.60 in trochanteric area, and an overall of R(2) = 0.66 for the total hip. Neck HI and BMD correlated significantly with volumetric structure parameters. We present here a method to assess HI that can explain 50% of an experimental failure load and determines bones with high fracture risk with similar accuracy as BMD. The HI also had good correlation with DXA and computed tomography-derived data.
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Affiliation(s)
- Jérôme Thevenot
- Department of Medical Technology, University of Oulu, Oulu, Finland
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Rocher E, El Hage R, Chappard C, Portier H, Rochefort GY, Benhamou CL. Bone mineral density, hip bone geometry, and calcaneus trabecular bone texture in obese and normal-weight children. J Clin Densitom 2013; 16:244-9. [PMID: 23473958 DOI: 10.1016/j.jocd.2013.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 11/22/2022]
Abstract
Our study aimed at comparing bone mineral density (BMD), geometric indices of hip bone strength, and indices of trabecular bone texture at the calcaneus in obese and normal-weight children. Fifty-three obese children (10.3 ± 1.4 yr) and 24 normal-weight children (10.4 ± 1.5 yr) participated in this study. Body composition, bone mineral content, and BMD at whole body (WB), lumbar spine (L2-L4), total forearm, and proximal femur (total hip [TH] and femoral neck [FN]) were measured by dual-energy X-ray absorptiometry (DXA). Bone geometry of the hip was evaluated by the hip structure analysis (HSA) program. DXA scans were analyzed at the FN at its narrowest region and the femoral shaft (FS) by the HSA program. Cross-sectional area (CSA) and section modulus (Z) were measured from hip BMD profiles. Texture analysis was performed on digitized radiographs of the calcaneus to assess trabecular bone microarchitecture, and the result was expressed as Hmean. WB BMD, L2-L4 BMD, TH BMD, and FN BMD were significantly higher in obese children compared with normal-weight peers (p < 0.05). FN Z and FS Z were not significantly different between the 2 groups, whereas Hmean parameter was significantly lower in obese children compared with normal-weight peers (p < 0.001). After adjustment for body weight, obese children displayed lower WB BMD, FN CSA, FN Z, FS CSA, and FS Z compared with normal-weight children. This study suggests that BMD of WB and geometric indices of hip bone strength are not adapted to the increased body weight in obese children.
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Abstract
The diagnosis and management of osteoporosis have been improved by the development of new quantitative methods of skeletal assessment and by the availability of an increasing number of therapeutic options, respectively. A number of imaging methods exist and all have advantages and disadvantages. Dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly utilized method for clinical diagnosis of osteoporosis and will remain so for the foreseeable future. The WHO 10-year fracture risk assessment tool (FRAX(®)) will improve clinical use of DXA and the cost-effectiveness of therapeutic intervention. Improved reporting of radiographic features that suggest osteoporosis and the presence of vertebral fracture, which are powerful predictors of future fractures, could increase the frequency of appropriate DXA referrals. Quantitative CT remains predominantly a research tool, but has advantages over DXA--allowing measurement of volumetric density, separate measures of cortical and trabecular bone density, and evaluation of bone shape and size. High resolution imaging, using both CT and MRI, has been introduced to measure trabecular and cortical bone microstructure. Although these methods provide detailed insights into the effects of disease and therapies on bone, they are technically challenging and not widely available, so they are unlikely to be used in clinical practice.
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Affiliation(s)
- Judith E Adams
- Manchester Academic Health Science Centre, The Royal Infirmary and University of Manchester, Department of Radiology, The Royal Infirmary, Manchester M13 9WL, UK.
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Marchand-Libouban H, Guillaume B, Bellaiche N, Chappard D. Texture analysis of computed tomographic images in osteoporotic patients with sinus lift bone graft reconstruction. Clin Oral Investig 2012; 17:1267-72. [PMID: 22886459 DOI: 10.1007/s00784-012-0808-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Bone implants are now widely used to replace missing teeth. Bone grafting (sinus lift) is a very useful way to increase the bone volume of the maxilla in patients with bone atrophy. There is a 6- to 9-month delay for the receiver grafted site to heal before the implants can be placed. Computed tomography is a useful method to measure the amount of remaining bone before implantation and to evaluate the quality of the receiver bone at the end of the healing period. Texture analysis is a non-invasive method useful to characterize bone microarchitecture on X-ray images. PATIENTS AND METHODS Ten patients in which a sinus lift surgery was necessary before implantation were analyzed in the present study. All had a bone reconstruction with a combination of a biomaterial (beta tricalcium phosphate) and autograft bone harvested at the chin. Computed tomographic images were obtained before grafting (t0), at mid-interval (t1, 4.2 ± 0.7 months) and before implant placement (t2, 9.2 ± 0.6 months). Texture analysis was done with the run-length method. RESULTS A significant increase of texture parameters at t1 reflected a gain of homogeneity due to the graft and the beginning of bone remodeling. At t2, some parameters remained high and corresponded to the persistence of bone trabeculae while the resorption of biomaterials was identified by other parameters which tended to return to pregraft values. CONCLUSION Texture analysis identified changes during the healing of the receiver site. CLINICAL RELEVANCE The method is known to correlate with microarchitectural changes in bone and could be a useful approach to characterized osseointegrated grafts.
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Affiliation(s)
- Hélène Marchand-Libouban
- LUNAM Université, GEROM-LHEA Bone Remodeling and Biomaterials-IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers, Cedex, France
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Le Corroller T, Halgrin J, Pithioux M, Guenoun D, Chabrand P, Champsaur P. Combination of texture analysis and bone mineral density improves the prediction of fracture load in human femurs. Osteoporos Int 2012; 23:163-9. [PMID: 21739104 DOI: 10.1007/s00198-011-1703-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 06/16/2011] [Indexed: 01/23/2023]
Abstract
UNLABELLED Twenty-one excised femurs were studied using (1) a high-resolution digital X-ray device to estimate three textural parameters, (2) dual-energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD), and (3) mechanical tests to failure. Textural parameters significantly correlated with BMD (p < 0.05) and bone strength (p < 0.05). Combining texture parameters and BMD significantly improved the fracture load prediction from adjusted r(2) = 0.74 to adjusted r(2) =0.82 (p < 0.05). INTRODUCTION The purpose of this study is to determine if the combination of bone texture parameters using a new high-resolution X-ray device and BMD measurement by DXA provided a better prediction of femoral failure load than BMD evaluation alone. METHODS The proximal ends of 21 excised femurs were studied using (1) a high-resolution digital X-ray device (BMA, D3A Medical Systems) to estimate three textural parameters: fractal parameter Hmean, co-occurrence, and run-length matrices, (2) DXA to measure BMD, and (3) mechanical tests to failure in a side-impact configuration. Regions of interest in the femoral neck, intertrochanteric region, and greater trochanter were selected for DXA and bone texture analysis. Every specimen was scanned twice with repositioning before mechanical testing to assess reproducibility using intraclass correlation coefficient (ICC) with 95% confidence interval. The prediction of femoral failure load was evaluated using multiple regression analysis. RESULTS Thirteen femoral neck and 8 intertrochanteric fractures were observed with a mean failure load of 2,612 N (SD, 1,382 N). Fractal parameter Hmean, co-occurrence, and run-length matrices each significantly correlated with site-matched BMD (p < 0.05) and bone strength (p < 0.05). The ICC of the textural parameters varied between 0.65 and 0.90. Combining bone texture parameters and BMD significantly improved the fracture load prediction from adjusted r(2) =0.74 to adjusted r(2) = 0.82 (p < 0.05). CONCLUSION In these excised femurs, the combination of bone texture parameters with BMD demonstrated a better performance in the failure load prediction than that of BMD alone.
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Affiliation(s)
- T Le Corroller
- Department of Radiology, Hôpital Sainte Marguerite, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France.
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Toljamo PS, Lammentausta E, Pulkkinen P, Tervonen O, Jämsä T, Nieminen MT. Dual-energy digital radiography in the assessment of bone mechanical properties. Physiol Meas 2011; 33:29-37. [DOI: 10.1088/0967-3334/33/1/29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Chappard D, Baslé MF, Legrand E, Audran M. New laboratory tools in the assessment of bone quality. Osteoporos Int 2011; 22:2225-40. [PMID: 21347743 DOI: 10.1007/s00198-011-1573-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 01/31/2011] [Indexed: 01/22/2023]
Abstract
Bone quality is a complex set of intricated and interdependent factors that influence bone strength. A number of methods have emerged to measure bone quality, taking into account the organic or the mineral phase of the bone matrix, in the laboratory. Bone quality is a complex set of different factors that are interdependent. The bone matrix organization can be described at five different levels of anatomical organization: nature (organic and mineral), texture (woven or lamellar), structure (osteons in the cortices and arch-like packets in trabecular bone), microarchitecture, and macroarchitecture. Any change in one of these levels can alter bone quality. An altered bone remodeling can affect bone quality by influencing one or more of these factors. We have reviewed here the main methods that can be used in the laboratory to explore bone quality on bone samples. Bone remodeling can be evaluated by histomorphometry; microarchitecture is explored in 2D on histological sections and in 3D by microCT or synchrotron. Microradiography and scanning electron microscopy in the backscattered electron mode can measure the mineral distribution; Raman and Fourier-transformed infra-red spectroscopy and imaging can simultaneously explore the organic and mineral phase of the matrix on multispectral images; scanning acoustic microscopy and nanoindentation provide biomechanical information on individual trabeculae. Finally, some histological methods (polarization, surface staining, fluorescence, osteocyte staining) may also be of interest in the understanding of quality as a component of bone fragility. A growing number of laboratory techniques are now available. Some of them have been described many years ago and can find a new youth; others having benefited from improvements in physical and computer techniques are now available.
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Affiliation(s)
- D Chappard
- INSERM, U922-IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers, France.
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Pulkkinen P, Partanen J, Jalovaara P, Nieminen MT, Jämsä T. Combination of radiograph-based trabecular and geometrical parameters can discriminate cervical hip fractures from controls in individuals with BMD in non-osteoporotic range. Bone 2011; 49:290-4. [PMID: 21550431 DOI: 10.1016/j.bone.2011.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/14/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
Abstract
Majority of hip fractures occur in individuals with bone mineral density (BMD) in non-osteoporotic range. This suggests that factors other than BMD are associated with increased fracture risk in these individuals. The aim of this study was to investigate the combined ability of radiograph-based trabecular and geometrical parameters to discriminate cervical hip fractures from controls in individuals with non-osteoporotic BMD. A total of 39 postmenopausal females with non-pathologic cervical hip fracture were recruited to the study. Nineteen of the fracture patients (48.7%) had non-osteoporotic BMD and they constituted the fracture group. The control group consisted of 35 BMD-matched non-osteoporotic females. Several geometrical and trabecular parameters were extracted from plain pelvic radiographs, and their combined ability to discriminate fracture patients from controls was studied using a receiver operating characteristics (ROC) analysis. Significant differences in several radiograph-based geometrical and trabecular parameters were found between the fracture patients and controls, whereas no statistically significant difference in BMD was observed (p=0.92) between the groups. Area under the ROC curve was 0.993 (95% CI 0.977-1.008) for the combined multiple regression model, which included both trabecular and geometrical parameters as explanatory factors. Here, the sensitivity of 100% was achieved with the specificity of 94%. In a cross-validation of the model, 94.4% of the fracture patients, and 94.1% of the controls were classified correctly. The combination of radiograph-based trabecular and geometrical parameters was able to discriminate the cervical hip fracture cases from controls with similar BMD, showing that the method can provide additional information on bone structure and fracture risk beyond BMD.
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Affiliation(s)
- P Pulkkinen
- Department of Medical Technology, Institute of Biomedicine, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.
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Bodic F, Amouriq Y, Gayet-Delacroix M, Maugars Y, Hamel L, Baslé MF, Chappard D. Relationships between bone mass and micro-architecture at the mandible and iliac bone in edentulous subjects: a dual X-ray absorptiometry, computerised tomography and microcomputed tomography study. Gerodontology 2011; 29:e585-94. [DOI: 10.1111/j.1741-2358.2011.00527.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ranjanomennahary P, Ghalila SS, Malouche D, Marchadier A, Rachidi M, Benhamou C, Chappard C. Comparison of radiograph-based texture analysis and bone mineral density with three-dimensional microarchitecture of trabecular bone. Med Phys 2011; 38:420-8. [PMID: 21361210 DOI: 10.1118/1.3528125] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Hip fracture is a serious health problem and textural methods are being developed to assess bone quality. The authors aimed to perform textural analysis at femur on high-resolution digital radiographs compared to three-dimensional (3D) microarchitecture comparatively to bone mineral density. METHODS Sixteen cadaveric femurs were imaged with an x-ray device using a C-MOS sensor. One 17 mm square region of interest (ROI) was selected in the femoral head (FH) and one in the great trochanter (GT). Two-dimensional (2D) textural features from the co-occurrence matrices were extracted. Site-matched measurements of bone mineral density were performed. Inside each ROI, a 16 mm diameter core was extracted. Apparent density (Dapp) and bone volume proportion (BV/TV(Arch)) were measured from a defatted bone core using Archimedes' principle. Microcomputed tomography images of the entire length of the core were obtained (Skyscan 1072) at 19.8 microm of resolution and usual 3D morphometric parameters were computed on the binary volume after calibration from BV/TV(Arch). Then, bone surface/bone volume, trabecular thickness, trabecular separation, and trabecular number were obtained by direct methods without model assumption and the structure model index was calculated. RESULTS In univariate analysis, the correlation coefficients between 2D textural features and 3D morphological parameters reached 0.83 at the FH and 0.79 at the GT. In multivariate canonical correlation analysis, coefficients of the first component reached 0.95 at the FH and 0.88 at the GT. CONCLUSIONS Digital radiographs, widely available and economically viable, are an alternative method for evaluating bone microarchitectural structure.
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Affiliation(s)
- P Ranjanomennahary
- Caractéristation du Tissu Osseux par Imagerie, U658 Inserm, Orleans, France
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Fritscher K, Grunerbl A, Hanni M, Suhm N, Hengg C, Schubert R. Trabecular bone analysis in CT and X-ray images of the proximal femur for the assessment of local bone quality. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:1560-1575. [PMID: 19520636 DOI: 10.1109/tmi.2009.2020734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Currently, conventional X-ray and CT images as well as invasive methods performed during the surgical intervention are used to judge the local quality of a fractured proximal femur. However, these approaches are either dependent on the surgeon's experience or cannot assist diagnostic and planning tasks preoperatively. Therefore, in this work a method for the individual analysis of local bone quality in the proximal femur based on model-based analysis of CT- and X-ray images of femur specimen will be proposed. A combined representation of shape and spatial intensity distribution of an object and different statistical approaches for dimensionality reduction are used to create a statistical appearance model in order to assess the local bone quality in CT and X-ray images. The developed algorithms are tested and evaluated on 28 femur specimen. It will be shown that the tools and algorithms presented herein are highly adequate to automatically and objectively predict bone mineral density values as well as a biomechanical parameter of the bone that can be measured intraoperatively.
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Affiliation(s)
- Karl Fritscher
- Department of Medical Image Analysis, Universityfor Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria.
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Bauer JS, Link TM. Advances in osteoporosis imaging. Eur J Radiol 2009; 71:440-9. [PMID: 19651482 DOI: 10.1016/j.ejrad.2008.04.064] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Accepted: 04/30/2008] [Indexed: 11/26/2022]
Abstract
In the assessment of osteoporosis, the measurement of bone mineral density (BMD(a)) obtained from dual energy X-ray absorptiometry (DXA; g/cm(2)) is the most widely used parameter. However, bone strength and fracture risk are also influenced by parameters of bone quality such as micro-architecture and tissue properties. This article reviews the radiological techniques currently available for imaging and quantifying bone structure, as well as advanced techniques to image bone quality. With the recent developments in magnetic resonance (MR) techniques, including the availability of clinical 3T scanners, and advances in computed tomography (CT) technology (e.g. clinical Micro-CT), in-vivo imaging of the trabecular bone architecture is becoming more feasible. Several in-vitro studies have demonstrated that bone architecture, measured by MR or CT, was a BMD-independent determinant of bone strength. In-vivo studies showed that patients with, and without, osteoporotic fractures could better be separated with parameters of bone architecture than with BMD. Parameters of trabecular architecture were more sensitive to treatment effects than BMD. Besides the 3D tomographic techniques, projection radiography has been used in the peripheral skeleton as an additional tool to better predict fracture risk than BMD alone. The quantification of the trabecular architecture included parameters of scale, shape, anisotropy and connectivity. Finite element analyses required highest resolution, but best predicted the biomechanical properties of the bone. MR diffusion and perfusion imaging and MR spectroscopy may provide measures of bone quality beyond trabecular micro-architecture.
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Affiliation(s)
- Jan S Bauer
- Department of Radiology, UCSF, San Francisco, CA, USA.
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Park EA, Hong SH, Kim KG, Choi JY, Shin CS, Kang HS. Experimental bone biopsies using two bone biopsy needles: quantitative micro-CT analysis of bone specimens. Acad Radiol 2009; 16:332-40. [PMID: 19201362 DOI: 10.1016/j.acra.2008.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/04/2008] [Accepted: 09/06/2008] [Indexed: 10/21/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to investigate whether samples obtained using two kinds of small trephines, 2.4 and 1.8 mm in inner diameter, are sufficient for the quantitative evaluation of metabolic bone disease using micro-computed tomographic (CT) three-dimensional parameter data sets. MATERIALS AND METHODS A total of 19 porcine lumbar vertebrae prior to biopsy and biopsy samples from the use of 2.4- and 1.8-mm trephines were examined using micro-CT imaging. For quantitative analysis, seven three-dimensional structural parameters, including trabecular bone volume, trabecular number, trabecular thickness, trabecular separation, the structure model index, the degree of anisotropy, and the trabecular bone pattern factor, were measured using CtAn software. The difference and agreement between the biopsy samples and the baseline vertebrae specimens before biopsy were assessed using paired t tests and Bland-Altman analysis, respectively. RESULTS There were no significant differences between the 2.4-mm samples and the baseline vertebrae specimens for trabecular bone volume, trabecular thickness, and trabecular number, with mean differences of -0.9%, 2.3%, and -3.1%, respectively; there was no significant difference between the 1.8-mm samples and the baseline vertebrae specimens only for trabecular thickness, with a mean difference of 1.9%. CONCLUSION Samples taken from the use of the 2.4-mm trephine were better for quantitative analysis than those from the use of the 1.8-mm trephine and were acceptable for the quantitative evaluation of trabecular bone volume, trabecular thickness, and trabecular number.
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Kazama JJ, Koda R, Yamamoto S, Narita I, Gejyo F, Tokumoto A. Comparison of quantitative cancellous bone connectivity analyses at two- and three-dimensional levels in dialysis patients. Calcif Tissue Int 2009; 84:38-44. [PMID: 19093066 DOI: 10.1007/s00223-008-9194-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
Abstract
Assessment of cancellous bone connectivity has the potential to aid in predicting fracture risk. Today, cancellous bone connectivity is generally assessed using bone sections obtained from biopsy. However, how reliably such two-dimensional (2-D) analyses visualize the 3-D properties has not been evaluated. Biopsied iliac bone samples were obtained from 47 chronic hemodialysis patients. Bone samples were observed using a microfocus X-ray computed tomography (microCT) system en bloc, and the cancellous bone microstructure was quantitatively assessed at both the 2- and 3-D levels. Cancellous bone microarchitecture was successfully reconstructed from the data obtained by the microCT system. Most of the results from node-strut analysis (NSA) revealed no statistically significant correlations between the 2- and 3-D analyses, with the exception that the number of nodes (N.Nd/TV) showed a mild but significant correlation. In contrast, the marrow space star volumes (V*m) of the 2- and 3-D analyses were highly correlated. NSA parameters including N.Nd/TV showed significant correlations with V*m at the 3-D level. In conclusion, V*m values were similar in the 2- and 3-D analyses, while most of the 2-D NSA parameters did not reflect the 3-D ones. Since V*m and most of the NSA parameters were correlated in the 3-D analyses, 2-D NSA would seem to have serious limitations for the assessment of cancellous bone microstructural properties. Further studies will thus be needed to establish appropriate methods for assessing cancellous bone connectivity in clinical practice.
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Affiliation(s)
- Junichiro James Kazama
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata, Niigata 951-8510, Japan.
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Abstract
The bone mass is constituted during the life by the modeling and remodeling mechanisms. Trabecular bone consists in a network of trabeculae (plates and rods) whose distribution is highly anisotropic: trabeculae are disposed parallel to the resultant of stress lines (Wolff's law). Trabecular microarchitecture appears conditioned by mechanical strains, which are exerted on the bones of the skeleton. However, few methods are currently clinically validated to appreciate and follow the evolution of microarchitecture in bone diseases. The most developed studies relate to microarchitectural measurements obtained by bone histomorphometry with the use of new algorithms, which can appreciate 2D various characteristics of the trabeculae, such as thickness and connectivity. Several works have shown that microarchitecture parameters should be obtained by using several independent techniques. X-ray microtomography (microCT), micro-RMI, synchrotron also allow the measurement in 3D of the trabecular microarchitecture in a nondestructive way on bone specimens. This review describes the evolution of our knowledge on bone microarchitecture, its role in bone diseases, such as osteoporosis and the various methods of histological evaluation in 2D and 3D.
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Affiliation(s)
- D Chappard
- Inserm, U922, LHEA, Faculty of Medicine, 1, rue Haute-de-Reculée, 49045 Angers cedex, France.
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Guggenbuhl P, Chappard D, Garreau M, Bansard JY, Chales G, Rolland Y. Reproducibility of CT-based bone texture parameters of cancellous calf bone samples: Influence of slice thickness. Eur J Radiol 2008; 67:514-20. [PMID: 17869469 DOI: 10.1016/j.ejrad.2007.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 07/18/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
Abstract
Bone microarchitecture is an important determinant of the fracture risk, independently of bone mineral density. At present, bone biopsy is required for microarchitecture assessment, and accessible non-invasive techniques are needed. In this study, we tested the short-term reproducibility and parameter changes of a non-invasive method for microarchitecture assessment with a medical computed tomography. Texture parameters (run lengths and co-occurrence) were extracted from bone sample images. Reproducibility and the influence of slice thickness (1, 3, 5 and 8mm) were also studied. After five repositionings, short-term reproducibility was found to be good. All run length parameters but one fell significantly with increasing slice thickness. Co-occurrence parameters showed different patterns of change. Short-term coefficients of variation of texture parameters used to assess bone microarchitecture were similar to those obtained elsewhere with other techniques. The results were influenced by slice thicknesses, emphasizing the importance of the conditions of acquisition.
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Affiliation(s)
- Pascal Guggenbuhl
- INSERM, U642, LTSI, Campus Beaulieu, Bat 22, 35042 Rennes Cédex, France.
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Lespessailles E, Gadois C, Kousignian I, Neveu JP, Fardellone P, Kolta S, Roux C, Do-Huu JP, Benhamou CL. Clinical interest of bone texture analysis in osteoporosis: a case control multicenter study. Osteoporos Int 2008; 19:1019-28. [PMID: 18196441 DOI: 10.1007/s00198-007-0532-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 11/14/2007] [Indexed: 01/22/2023]
Abstract
UNLABELLED We demonstrate the clinical interest of bone texture analysis with a new high resolution X-ray device. We have found that the combination of BMD and texture parameter values provided a better assessment of the fracture risk than that obtainable solely by BMD measurement. INTRODUCTION Osteoporosis is characterized by BMD and trabecular bone microarchitecture. We have developed a new high-resolution X-ray device with direct digitization. The aim of this study was to demonstrate in a multicenter case control study the clinical interest of bone texture analysis with this new device. METHODS In this cross-sectional multicenter case-control population study in post-menopausal women, 159 osteoporotic fractures were compared with 219 control cases. Images were obtained on calcaneus with a direct digital X-ray device (BMA, D3A Medical Systems). Co-occurrence, run-length matrices and the fractal parameter Hmean were evaluated. BMD was measured at the lumbar spine (LS), femoral neck (FN) and total hip (TH) by DXA. RESULTS The three texture parameters were significantly lower in osteoporotic fracture cases than in control cases. These differences persisted after adjustment for TH BMD. Receiver operating characteristic curves were used to compare the discriminant capacity of texture parameters and BMD measurements for fracture. The highest areas under curve (AUC) were 0.721 for TH BMD and 0.706 for Hmean (AUC THBMD vs. AUC Hmean, p = NS). We determined the threshold between high and low Hmean parameter values and then the odds ratios (OR) of fracture for low Hmean, for BMD < or =2.5 SD in the T-score and for combinations of both parameters. The OR of fracture for low H was 2.72 (95% CI, 1.36-5.4). For a FN BMD < or = -2.5 SD, the OR of 4.78 (2.19-10.43) shifted to 14.06 (4.41-44.85) adding H. CONCLUSIONS These data confirmed the clinical interest of the combination of BMD and texture parameters to improve the assessment of the risk of fracture other that obtainable by the sole BMD measurement.
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Affiliation(s)
- E Lespessailles
- Ipros - Service de Rhumatologie CHR d'Orléans, Orleans, France.
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Pulkkinen P, Jämsä T, Lochmüller EM, Kuhn V, Nieminen MT, Eckstein F. Experimental hip fracture load can be predicted from plain radiography by combined analysis of trabecular bone structure and bone geometry. Osteoporos Int 2008; 19:547-58. [PMID: 17891327 DOI: 10.1007/s00198-007-0479-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 09/04/2007] [Indexed: 11/30/2022]
Abstract
UNLABELLED Computerized analysis of the trabecular structure was used to test whether femur failure load can be estimated from radiographs. The study showed that combined analysis of trabecular bone structure and geometry predicts in vitro failure load with similar accuracy as DXA. INTRODUCTION Since conventional radiography is widely available with low imaging cost, it is of considerable interest to discover how well bone mechanical competence can be determined using this technology. We tested the hypothesis that the mechanical strength of the femur can be estimated by the combined analysis of the bone trabecular structure and geometry. METHODS The sample consisted of 62 cadaver femurs (34 females, 28 males). After radiography and DXA, femora were mechanically tested in side impact configuration. Fracture patterns were classified as being cervical or trochanteric. Computerized image analysis was applied to obtain structure-related trabecular parameters (trabecular bone area, Euler number, homogeneity index, and trabecular main orientation), and set of geometrical variables (neck-shaft angle, medial calcar and femoral shaft cortex thicknesses, and femoral neck axis length). Multiple linear regression analysis was performed to identify the variables that best explain variation in BMD and failure load between subjects. RESULTS In cervical fracture cases, trabecular bone area and femoral neck axis length explained 64% of the variability in failure loads, while femoral neck BMD also explained 64%. In trochanteric fracture cases, Euler number and femoral cortex thickness explained 66% of the variability in failure load, while trochanteric BMD explained 72%. CONCLUSIONS Structural parameters of trabecular bone and bone geometry predict in vitro failure loads of the proximal femur with similar accuracy as DXA, when using appropriate image analysis technology.
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Affiliation(s)
- P Pulkkinen
- Deparment of Medical Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
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Podsiadlo P, Dahl L, Englund M, Lohmander LS, Stachowiak GW. Differences in trabecular bone texture between knees with and without radiographic osteoarthritis detected by fractal methods. Osteoarthritis Cartilage 2008; 16:323-9. [PMID: 17825585 DOI: 10.1016/j.joca.2007.07.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 07/16/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop an accurate method for quantifying differences in the trabecular structure in the tibial bone between subjects with and without knee osteoarthritis (OA). METHODS Standard knee radiographs were taken from 26 subjects (seven women) with meniscectomy and radiographic OA Kellgren & Lawrence grade 2 or worse in the medial compartment. Each case knee was individually matched by sex, age, body mass index and medial or lateral compartment with a control knee. A newly developed augmented Hurst orientation transform (HOT) method was used to calculate texture parameters for regions selected in X-ray images of non-OA and OA tibial bones. This method produces a mean value of fractal dimensions (FD MEAN), FDs in the vertical (FDV) and horizontal (FDH) directions and along a direction of the roughest part of the tibial bone (FDSta), fractal signatures and a texture aspect ratio (Str). The ratio determines a degree of the bone texture anisotropy. Reproducibility was calculated using an intraclass correlation coefficient (ICC). Comparisons between cases and controls were made with paired t tests. The performance of the HOT method was evaluated against a benchmark fractal signature analysis (FSA) method. RESULTS Compared with controls, trabecular bone in OA knees showed significantly lower FD MEAN, FDV, FDH and FDSta and higher Str at trabecular image sizes 0.2-1.1mm (P<0.05, HOT). The reproducibility of all parameters was very good (ICC>0.8). In the medial compartment, fractal signatures calculated for OA horizontal and vertical trabeculae were significantly lower at sizes 0.3-0.55 mm (P<0.05, HOT) and 0.3-0.65 mm (P<0.001, FSA). In the lateral compartment, FDs calculated for OA trabeculae were lower than controls (horizontal: 0.3-0.55 mm (P<0.05, HOT) and 0.3-0.65 mm (P<0.001, FSA); vertical: 0.3-0.4mm (P<0.05, HOT) and 0.3-0.35 mm (P<0.001, FSA). CONCLUSION The augmented HOT method produces fractal signatures that are comparable to those obtained from the benchmark FSA method. The HOT method provides a more detailed description of OA changes in bone anisotropy than the FSA method. This includes a degree of bone anisotropy measured using data from all possible directions and a texture roughness calculated for the roughest part of the bone. It appears that the augmented HOT method is well suited to quantify OA changes in the tibial bone structure.
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Affiliation(s)
- P Podsiadlo
- Tribology Laboratory, School of Mechanical Engineering, University of Western Australia.
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Abstract
Bone strength and stiffness depend strongly on bone mass, but they also depend on the microarchitecture and tissue quality of both cancellous and cortical bone. All these aspects differ between individuals and between anatomic sites. This review discusses ways to characterize the three-dimensional cancellous architecture as well as changes in architecture and bone composition caused by bone remodeling. The methods used range from detailed descriptions of sizes and distances in cancellous bone to coarser texture analysis methods using clinical data. As the resolution of clinical images increases, it may become possible to use knowledge of the relationship between bone microarchitecture and strength to predict fracture risk clinically.
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Lespessailles E, Gadois C, Lemineur G, Do-Huu JP, Benhamou L. Bone texture analysis on direct digital radiographic images: precision study and relationship with bone mineral density at the os calcis. Calcif Tissue Int 2007; 80:97-102. [PMID: 17308991 DOI: 10.1007/s00223-006-0216-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 10/23/2006] [Indexed: 11/28/2022]
Abstract
Assessment of bone microarchitecture in complement to bone mineral density (BMD) exam could improve prediction of osteoporotic fractures. A high-resolution X-ray prototype was developed to assess microarchitecture quality. Images were obtained on os calcis; then, three texture parameters were calculated on the same region of interest (ROI): a fractal parameter, a run-length parameter, and a co-occurrence parameter. This work describes the reproducibility of this method. We also examine the relationship between texture parameters and BMD at a site-matched ROI. Measurements on the left heel were performed on 30 healthy women, on the same day, with repositioning for short-term precision error. An additional measurement was done at 1 week to evaluate mid-term precision error on 14 subjects. Os calcis images from 10 healthy women were used to evaluate both intra- and interobserver reproducibility. Thirty other healthy patients were measured successively on two similar devices for interprototype comparison. BMD and texture analyses of the left heel were obtained from 57 women. Short-term precision errors ranged 1.16-1.24% according to the texture parameter. Mid-term precision error was slightly higher than short-term precision for the mean Hurst exponent parameter. Comparisons of texture parameters and BMD at a site-matched ROI on the os calcis showed no significant relationships. The results also show that the use of this high-resolution digital X-ray device improves the reproducibility of parameter measurement compared to the indirect digitization of radiologic films previously used.
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Affiliation(s)
- E Lespessailles
- Institut de Prévention et de Recherche de l'Ostéoporose, Service de Rhumatologie CHR d'Orléans, 1 rue porte madeleine 4500 Orléans, France.
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Jennane R, Harba R, Lemineur G, Bretteil S, Estrade A, Benhamou CL. Estimation of the 3D self-similarity parameter of trabecular bone from its 2D projection. Med Image Anal 2007; 11:91-8. [PMID: 17188551 DOI: 10.1016/j.media.2006.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 07/03/2006] [Accepted: 11/08/2006] [Indexed: 11/17/2022]
Abstract
It has been shown that the analysis of two dimensional (2D) bone X-ray images based on the fractional Brownian motion (fBm) model is a good indicator for quantifying alterations in the three dimensional (3D) bone micro-architecture. However, this 2D measurement is not a direct assessment of the 3D bone properties. In this paper, we first show that S(3D), the self-similarity parameter of 3D fBm, is linked to S(2D), that of its 2D projection, by S(3D)=S(2D)-0.5. In the light of this theoretical result, we have experimentally examined whether this relation holds for trabecular bone. Twenty one specimens of trabecular bone were derived from frozen human femoral heads. They were digitized using a high resolution mu-CT. Their projections were simulated numerically by summing the data in the three orthogonal directions and both 3D and 2D self-similarity parameters were measured. Results show that the self-similarity of the 3D bone volumes and that of their projections are linked by the previous equation. This demonstrates that a simple projection provides 3D information about the bone structure. This information can be a valuable adjunct to the bone mineral density for the early diagnosis of osteoporosis.
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Affiliation(s)
- Rachid Jennane
- Laboratory of Electronics, Signals and Images, GDR-ISIS, Université d'Orléans, BP 6744, 45067 Orleans Cedex 2, France.
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Abstract
Osteoporosis is a metabolic disorder that manifests changes in bone density and structure accompanied by an increased susceptibility to fractures. Recent studies have demonstrated the potential contributions of trabecular bone microarchitecture in the assessment of the therapeutic efficacy of emerging treatments, and also in the assessment of fracture risk. The main goal of this paper is to emphasize the clinical implementation of bone microarchitecture measurements. Thus, this paper provides an overview of the main imaging modalities for depicting trabecular bone microarchitecture and a corresponding description of common computed structural bone parameters. The imaging modalities presented to characterize the complex three-dimensional trabecular bone network include micro-CT, quantitative CT, and magnetic resonance imaging. Two-dimensional analyses of radiographic patterns are also discussed. Results demonstrating the ability to distinguish between different populations based on trabecular bone microarchitecture in longitudinal studies are also presented for the various imaging modalities.
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Affiliation(s)
- Julio Carballido-Gamio
- QB3 Building, 2nd Floor, Suite 203, 1700 4th Street, University of California, San Francisco, 94158, USA
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