1
|
Chen M, Gerges M, Raynor WY, Park PSU, Nguyen E, Chan DH, Gholamrezanezhad A. State of the Art Imaging of Osteoporosis. Semin Nucl Med 2024; 54:415-426. [PMID: 38087745 DOI: 10.1053/j.semnuclmed.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 05/18/2024]
Abstract
Osteoporosis is a common disease, particularly prevalent in geriatric populations, which causes significant worldwide morbidity due to increased bone fragility and fracture risk. Currently, the gold-standard modality for diagnosis and evaluation of osteoporosis progression and treatment relies on dual-energy x-ray absorptiometry (DXA), which measures bone mineral density (BMD) and calculates a score based upon standard deviation of measured BMD from the mean. However, other imaging modalities can also be used to evaluate osteoporosis. Here, we review historical as well as current research into development of new imaging modalities that can provide more nuanced or opportunistic analyses of bone quality, turnover, and density that can be helpful in triaging severity and determining treatment success in osteoporosis. We discuss the use of opportunistic computed tomography (CT) scans, as well as the use of quantitative CT to help determine fracture risk and perform more detailed bone quality analysis than would be allowed by DXA . Within magnetic resonance imaging (MRI), new developments include the use of advanced MRI techniques such as quantitative susceptibility mapping (QSM), magnetic resonance spectroscopy, and chemical shift encoding-based water-fat MRI (CSE-MRI) to enable clinicians improved assessment of nonmineralized bone compartments as well as a way to longitudinally assess bone quality without the repeated exposure to ionizing radiation. Within ultrasound, development of quantitative ultrasound shows promise particularly in future low-cost, broadly available screening tools. We focus primarily on historical and recent developments within radiotracer use as applicable to osteoporosis, particularly in the use of hybrid methods such as NaF-PET/CT, wherein patients with osteoporosis show reduced uptake of radiotracers such as NaF. Use of radiotracers may provide clinicians with even earlier detection windows for osteoporosis than would traditional biomarkers. Given the metabolic nature of this disease, current investigation into the role molecular imaging can play in the prediction of this disease as well as in replacing invasive diagnostic procedures shows particular promise.
Collapse
Affiliation(s)
- Michelle Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maria Gerges
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Peter Sang Uk Park
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Edward Nguyen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David H Chan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| |
Collapse
|
2
|
Soldati E, Roseren F, Guenoun D, Mancini L, Catelli E, Prati S, Sciutto G, Vicente J, Iotti S, Bendahan D, Malucelli E, Pithioux M. Multiscale Femoral Neck Imaging and Multimodal Trabeculae Quality Characterization in an Osteoporotic Bone Sample. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8048. [PMID: 36431532 PMCID: PMC9694313 DOI: 10.3390/ma15228048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Although multiple structural, mechanical, and molecular factors are definitely involved in osteoporosis, the assessment of subregional bone mineral density remains the most commonly used diagnostic index. In this study, we characterized bone quality in the femoral neck of one osteoporotic patients as compared to an age-matched control subject, and so used a multiscale and multimodal approach including X-ray computed microtomography at different spatial resolutions (pixel size: 51.0, 4.95 and 0.9 µm), microindentation and Fourier transform infrared spectroscopy. Our results showed abnormalities in the osteocytes lacunae volume (358.08 ± 165.00 for the osteoporotic sample vs. 287.10 ± 160.00 for the control), whereas a statistical difference was found neither for shape nor for density. The osteoporotic femoral head and great trochanter reported reduced elastic modulus (Es) and hardness (H) compared to the control reference (−48% (p < 0.0001) and −34% (p < 0.0001), respectively for Es and H in the femoral head and −29% (p < 0.01) and −22% (p < 0.05), respectively for Es and H in the great trochanter), whereas the corresponding values in the femoral neck were in the same range. The spectral analysis could distinguish neither subregional differences in the osteoporotic sample nor between the osteoporotic and healthy samples. Although, infrared spectroscopic measurements were comparable among subregions, and so regardless of the bone osteoporotic status, the trabecular mechanical properties were comparable only in the femoral neck. These results illustrate that bone remodeling in osteoporosis is a non-uniform process with different rates in different bone anatomical regions, hence showing the interest of a clear analysis of the bone microarchitecture in the case of patients’ osteoporotic evaluation.
Collapse
Affiliation(s)
- Enrico Soldati
- Aix Marseille University, CNRS, IUSTI, 13453 Marseille, France
- Aix Marseille University, CNRS, CRMBM, 13385 Marseille, France
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
| | - Flavy Roseren
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
| | - Daphne Guenoun
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Sainte Marguerite Hospital, Institute for Locomotion, Department of Radiology, 13274 Marseille, France
| | - Lucia Mancini
- Elettra-Sincrotrone Trieste S.C.p.A, SS 14–km 1535 in Area Science Park, Basovizza, 34149 Trieste, Italy
- Slovenian National Building and Civil Engineering Institute, Dimičeva ulica 12, 1000 Ljubljana, Slovenia
| | - Emilio Catelli
- University of Bologna, Department of Chemistry “G. Ciamician”, Ravenna Campus, Via Guaccimanni, 42, 48121 Ravenna, Italy
| | - Silvia Prati
- University of Bologna, Department of Chemistry “G. Ciamician”, Ravenna Campus, Via Guaccimanni, 42, 48121 Ravenna, Italy
| | - Giorgia Sciutto
- University of Bologna, Department of Chemistry “G. Ciamician”, Ravenna Campus, Via Guaccimanni, 42, 48121 Ravenna, Italy
| | - Jerome Vicente
- Aix Marseille University, CNRS, IUSTI, 13453 Marseille, France
| | - Stefano Iotti
- Università di Bologna, Department of Pharmacy and Biotechnology (FaBit), Via Zamboni 33, 40126 Bologna, Italy
- National Institute of Biostructures and Biosystems, Viale delle Medaglie d’Oro 305, 00136 Roma, Italy
| | - David Bendahan
- Aix Marseille University, CNRS, CRMBM, 13385 Marseille, France
| | - Emil Malucelli
- Università di Bologna, Department of Pharmacy and Biotechnology (FaBit), Via Zamboni 33, 40126 Bologna, Italy
| | - Martine Pithioux
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13274 Marseille, France
| |
Collapse
|
3
|
Oláh T, Cai X, Gao L, Walter F, Pape D, Cucchiarini M, Madry H. Quantifying the Human Subchondral Trabecular Bone Microstructure in Osteoarthritis with Clinical CT. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2201692. [PMID: 35670136 PMCID: PMC9376842 DOI: 10.1002/advs.202201692] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/26/2022] [Indexed: 06/12/2023]
Abstract
Osteoarthritis (OA) is characterized by critical alterations of the subchondral bone microstructure, besides the well-known cartilaginous changes. Clinical computed tomography (CT) detection of quantitative 3D microstructural subchondral bone parameters is applied to monitor changes of subchondral bone structure in different stages of human OA and is compared with micro-CT, the gold standard. Determination by clinical CT (287 µm resolution) of key microstructural parameters in tibial plateaus with mild-to-moderate and severe OA reveals strong correlations to micro-CT (35 µm), high inter- and intraobserver reliability, and small relative differences. In vivo, normal, mild-to-moderate, and severe OA are compared with clinical CT (331 µm). All approaches detect characteristic expanded trabecular structure in severe OA and fundamental microstructural correlations with clinical OA stage. Multivariate analyses at various in vivo and ex vivo imaging resolutions always reliably separate mild-to-moderate from severe OA (except mild-to-moderate OA from normal), revealing a striking similarity between 287 µm clinical and 35 µm micro-CT. Thus, accurate structural measurements using clinical CT with a resolution near the trabecular dimensions are possible. Clinical CT offers an opportunity to quantitatively monitor subchondral bone microstructure in clinical and experimental settings as an advanced tool of investigating OA and other diseases affecting bone architecture.
Collapse
Affiliation(s)
- Tamás Oláh
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Xiaoyu Cai
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Liang Gao
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Frédéric Walter
- Clinique d'EichCentre Hospitalier de Luxembourg78 Rue d'EichLuxembourg1460Luxembourg
| | - Dietrich Pape
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Clinique d'EichCentre Hospitalier de Luxembourg78 Rue d'EichLuxembourg1460Luxembourg
| | - Magali Cucchiarini
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Henning Madry
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| |
Collapse
|
4
|
Haque E, Xiao P, Ye K, Wang X. Probability-based approach for characterization of microarchitecture and its effect on elastic properties of trabecular bone. J Mech Behav Biomed Mater 2022; 131:105254. [DOI: 10.1016/j.jmbbm.2022.105254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 10/18/2022]
|
5
|
Vivekanandhan S, Subramaniam J, Mariamichael A. A computer-aided system for automatic extraction of femur neck trabecular bone architecture using isotropic volume construction from clinical hip computed tomography images. Proc Inst Mech Eng H 2016; 230:930-41. [DOI: 10.1177/0954411916663581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 07/18/2016] [Indexed: 12/28/2022]
Abstract
Hip fractures due to osteoporosis are increasing progressively across the globe. It is also difficult for those fractured patients to undergo dual-energy X-ray absorptiometry scans due to its complicated protocol and its associated cost. The utilisation of computed tomography for the fracture treatment has become common in the clinical practice. It would be helpful for orthopaedic clinicians, if they could get some additional information related to bone strength for better treatment planning. The aim of our study was to develop an automated system to segment the femoral neck region, extract the cortical and trabecular bone parameters, and assess the bone strength using an isotropic volume construction from clinical computed tomography images. The right hip computed tomography and right femur dual-energy X-ray absorptiometry measurements were taken from 50 south-Indian females aged 30–80 years. Each computed tomography image volume was re-constructed to form isotropic volumes. An automated system by incorporating active contour models was used to segment the neck region. A minimum distance boundary method was applied to isolate the cortical and trabecular bone components. The trabecular bone was enhanced and segmented using trabecular enrichment approach. The cortical and trabecular bone features were extracted and statistically compared with dual-energy X-ray absorptiometry measured femur neck bone mineral density. The extracted bone measures demonstrated a significant correlation with neck bone mineral density ( r > 0.7, p < 0.001). The inclusion of cortical measures, along with the trabecular measures extracted after isotropic volume construction and trabecular enrichment approach procedures, resulted in better estimation of bone strength. The findings suggest that the proposed system using the clinical computed tomography images scanned with low dose could eventually be helpful in osteoporosis diagnosis and its treatment planning.
Collapse
|
6
|
Extraction of 3D Femur Neck Trabecular Bone Architecture from Clinical CT Images in Osteoporotic Evaluation: a Novel Framework. J Med Syst 2015; 39:81. [DOI: 10.1007/s10916-015-0266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
|
7
|
Driban JB, Barbe MF, Amin M, Kalariya NS, Zhang M, Lo GH, Tassinari AM, Harper D, Price LL, Eaton CB, Schneider E, McAlindon TE. Validation of quantitative magnetic resonance imaging-based apparent bone volume fraction in peri-articular tibial bone of cadaveric knees. BMC Musculoskelet Disord 2014; 15:143. [PMID: 24779374 PMCID: PMC4021054 DOI: 10.1186/1471-2474-15-143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 04/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the knee, high-resolution magnetic resonance (MR) imaging has demonstrated that increased apparent bone volume fraction (trabecular bone volume per total volume; BV/TV) in the peri-articular proximal medial tibia is associated with joint space narrowing and the presence of bone marrow lesions. However, despite evidence of construct validity, MR-based apparent BV/TV has not yet been cross-validated in the proximal medial tibia by comparison with a gold standard (e.g., micro-computed tomography [microCT]). In this cadaveric validation study we explored the association between MR-based apparent BV/TV and microCT-based BV/TV in the proximal peri-articular medial tibia. METHODS Fresh cadaveric whole knee specimens were obtained from individuals 51 to 80 years of age with no knee pathology other than osteoarthritis. Ten knees were collected from five cadavers within 10 hours of death and underwent a 3-Tesla MR exam including a coronal-oblique 3-dimensional fast imaging with steady state precession (3D FISP) sequence within 36 hours of death. The specimens were placed in a 4% paraformaldehyde in phosphate buffer within 58 hours of death. After preservation, a subchondral region from the tibial plateau was collected and underwent microCT imaging with a voxel size of 9 μm x 9 μm x 9 μm. A single reader analyzed the microCT images in a similar volume of interest as selected in the MR measures. A different reader analyzed the MR-based trabecular morphometry using a custom analysis tool. To analyze the MR-based trabecular morphometry, a rectangular region of interest (ROI) was positioned on the 20 central images in the proximal medial tibial subchondral bone. The primary outcome measures were MR-based and microCT-based trabecular BV/TV in the proximal medial tibia. RESULTS The MR-based apparent BV/TV was strongly correlated with microCT-based BV/TV (r=0.83, confidence interval=0.42 to 0.96), despite the MR-based apparent BV/TV being systematically lower than measured using microCT. CONCLUSIONS MR-based apparent BV/TV in the proximal peri-articular medial tibia has good construct validity and may represent an alternative for CT-based BV/TV.
Collapse
Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Piccinini M, Cugnoni J, Botsis J, Zacchetti G, Ammann P, Wiskott A. Factors affecting subject-specific finite element models of implant-fitted rat bone specimens: critical analysis of a technical protocol. Comput Methods Biomech Biomed Engin 2013; 17:1403-17. [DOI: 10.1080/10255842.2012.736502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Abstract
Osteoporosis is becoming an increasingly important public health issue, and effective treatments to prevent fragility fractures are available. Osteoporosis imaging is of critical importance in identifying individuals at risk for fractures who would require pharmacotherapy to reduce fracture risk and also in monitoring response to treatment. Dual x-ray absorptiometry is currently the state-of-the-art technique to measure bone mineral density and to diagnose osteoporosis according to the World Health Organization guidelines. Motivated by a 2000 National Institutes of Health consensus conference, substantial research efforts have focused on assessing bone quality by using advanced imaging techniques. Among these techniques aimed at better characterizing fracture risk and treatment effects, high-resolution peripheral quantitative computed tomography (CT) currently plays a central role, and a large number of recent studies have used this technique to study trabecular and cortical bone architecture. Other techniques to analyze bone quality include multidetector CT, magnetic resonance imaging, and quantitative ultrasonography. In addition to quantitative imaging techniques measuring bone density and quality, imaging needs to be used to diagnose prevalent osteoporotic fractures, such as spine fractures on chest radiographs and sagittal multidetector CT reconstructions. Radiologists need to be sensitized to the fact that the presence of fragility fractures will alter patient care, and these fractures need to be described in the report. This review article covers state-of-the-art imaging techniques to measure bone mineral density, describes novel techniques to study bone quality, and focuses on how standard imaging techniques should be used to diagnose prevalent osteoporotic fractures.
Collapse
Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA 94143, USA.
| |
Collapse
|
12
|
Abstract
Osteoporosis is becoming an increasingly important public health issue, and effective treatments to prevent fragility fractures are available. Osteoporosis imaging is of critical importance in identifying individuals at risk for fractures who would require pharmacotherapy to reduce fracture risk and also in monitoring response to treatment. Dual x-ray absorptiometry is currently the state-of-the-art technique to measure bone mineral density and to diagnose osteoporosis according to the World Health Organization guidelines. Motivated by a 2000 National Institutes of Health consensus conference, substantial research efforts have focused on assessing bone quality by using advanced imaging techniques. Among these techniques aimed at better characterizing fracture risk and treatment effects, high-resolution peripheral quantitative computed tomography (CT) currently plays a central role, and a large number of recent studies have used this technique to study trabecular and cortical bone architecture. Other techniques to analyze bone quality include multidetector CT, magnetic resonance imaging, and quantitative ultrasonography. In addition to quantitative imaging techniques measuring bone density and quality, imaging needs to be used to diagnose prevalent osteoporotic fractures, such as spine fractures on chest radiographs and sagittal multidetector CT reconstructions. Radiologists need to be sensitized to the fact that the presence of fragility fractures will alter patient care, and these fractures need to be described in the report. This review article covers state-of-the-art imaging techniques to measure bone mineral density, describes novel techniques to study bone quality, and focuses on how standard imaging techniques should be used to diagnose prevalent osteoporotic fractures.
Collapse
Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA 94143, USA.
| |
Collapse
|
13
|
Burghardt AJ, Link TM, Majumdar S. High-resolution computed tomography for clinical imaging of bone microarchitecture. Clin Orthop Relat Res 2011; 469:2179-93. [PMID: 21344275 PMCID: PMC3126972 DOI: 10.1007/s11999-010-1766-x] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of bone structure, one component of bone quality, has emerged as a contributor to bone strength. The application of high-resolution imaging in evaluating bone structure has evolved from an in vitro technology for small specimens to an emerging clinical research tool for in vivo studies in humans. However, many technical and practical challenges remain to translate these techniques into established clinical outcomes. QUESTIONS/PURPOSES We reviewed use of high-resolution CT for evaluating trabecular microarchitecture and cortical ultrastructure of bone specimens ex vivo, extension of these techniques to in vivo human imaging studies, and recent studies involving application of high-resolution CT to characterize bone structure in the context of skeletal disease. METHODS We performed the literature review using PubMed and Google Scholar. Keywords included CT, MDCT, micro-CT, high-resolution peripheral CT, bone microarchitecture, and bone quality. RESULTS Specimens can be imaged by micro-CT at a resolution starting at 1 μm, but in vivo human imaging is restricted to a voxel size of 82 μm (with actual spatial resolution of ~ 130 μm) due to technical limitations and radiation dose considerations. Presently, this mode is limited to peripheral skeletal regions, such as the wrist and tibia. In contrast, multidetector CT can assess the central skeleton but incurs a higher radiation burden on the subject and provides lower resolution (200-500 μm). CONCLUSIONS CT currently provides quantitative measures of bone structure and may be used for estimating bone strength mathematically. The techniques may provide clinically relevant information by enhancing our understanding of fracture risk and establishing the efficacy of antifracture for osteoporosis and other bone metabolic disorders.
Collapse
Affiliation(s)
- Andrew J. Burghardt
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Campus Box 2520, QB3 Building, 2nd Floor, Suite 203, 1700 4th Street, San Francisco, CA 94158 USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Campus Box 2520, QB3 Building, 2nd Floor, Suite 203, 1700 4th Street, San Francisco, CA 94158 USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Campus Box 2520, QB3 Building, 2nd Floor, Suite 203, 1700 4th Street, San Francisco, CA 94158 USA
| |
Collapse
|
14
|
Kim N, Lee JG, Song Y, Kim HJ, S. Yeom J, Cho G. Evaluation of MRI resolution affecting trabecular bone parameters: Determination of acceptable resolution. Magn Reson Med 2011; 67:218-25. [DOI: 10.1002/mrm.22984] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 03/10/2011] [Accepted: 04/06/2011] [Indexed: 11/05/2022]
|
15
|
Variation of trabecular architecture in proximal femur of postmenopausal women. J Biomech 2011; 44:248-56. [DOI: 10.1016/j.jbiomech.2010.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 10/13/2010] [Indexed: 01/02/2023]
|
16
|
Baum T, Carballido-Gamio J, Huber MB, Müller D, Monetti R, Räth C, Eckstein F, Lochmüller EM, Majumdar S, Rummeny EJ, Link TM, Bauer JS. Automated 3D trabecular bone structure analysis of the proximal femur--prediction of biomechanical strength by CT and DXA. Osteoporos Int 2010; 21:1553-64. [PMID: 19859642 PMCID: PMC2912724 DOI: 10.1007/s00198-009-1090-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 10/01/2009] [Indexed: 12/19/2022]
Abstract
SUMMARY The standard diagnostic technique for assessing osteoporosis is dual X-ray absorptiometry (DXA) measuring bone mass parameters. In this study, a combination of DXA and trabecular structure parameters (acquired by computed tomography [CT]) most accurately predicted the biomechanical strength of the proximal femur and allowed for a better prediction than DXA alone. INTRODUCTION An automated 3D segmentation algorithm was applied to determine specific structure parameters of the trabecular bone in CT images of the proximal femur. This was done to evaluate the ability of these parameters for predicting biomechanical femoral bone strength in comparison with bone mineral content (BMC) and bone mineral density (BMD) acquired by DXA as standard diagnostic technique. METHODS One hundred eighty-seven proximal femur specimens were harvested from formalin-fixed human cadavers. BMC and BMD were determined by DXA. Structure parameters of the trabecular bone (i.e., morphometry, fuzzy logic, Minkowski functionals, and the scaling index method [SIM]) were computed from CT images. Absolute femoral bone strength was assessed with a biomechanical side-impact test measuring failure load (FL). Adjusted FL parameters for appraisal of relative bone strength were calculated by dividing FL by influencing variables such as body height, weight, or femoral head diameter. RESULTS The best single parameter predicting FL and adjusted FL parameters was apparent trabecular separation (morphometry) or DXA-derived BMC or BMD with correlations up to r = 0.802. In combination with DXA, structure parameters (most notably the SIM and morphometry) added in linear regression models significant information in predicting FL and all adjusted FL parameters (up to R(adj) = 0.872) and allowed for a significant better prediction than DXA alone. CONCLUSION A combination of bone mass (DXA) and structure parameters of the trabecular bone (linear and nonlinear, global and local) most accurately predicted absolute and relative femoral bone strength.
Collapse
Affiliation(s)
- T Baum
- Institut für Röntgendiagnostik, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Krug R, Burghardt AJ, Majumdar S, Link TM. High-resolution imaging techniques for the assessment of osteoporosis. Radiol Clin North Am 2010; 48:601-21. [PMID: 20609895 DOI: 10.1016/j.rcl.2010.02.015] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The importance of assessing the bone's microarchitectural make-up in addition to its mineral density in the context of osteoporosis has been emphasized in several publications. The high spatial resolution required to resolve the bone's microstructure in a clinically feasible scan time is challenging. At present, the best suited modalities meeting these requirements in vivo are high-resolution peripheral quantitative imaging (HR-pQCT) and magnetic resonance imaging (MRI). Whereas HR-pQCT is limited to peripheral skeleton regions like the wrist and ankle, MRI can also image other sites like the proximal femur but usually with lower spatial resolution. In addition, multidetector computed tomography has been used for high-resolution imaging of trabecular bone structure; however, the radiation dose is a limiting factor. This article provides an overview of the different modalities, technical requirements, and recent developments in this emerging field. Details regarding imaging protocols as well as image postprocessing methods for bone structure quantification are discussed.
Collapse
Affiliation(s)
- Roland Krug
- MQIR, Department of Radiology and Biomedical Imaging, University of California-San Francisco, UCSF China Basin Landing, 185 Berry Street, San Francisco, CA 94107, USA.
| | | | | | | |
Collapse
|
18
|
Djuric M, Djonic D, Milovanovic P, Nikolic S, Marshall R, Marinkovic J, Hahn M. Region-specific sex-dependent pattern of age-related changes of proximal femoral cancellous bone and its implications on differential bone fragility. Calcif Tissue Int 2010; 86:192-201. [PMID: 20012269 DOI: 10.1007/s00223-009-9325-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 11/13/2009] [Indexed: 11/26/2022]
Abstract
Despite evident interest in age-related bone changes, data on regional differences within the proximal femur are scarce. To date, there has been no comprehensive study on site-specific age-related changes in the trabecular architecture of three biomechanically important femoral subregions (medial neck, lateral neck, and intertrochanteric region) for both genders. In this study we investigated age-related deterioration in the trabecular architecture of those three subregions of the femoral neck for both genders. The research sample included 52 proximal femora (26 males, 26 females; age range, 26-96 years) from Forensic Department at University of Belgrade. Bone sections from the three regions of interest were scanned by micro-CT at University of Hamburg. The study revealed that proximal femoral microarchitecture cannot be perceived as homogeneous and, more importantly, that the aging process is not uniform. Besides the initial intersite differences, microarchitecture changed differently with increasing age, maintaining significant differences between the regions. In addition, we observed a different aging pattern between genders: deterioration was most significant in the intertrochanteric region in women, while the lateral neck was most affected in men. This finding supports epidemiological data about the differential occurrence of cervical vs. trochanteric fractures in aging males and females. In conclusion, the aging process in the proximal femur cannot be regarded as a simple function of quantitative bone loss but, rather, as an alteration of specific architecture that may degrade bone strength.
Collapse
Affiliation(s)
- Marija Djuric
- Laboratory for Anthropology, Department of Anatomy, School of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia.
| | | | | | | | | | | | | |
Collapse
|
19
|
Huber MB, Carballido-Gamio J, Fritscher K, Schubert R, Haenni M, Hengg C, Majumdar S, Link TM. Development and testing of texture discriminators for the analysis of trabecular bone in proximal femur radiographs. Med Phys 2010; 36:5089-98. [PMID: 19994519 DOI: 10.1118/1.3215535] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Texture analysis of femur radiographs may serve as a potential low cost technique to predict osteoporotic fracture risk and has received considerable attention in the past years. A further application of this technique may be the measurement of the quality of specific bone compartments to provide useful information for treatment of bone fractures. Two challenges of texture analysis are the selection of the best suitable texture measure and reproducible placement of regions of interest (ROIs). The goal of this in vitro study was to automatically place ROIs in radiographs of proximal femur specimens and to calculate correlations between various different texture analysis methods and the femurs' anchorage strength. METHODS Radiographs were obtained from 14 femoral specimens and bone mineral density (BMD) was measured in the femoral neck. Biomechanical testing was performed to assess the anchorage strength in terms of failure load, breakaway torque, and number of cycles. Images were segmented using a framework that is based on the usage of level sets and statistical in-shape models. Five ROIs were automatically placed in the head, upper and lower neck, trochanteric, and shaft compartment in an atlas subject. All other subjects were registered rigidly, affinely, and nonlinearly, and the resulting transformation was used to map the five ROIs onto the individual femora. RESULTS In each ROI, texture features were extracted using gray level co-occurence matrices (GLCM), third-order GLCM, morphological gradients (MGs), Minkowski dimensions (MDs), Minkowski functionals (MFs), Gaussian Markov random fields, and scaling index method (SIM). Coefficients of determination for each texture feature with parameters of anchorage strength were computed. In a stepwise multiregression analysis, the most predictive parameters were identified in different models. Texture features were highly correlated with anchorage strength estimated by the failure load of up to R2=0.61 (MF and MG features, p<0.01) and were partially independent of BMD. The correlations were dependent on the choice of the ROI and the texture measure. The best predictive multiregression model for failure load R2adj=0.86 (p<0.001) included a set of recently developed texture methods (MF and SIM) but excluded bone mineral density and commonly used texture measures. CONCLUSIONS The results suggest that texture information contained in trabecular bone structure visualized on radiographs may predict whether an implant anchorage can be used and may determine the local bone quality from preoperative radiographs.
Collapse
Affiliation(s)
- M B Huber
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, San Francisco, California 94143, USA.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Jan S Bauer
- Department of Radiology, UCSF, San Francisco, CA, USA.
| | | |
Collapse
|
21
|
Folkesson J, Krug R, Goldenstein J, Issever AS, Fang C, Link TM, Majumdar S. Evaluation of correction methods for coil-induced intensity inhomogeneities and their influence on trabecular bone structure parameters from MR images. Med Phys 2009; 36:1267-74. [PMID: 19472635 DOI: 10.1118/1.3097281] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Magnetic resonance (MR) imaging-based quantitative trabecular bone structure analysis has gained increasing interest in osteoporotic fracture risk assessment and treatment evaluation related to osteoporosis. In vivo MR images of anatomic regions such as the proximal femur and distal tibia are generally acquired with a surface coil in order to obtain sufficient sensitivity and resolution for quantification of the trabeculae. However, these coils introduce intensity inhomogeneities which affect the trabecular bone structure analysis. This work evaluates the applicability of a fully automatic coil correction by nonparametric nonuniform intensity normalization (N3) in the analysis of trabecular bone parameters. The ability to correct for coil-induced intensity inhomogeneity was evaluated ex vivo on proximal femur specimens scanned with both a surface coil and a volume coil, which allowed for a direct evaluation of the performance of the coil correction methods without any major confounding factors. In addition, trabecular bone parameter values were correlated with values from high-resolution peripheral computed tomography (HR-pQCT) scans, and the reproducibility of trabecular bone parameters was evaluated in an in vivo study of repeat hip MR scans. The trabecular bone parameters determined from MR surface coil scans processed with the N3 coil correction method showed significant correlation (p < 0.05) with corresponding values from homogeneous intensity data in the ex vivo study. This can be compared to the correlation without coil correction (p < 0.5), and coil correction using low-pass filtering (LPF) (p < 0.53). The in vivo interscan variability was reduced from 8.9% to 12.8% using LPF-based to 3.6%-8.4% (CV) using N3 coil correction; hence the results showed that N3 is advantageous to LPF-based coil correction. No significant differences in correlation to HR-pQCT data were found for the coil correction methods. The significant correlations with volume coil data and high reproducibility of the N3 processed data imply that N3 coil correction preserve image information while accurately correcting for coil-induced intensity inhomogeneities, which makes it suitable for quantitative analysis of trabecular bone structure from MR images acquired with surface coils.
Collapse
Affiliation(s)
- Jenny Folkesson
- Department of Radiology and Biomedical Imaging, Musculoskeletal and Quantitative Imaging Research Group (MQIR), University of California, San Francisco, California 94158, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Diederichs G, Link TM, Kentenich M, Schwieger K, Huber MB, Burghardt AJ, Majumdar S, Rogalla P, Issever AS. Assessment of trabecular bone structure of the calcaneus using multi-detector CT: correlation with microCT and biomechanical testing. Bone 2009; 44:976-83. [PMID: 19442610 DOI: 10.1016/j.bone.2009.01.372] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 01/09/2009] [Accepted: 01/14/2009] [Indexed: 11/30/2022]
Abstract
The prediction of bone strength can be improved when determining bone mineral density (BMD) in combination with measures of trabecular microarchitecture. The goal of this study was to assess parameters of trabecular bone structure and texture of the calcaneus by clinical multi-detector row computed tomography (MDCT) in an experimental in situ setup and to correlate these parameters with microCT (microCT) and biomechanical testing. Thirty calcanei in 15 intact cadavers were scanned using three different protocols on a 64-slice MDCT scanner with an in-plane pixel size of 208 microm and 500 microm slice thickness. Bone cores were harvested from each specimen and microCT images with a voxel size of 16 microm were obtained. After image coregistration, trabecular bone structure and texture were evaluated in identical regions on the MDCT images. After data acquisition, uniaxial compression testing was performed. Significant correlations between MDCT- and microCT-derived measures of bone volume fraction (BV/TV), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp) were found (range, R(2)=0.19-0.65, p<0.01 or 0.05). The MDCT-derived parameters of volumetric BMD, app. BV/TV, app. Tb.Th and app. Tb.Sp were capable of predicting 60%, 63%, 53% and 25% of the variation in bone strength (p<0.01). When combining those measures with one additional texture index (either GLCM, TOGLCM or MF.euler), prediction of mechanical competence was significantly improved to 86%, 85%, 71% and 63% (p<0.01). In conclusion, this study showed the feasibility of trabecular microarchitecture assessment using MDCT in an experimental setup simulating the clinical situation. Multivariate models of BMD or structural parameters combined with texture indices improved prediction of bone strength significantly and might provide more reliable estimates of fracture risk in patients.
Collapse
Affiliation(s)
- Gerd Diederichs
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Bauer JS, Monetti R, Krug R, Matsuura M, Mueller D, Eckstein F, Rummeny EJ, Lochmueller EM, Raeth CW, Link TM. Advances of 3T MR imaging in visualizing trabecular bone structure of the calcaneus are partially SNR-independent: Analysis using simulated noise in relation to micro-CT, 1.5T MRI, and biomechanical strength. J Magn Reson Imaging 2009; 29:132-40. [DOI: 10.1002/jmri.21625] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
24
|
Blumenfeld J, Studholme C, Carballido-Gamio J, Carpenter D, Link TM, Majumdar S. Three-dimensional image registration of MR proximal femur images for the analysis of trabecular bone parameters. Med Phys 2008; 35:4630-9. [PMID: 18975709 DOI: 10.1118/1.2977764] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study investigated the feasibility of automatic image registration of MR high-spatial resolution proximal femur trabecular bone images as well as the effects of gray-level interpolation and volume of interest (VOI) misalignment on MR-derived trabecular bone structure parameters. For six subjects in a short-term study, a baseline scan and a follow-up scan of the proximal femur were acquired on the same day. For ten subjects in a long-term study, a follow-up scan of the proximal femur was acquired 1 year after the baseline. An automatic image registration technique, based on mutual information, utilized a baseline and a follow-up scan to compute transform parameters that aligned the two images. In the short-term study, these parameters were subsequently used to transform the follow-up image with three different gray-level interpolators. Nearest-neighbor interpolation and B-spline approximation did not significantly alter bone parameters, while linear interpolation significantly modified bone parameters (p<0.01). Improvement in image alignment due to the automatic registration for the long-term and short-term study was determined by inspecting difference images and 3D renderings. This work demonstrates the first application of automatic registration, without prior segmentation, of high-spatial resolution trabecular bone MR images of the proximal femur. Additionally, inherent heterogeneity in trabecular bone structure and imprecise positioning of the VOI along the slice (anterior-posterior) direction resulted in significant changes in bone parameters (p<0.01). Results suggest that automatic mutual information registration using B-spline approximation or nearest neighbor gray-level interpolation to transform the final image ensures VOI alignment between baseline and follow-up images and does not compromise the integrity of MR-derived trabecular bone parameters used in this study.
Collapse
Affiliation(s)
- Janet Blumenfeld
- Department of Radiology and UCSF-UCB Joint Graduate Group in Bioengineering, University of California, San Francisco, San Francisco, California 94107, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Cui WQ, Won YY, Baek MH, Lee DH, Chung YS, Hur JH, Ma YZ. Age-and region-dependent changes in three-dimensional microstructural properties of proximal femoral trabeculae. Osteoporos Int 2008; 19:1579-87. [PMID: 18437273 DOI: 10.1007/s00198-008-0601-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 01/08/2008] [Indexed: 10/22/2022]
Abstract
UNLABELLED This study investigated regional variations in the 3D microstructure of trabecular bone in human proximal femur, with respect to aging. The results demonstrate that age-related changes in trabecular microstructure significantly varied from different sub-regions of the proximal femur. INTRODUCTION We hypothesize that the age-related changes in trabecular bone microstructure appear to be varied from specific anatomic sub-regions of the proximal femur followed by non-uniform bone loss. The purpose of this study was therefore to explore regional variations in the 3D microstructure of trabecular bone in human proximal femur, with respect to aging. METHODS A total of 162 trabecular bone cores from six regions of 27 femora of male cadaver donors were scanned using micro-computed tomography (micro-CT). The following microstructural parameters were calculated: bone volume fraction (BV/TV), trabecular number (Tb.N), thickness (Tb.Th) and separation (Tb.Sp), structure model index (SMI), and degree of anisotropy (DOA). RESULTS Age-related changes in trabecular microstructure varied from different regions of the proximal femur. There was a significant decrease in bone volume fraction and an almost identical decrease in trabecular thickness associated with aging at any region. Regional analysis demonstrated a significant difference in BV/TV, Tb.Th, Tb.Sp, Tb.N and DOA between superior and inferior neck, as well as a significant difference in BV/TV, Tb.Sp, Tb.N, SMI and DOA between superior and inferior trochanter. CONCLUSIONS Age-related changes in bone loss and trabecular microstructure within the male proximal femur are not uniform in this cadaveric population.
Collapse
Affiliation(s)
- W-Q Cui
- Department of Orthopaedic Surgery, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, South Korea
| | | | | | | | | | | | | |
Collapse
|
26
|
Diederichs G, Link T, Marie K, Huber M, Rogalla P, Burghardt A, Majumdar S, Issever A. Feasibility of measuring trabecular bone structure of the proximal femur using 64-slice multidetector computed tomography in a clinical setting. Calcif Tissue Int 2008; 83:332-41. [PMID: 18855036 DOI: 10.1007/s00223-008-9181-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 09/18/2008] [Indexed: 11/28/2022]
Abstract
We studied the feasibility of cancellous bone structure assessment of the proximal femur using multidetector computed tomography (MDCT) in an simulated in vivo experimental model. The proximal femur of 15 intact human cadavers was examined using 64-row MDCT using a thin-section protocol with an in-plane spatial resolution of 273 mum. High-resolution peripheral quantitative computed tomography (HR-pQCT) of the isolated specimens with a voxel size of 82 mum served as a standard of reference. Trabecular bone structure and optimized textural parameters were calculated in MDCT images and compared to measures obtained by HR-pQCT. Significant correlations between MDCT- and HR-pQCT-derived values for bone fraction (r = 0.87), trabecular separation (r = 0.66), and number (r = 0.53) were found. Parameters derived from textural analysis performed better in predicting trabecular separation (up to r = 0.86) and number (up to r = 0.83). Trabecular thickness could not be quantified correctly using MDCT, most likely due to its limited resolution. Individual parameters for assessement of trabecular microarchitecture can be measured using MDCT-derived imaging studies and a simulated in vivo setup. Thus, in vivo assessment of bone architecture in addition to BMD may be feasible in clinical practice.
Collapse
Affiliation(s)
- Gerd Diederichs
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Huber MB, Carballido-Gamio J, Bauer JS, Baum T, Eckstein F, Lochmüller EM, Majumdar S, Link TM. Proximal femur specimens: automated 3D trabecular bone mineral density analysis at multidetector CT--correlation with biomechanical strength measurement. Radiology 2008; 247:472-81. [PMID: 18430879 DOI: 10.1148/radiol.2472070982] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate an automated volume of interest (VOI)-fitting algorithm for quantitative computed tomography (CT) of proximal femur specimens, correlate bone mineral density (BMD) with biomechanically determined bone strength in vitro, and compare that correlation with those observed at dual-energy x-ray absorptiometry (DXA) measurement of BMD. MATERIALS AND METHODS The study was compliant with institutional and legislative requirements; donors had dedicated their body for education and research before death. Multidetector CT and DXA scans were acquired in 178 proximal femur specimens harvested from human cadavers (91 women, 87 men; mean age at death, 79 years +/- 10.2; range, 52-100 years). An automated VOI-fitting algorithm was used to calculate BMD and bone mineral content (BMC) in the head, neck, and trochanter from CT findings and pixel distribution parameters. The femur failure load (FL) was determined by using a mechanical test. Quantitative CT BMD, quantitative CT pixel distribution parameters, DXA BMD, and FL were correlated at multiple regression analysis. RESULTS Mean precision errors in quantitative CT BMD measurements at segmentation with repositioning were 0.56%, 2.26%, and 0.61% for the head, neck, and trochanter, respectively. For the head, neck, and trochanter, respectively, r values were 0.77, 0.53, and 0.59 for the correlation between quantitative CT BMD and FL and 0.74, 0.55, and 0.65 for the correlation between quantitative CT BMC and FL (P < .001). Values ranged from 0.77 to 0.80 for correlations between DXA BMD and FL and from 0.73 to 0.82 for correlations between DXA BMC and FL (P < .001). In a multiple regression model that included quantitative CT pixel distributions, adjusted multivariate correlation coefficient values for correlations with FL increased to up to 0.88. CONCLUSION Regional BMD of the proximal femur can be determined in vitro from quantitative CT data with high precision by using an automated VOI-fitting algorithm. The best multiple regression model for predicting FL included DXA BMD and regional quantitative CT BMD measurements.
Collapse
Affiliation(s)
- Markus B Huber
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Helgason B, Perilli E, Schileo E, Taddei F, Brynjólfsson S, Viceconti M. Mathematical relationships between bone density and mechanical properties: a literature review. Clin Biomech (Bristol, Avon) 2008; 23:135-46. [PMID: 17931759 DOI: 10.1016/j.clinbiomech.2007.08.024] [Citation(s) in RCA: 320] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 08/17/2007] [Accepted: 08/31/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND In many published studies, elastic properties of bone are correlated to the bone density, in order to derive an empirical elasticity-density relationship. The most common use of these relationships is the prediction of the bone local properties from medical imaging data in subject-specific numerical simulation studies. The proposed relationships are substantially different one from the other. It is unclear whether such differences in elasticity-density relationships can be entirely explained in terms of methodological discrepancies among studies. METHODS All relevant literature was reviewed. Only elasticity-density relationships derived from similarly controlled experiments were included and properly normalized. The resulting relationships were grouped according to the most important methodological differences: type of end support during testing, specimen geometry, and anatomical sampling location. FINDINGS Even after normalization with respect to strain rate and densitometric measurement unit, substantial inter-study differences do exist, and they can only be partially explained by the methodological differences between studies. INTERPRETATION Some recommendations are made for the application of elasticity-density relationships to subject-specific finite element studies. The importance of defining a standardized mechanical testing methodology for bone specimens is stressed, and some guidelines that emerged from the literature are proposed. To identify density-elasticity relationships suitable for use in subject-specific FE studies, the development of a benchmark study is also proposed, where the elasticity-density relationship is taken as the variable under study, and a numerical model of known numerical accuracy predicts experimental strain measurements.
Collapse
Affiliation(s)
- Benedikt Helgason
- University of Iceland, Department of Mechanical and Industrial Engineering, Reykjavík, Iceland
| | | | | | | | | | | |
Collapse
|
29
|
Patel PV, Eckstein F, Carballido-Gamio J, Phan C, Matsuura M, Lochmüller EM, Majumdar S, Link TM. Fuzzy logic structure analysis of trabecular bone of the calcaneus to estimate proximal femur fracture load and discriminate subjects with and without vertebral fractures using high-resolution magnetic resonance imaging at 1.5 T and 3 T. Calcif Tissue Int 2007; 81:294-304. [PMID: 17705050 DOI: 10.1007/s00223-007-9058-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 07/01/2007] [Indexed: 10/22/2022]
Abstract
Newly developed fuzzy logic-derived structural parameters were used to characterize trabecular bone architecture in high-resolution magnetic resonance imaging (HR-MRI) of human cadaver calcaneus specimens. These parameters were compared to standard histomorphological structural measures and analyzed concerning performance in discriminating vertebral fracture status and estimating proximal femur fracture load. Sets of 60 sagittal 1.5 T and 3.0 T HR-MRI images of the calcaneus were obtained in 39 cadavers using a fast gradient recalled echo sequence. Structural parameters equivalent to bone histomorphometry and fuzzy logic-derived parameters were calculated using two chosen regions of interest. Calcaneal, spine, and hip bone mineral density (BMD) measurements were also obtained. Fracture status of the thoracic and lumbar spine was assessed on lateral radiographs. Finally, mechanical strength testing of the proximal femur was performed. Diagnostic performance in discriminating vertebral fracture status and estimating femoral fracture load was calculated using regression analyses, two-tailed t-tests of significance, and receiver operating characteristic (ROC) analyses. Significant correlations were obtained at both field strengths between all structural and fuzzy logic parameters (r up to 0.92). Correlations between histomorphological or fuzzy logic parameters and calcaneal BMD were mostly significant (r up to 0.78). ROC analyses demonstrated that standard structural parameters were able to differentiate persons with and without vertebral fractures (area under the curve [A(Z)] up to 0.73). However, none of the parameters obtained in the 1.5-T images and none of the fuzzy logic parameters discriminated persons with and without vertebral fractures. Significant correlations were found between fuzzy or structural parameters and femoral fracture load. Using multiple regression analysis, none of the structural or fuzzy parameters were found to add discriminative value to BMD alone. In summary significant correlations were obtained at both field strengths between all structural and fuzzy logic parameters. However, fuzzy logic-based calcaneal parameters were not well suited for vertebral fracture discrimination. Although significant correlations were found between fuzzy or structural parameters and femoral fracture load, multiple regression analysis showed limited improvement for estimating femoral failure load in addition to femoral BMD alone. Local femoral measurements are still needed to estimate femoral bone strength. Overall, parameters obtained at 3.0 T performed better than those at 1.5 T.
Collapse
Affiliation(s)
- Priyesh V Patel
- Department of Radiology, University of California, San Francisco, CA 94143-0628, USA
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Bauer JS, Link TM, Burghardt A, Henning TD, Mueller D, Majumdar S, Prevrhal S. Analysis of trabecular bone structure with multidetector spiral computed tomography in a simulated soft-tissue environment. Calcif Tissue Int 2007; 80:366-73. [PMID: 17520165 DOI: 10.1007/s00223-007-9021-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 02/27/2007] [Indexed: 11/28/2022]
Abstract
We investigated the influence of soft tissue (ST) on image quality by high-resolution multidetector computed tomography (MDCT) scans and assessed the effect of surrounding ST on the quantification of trabecular bone structure. Eight bone cores obtained from human proximal femoral heads discarded during hip replacement surgery were scanned with micro-computed tomography (microCT) as well as with MDCT both without (w/o) and with (w) simulated surrounding ST, where a phantom imitated a human torso. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured in all scans. Apparent trabecular bone structure parameters were calculated and compared to similar parameters obtained in coregistered sections of the microCT scans. Residual errors were calculated as root-mean-square (RMS) errors relative to the microCT measurements. Compared to microCT results, trabecular structure parameters were overestimated by MDCT both w and w/o ST. SNR and CNR were significantly higher in the scans w/o ST. Significant correlations between microCT and MDCT results were found for bone fraction (r = 0.90 w/o ST, r = 0.84 w ST), trabecular number, and separation. RMS ranged from 10% to 15% for MDCT w/o ST and from 10% to 17% for MDCT w ST. Only bone fraction showed significantly different RMS and correlations for scans w/o vs. w ST (P < 0.05). This study showed that MDCT is able to visualize trabecular bone structure in an in vivo-like setting at skeletal sites within the torso such as the proximal femur. Even though ST scatter compromises image quality substantially, the major characteristics of the trabecular network can still be appreciated and quantified.
Collapse
Affiliation(s)
- Jan S Bauer
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology, University of California in San Francisco, San Francisco, CA, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Phan CM, Matsuura M, Bauer JS, Dunn TC, Newitt D, Lochmueller EM, Eckstein F, Majumdar S, Link TM. Trabecular bone structure of the calcaneus: comparison of MR imaging at 3.0 and 1.5 T with micro-CT as the standard of reference. Radiology 2006; 239:488-96. [PMID: 16569786 DOI: 10.1148/radiol.2392050574] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate in vitro the calcaneal trabecular bone structure in elderly human donors with high spatial resolution magnetic resonance (MR) imaging at 3.0 T and 1.5 T, to quantitatively compare MR measures of bone microarchitecture with those from micro-computed tomography (CT), and to compare the performance of 3.0-T MR imaging with that of 1.5-T MR imaging in differentiating donors with spinal fractures from those without spinal fractures. MATERIALS AND METHODS The study was performed in line with institutional and legislative requirements; all donors had dedicated their body for educational and research purposes prior to death. Sagittal MR images of 49 human calcaneus cadaveric specimens were obtained (mean age of donors, 79.5 years +/- 11 [standard deviation]; 26 male donors, 23 female donors). After the spatial coregistering of images acquired at 3.0-T and 1.5-T MR imaging, the signal-to-noise-ratios and structural parameters obtained at each magnetic field strength were compared in corresponding sections. Micro-CT was performed on calcaneus cores obtained from corresponding regions in 40 cadaveric specimens. Vertebral deformities of the thoracic and lumbar spine were radiographically classified by using the spinal fracture index. Diagnostic performance of the structural parameters in differentiating donors with vertebral fractures from those without was assessed by using receiver operator characteristic (ROC) analysis, including area under the ROC curve (A(z)). RESULTS Correlations between structural parameters at 3.0-T MR imaging and those at micro-CT were significantly higher (P < .05) than correlations between structural parameters at 1.5-T MR imaging and those at micro-CT (trabecular thickness, r = 0.76 at 3.0 T vs r = 0.57 at 1.5 T). Trabecular dimensions were amplified at 3.0 T because of increasing susceptibility artifacts. Also, higher ROC values were found for structural parameters at 3.0 T than at 1.5 T, but differences were not significant (trabecular thickness, A(z) = 0.75 at 3.0 T vs A(z) = 0.66 at 1.5 T, P > .05). CONCLUSION MR imaging at 3.0 T provided a better measure of the trabecular bone structure than did MR imaging at 1.5 T. There was a trend for better differentiation of donors with from those without osteoporotic vertebral fractures at 3.0 T than at 1.5 T.
Collapse
Affiliation(s)
- Catherine M Phan
- Department of Radiology, University of California, San Francisco, 400 Parnassus Ave, A 367, Box 0628, San Francisco, CA 94143-0628, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Bauer JS, Kohlmann S, Eckstein F, Mueller D, Lochmüller EM, Link TM. Structural analysis of trabecular bone of the proximal femur using multislice computed tomography: a comparison with dual X-ray absorptiometry for predicting biomechanical strength in vitro. Calcif Tissue Int 2006; 78:78-89. [PMID: 16467973 DOI: 10.1007/s00223-005-0070-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 10/08/2005] [Indexed: 10/25/2022]
Abstract
We investigated whether trabecular microstructural parameters determined in multislice spiral computed tomographic (MSCT) images of proximal femur specimens differed in male and female donors and improved the prediction of biomechanical strength of the femur compared to bone mineral density (BMD) and content (BMC) determined with dual X-ray absorptiometry (DXA) as the standard diagnostic technique. Proximal femur specimens (n = 119) were harvested from formalin-fixed human cadavers (mean age 80 +/- 10 years). BMD was determined using DXA. Trabecular microstructural parameters (bone volume fraction, fractal dimension, and trabecular thickness, spacing, and number) were calculated in MSCT-derived images of the proximal femur. Failure load (FL) was measured using a biomechanical side-impact test. An age-, height-, and weight-matched subgroup (n = 54) was chosen to compare male and female donors. BMC, BMD, and structural parameters correlated significantly with FL, with r up to 0.75, 0.71, and 0.71, respectively. In a multiple regression model, an increase up to r = 0.82 was obtained when combining trabecular structural parameters and BMC. BMD differed between males and females only at the trochanter. BMC showed significant gender differences in all regions. This experimental study showed that a combination of BMC and microstructural parameters could improve the prediction of FL, suggesting that bone mass and trabecular structure carry overlapping but complementary information and that a combination of the two provides the best prediction of bone strength. Male donors had larger femora even after adjustment for body size and height, but no differences in trabecular structure were found between males and females.
Collapse
Affiliation(s)
- J S Bauer
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology, University of California, San Francisco, CA, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Ito M, Ikeda K, Nishiguchi M, Shindo H, Uetani M, Hosoi T, Orimo H. Multi-detector row CT imaging of vertebral microstructure for evaluation of fracture risk. J Bone Miner Res 2005; 20:1828-36. [PMID: 16160740 DOI: 10.1359/jbmr.050610] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 06/04/2005] [Accepted: 06/16/2005] [Indexed: 11/18/2022]
Abstract
UNLABELLED We applied MDCT for in vivo evaluation of the microarchitecture of human vertebrae. Microstructure parameters, such as structure model index, Euler's number, and bone volume fraction, revealed higher relative risk for prevalent vertebral fracture than did BMD obtained by DXA. Thus, microstructure analysis by MDCT, together with simultaneously obtained volumetric BMD values, is useful for clinical assessment of fracture risk. INTRODUCTION BMD measurement by DXA alone has limitations in predicting fracture, and methods for clinical assessment of bone quality, such as microstructure, are awaited. This study was undertaken to examine the applicability of multidetector row CT (MDCT) for in vivo evaluation of trabecular microstructure. MATERIALS AND METHODS Optimal conditions for MDCT scanning were determined at a spatial resolution of 250 x 250 x 500 mum, using muCT data of excised human vertebra specimens as a reference. We analyzed the trabecular microstructure of the vertebrae of 82 postmenopausal women (55-76 years old), including 39 women with and 43 without a recent vertebral fracture. RESULTS Microstructure indices obtained by MDCT scanning revealed higher relative risk for prevalent vertebral fracture (OR: 16.0 for structure model index, 13.6 for bone volume fraction, and 13.1 for Euler's number) than did spinal BMD obtained by DXA (OR: 4.8). MDCT could also provide volumetric BMD data, which had higher diagnostic value (OR: 12.7) than did DXA. CONCLUSION Vertebral microarchitecture can be visualized by MDCT, and microstructure parameters obtained by MDCT, together with volumetric BMD, provided better diagnostic performance for assessing fracture risk than DXA measurement.
Collapse
Affiliation(s)
- Masako Ito
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan.
| | | | | | | | | | | | | |
Collapse
|
34
|
Wilkie JR, Giger ML, Chinander MR, Vokes TJ, Nishikawa RM, Carlin MD. Investigation of physical image quality indices of a bone densitometry system. Med Phys 2004; 31:873-81. [PMID: 15125005 DOI: 10.1118/1.1650528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Osteoporosis is a disease characterized by a loss of bone mass and a deterioration of bone structure. Bone mineral density (BMD) measures bone mass and is currently the method used to diagnose osteoporosis, while computerized radiographic texture analysis (RTA) is being investigated as a measure of bone structure. The GE/Lunar PIXI peripheral bone densitometer (PD) system, which uses dual-energy subtraction to measure BMD, also provides a digital image of the heel or forearm. The goal of our current research was to evaluate the physical imaging properties of the PIXI system (pixel size of 0.2 mm) compared to a Fuji computed radiography (CR) system (pixel size of 0.1 mm) to determine its suitability for texture analysis from image data. Contrast was measured using a series of uniform images covering the useful clinical exposure range. Spatial resolution was characterized by the presampling modulation transfer function (MTF) determined by an edge method. Noise power spectra (NPS) for different exposures were calculated using a two-dimensional Fourier analysis method. The expectation modulation transfer function was measured and combined with the NPS data to calculate the noise-equivalent number of quanta. The slope of the characteristic curve of the peripheral densitometer (PD) system was found to be position dependent across the image, although this dependence was substantially reduced by use of the system's clinical-settings corrections. An MTF value of 0.5 was found at 0.5 cycles/mm for the densitometry system compared to the same value at 1.6 cycles/mm for the CR system. Unlike the CR system, the NPS of the densitometry system was found not to be directionally dependent and did not drop off at higher spatial frequencies.
Collapse
Affiliation(s)
- Joel R Wilkie
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637, USA
| | | | | | | | | | | |
Collapse
|
35
|
Wilkie JR, Giger ML, Chinander MR, Vokes TJ, Li H, Dixon L, Jaros V. Comparison of radiographic texture analysis from computed radiography and bone densitometry systems. Med Phys 2004; 31:882-91. [PMID: 15125006 DOI: 10.1118/1.1650529] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Osteoporosis is a disease that results in an increased risk of bone fracture due to a loss of bone mass and deterioration of bone structure. Bone mineral density (BMD) provides a measure of bone mass and is frequently measured by bone densitometry systems to diagnose osteoporosis. In addition, computerized radiographic texture analysis (RTA) is currently being investigated as a measure of bone structure and as an additional diagnostic predictor of osteoporosis. In this study, we assessed the ability of a peripheral bone densitometry (PD) system to yield images useful for RTA. The benefit of such a system is that it measures BMD by dual-energy x-ray absorptiometry and therefore provides high- and low-energy digital radiographic images. The bone densitometry system investigated was the GE/Lunar PIXI, which provides 512 x 512 digital images of the heel or forearm (0.2 mm pixels). We compared texture features of heel images obtained with this PD system to those obtained on a Fuji computed radiography (CR) system (0.1 mm pixels). Fourier and fractal-based texture features of images from 24 subjects who had both CR and BMD exams were calculated, and correlation between the two systems was analyzed. Fourier-based texture features characterize the magnitude, frequency content, and orientation of the trabecular bone pattern. Good correlation was found between the two modalities for the first moment (FMP) with r=0.71 (p value<0.0001) and for minimum FMP with r=0.52 (p value=0.008). Root-mean-square (RMS) did not correlate with r=0.31 (p value>0.05), while the standard deviation of the RMS did correlate with r=0.79 (p value<0.0001). Good correlation was also found between the two modalities for the fractal-based texture features with r=0.79 (p value<0.0001) for the global Minkowski dimension and r=0.63 (p value=0.0007) for the fractal dimension from a box counting method. The PD system therefore may have the potential for yielding heel images suitable for RTA.
Collapse
Affiliation(s)
- Joel R Wilkie
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Damilakis J, Maris T, Papadokostakis G, Sideri L, Gourtsoyiannis N. Discriminatory Ability of Magnetic Resonance T2* Measurements in a Sample of Postmenopausal Women With Low-Energy Fractures. Invest Radiol 2004; 39:706-12. [PMID: 15486532 DOI: 10.1097/00004424-200411000-00009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES We sought to assess the ability of magnetic resonance T2* measurements to discriminate between patients with and without osteoporotic fracture and compare the results with the discriminatory ability of speed of sound (SOS) measured at the phalanx and axial bone mineral density (BMD). MATERIALS AND METHODS T2* measurements of lumbar spine were obtained at 1.5 T in 26 postmenopausal women with osteoporotic fractures and 28 age-matched healthy control subjects. A multiecho gradient echo (MEGRE) pulse train sequence was used with echo times of 2.70-74.93 milliseconds using 2.33-millisecond interecho intervals. BMD measurements were made in the axial skeleton. SOS also was measured at the finger phalanges. RESULTS The in vivo short-term reproducibility for T2* was 1.85%. T2*, spinal BMD, total hip BMD, and SOS measurements were found to give comparable discrimination between normal and osteoporotic women with odds ratios of 2.6, 2.6, 3.2, and 2.2, respectively. CONCLUSIONS T2* measurements of lumbar spine are reproducible and capable of differentiating between postmenopausal women with and those without osteoporotic fractures.
Collapse
Affiliation(s)
- John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Iraklion, Crete, Greece.
| | | | | | | | | |
Collapse
|
37
|
Cortet B, Chappard D, Boutry N, Dubois P, Cotten A, Marchandise X. Relationship between computed tomographic image analysis and histomorphometry for microarchitectural characterization of human calcaneus. Calcif Tissue Int 2004; 75:23-31. [PMID: 15129367 DOI: 10.1007/s00223-004-0086-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study aimed to characterize the relationships between several variables reflecting bone microarchitecture assessed by both computed tomographic (CT) image analysis and histomorphometry (conventional CT system) at the calcaneus. A total of 24 cadaveric specimens were studied. The mean age at death was 78 +/- 10 years (range, 53-93 years). A total of 15 sagittal sections (1 mm in width and spaced 2 mm apart) were selected for CT analysis; 6 undecalcified sections (7 microm) were analyzed for histomorphometry. The histomorphometric analysis was performed on a Leica Quantimet Q570 image analyzer. Features measured by both methods were: bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), interconnectivity index (ICI), number of nodes (N Nd), number of terminus (N Tm), node-to-node strut count (NNS), node-to-terminus strut count (NTS), terminus-to-terminus strut count (TTS), marrow space star volume (SV), Euler number (EN), and fractal dimension (FD). The coefficient of correlations' values (simple linear regression) between histomorphometry and CT image analysis varied according to the parameters selected. R values were high for BV/TV, Tb.N, and Tb.Sp (range, 0.69-0.90; P < 0.01). R values were less significant for some variables also obtained from the binary image: SV (0.5, P < 0.05) and EN (0.43, P < 0.05). Finally R values were also significant for (two) variables obtained from skeletonized images, i.e., N Nd (0.4, P < 0.05) and N Tm (0.61, P < 0.01). Other correlations were not statistically significant. Moreover, for some variables the relationships between the two methods (CT analysis and histomorphometry) seemed best-described by using nonlinear models. For example, a logarithmic model was more appropriate for SV (r = 0.71, P < 0.01), N Nd (r = 0.52, P < 0.01). Finally the relationship between apparent (App) N Tm and N Tm was most satisfying when using an exponential model (r = 0.64, P < 0.01). In conclusion, trabecular bone structure measures determined on CT images show highly significant correlations with those determined using histomorphometry. The level of correlation varies according to the type of method used for characterizing bone structure, however, and the strongest correlations were found for the most basic features (Parfitt's parameters). Finally, for some variables, nonlinear models seem more appropriate.
Collapse
Affiliation(s)
- B Cortet
- Department of Rheumatology, University-Hospital of Lille, 59037 Lille CEDEX, France.
| | | | | | | | | | | |
Collapse
|
38
|
Nägele E, Kuhn V, Vogt H, Link TM, Müller R, Lochmüller EM, Eckstein F. Technical considerations for microstructural analysis of human trabecular bone from specimens excised from various skeletal sites. Calcif Tissue Int 2004; 75:15-22. [PMID: 15037972 DOI: 10.1007/s00223-004-0151-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to test the effect of repositioning, systematic displacements of the region of interest (ROI), and acquisition parameters (scan mode and integration time) on quantitative analysis of human trabecular bone microstructure at various skeletal sites, using microcomputed tomographic (microCT) technology. We investigated 28 cylindrical specimens of human trabecular bone (length 14 mm, diameter 8 mm) from four skeletal sites (femoral neck, greater trochanter, second lumbar vertebra, and distal radius). These specimens were selected from over 200 microCT measurements, in order to cover a large range of bone volume fraction (BV/TV) observed at each site. Cylindrical ROIs (length 6 mm, diameter 6 mm) were examined twice at an isotropic resolution of 26 microm, 8 weeks apart. In addition, comparative analyses were performed for displacements of the volumes of interest (VOIs) by 1, 2, 3, and 4 mm (83.4%, 66.6%, 50%, and 33.3% overlap), respectively. Eventually, comparative measurements were obtained at different resolution scan modes and integration times. The results show that microCT measurements are highly reproducible (range of the root mean square coefficient variation % (RMS CV%) = 0.64% to 1.29% for BV/TV at different sites). Displacements of the VOI of up to 4 mm generally led to non significant systematic differences in mean values of < 10%. When comparing various combinations of resolution scan modes and integration times, the use of an integration time of 100 ms was found to be preferable for determining microstructural parameters from human samples with this microCT scanner.
Collapse
Affiliation(s)
- E Nägele
- Musculoskeletal Research Group, Institute of Anatomy, Ludwig-Maximilians-Universität München, Pettenkoferstr. 11, D-80336 München, Germany
| | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Technologic developments and applications such as dual energy x-ray absorptiometry, magnetic resonance imaging, and computed tomography have enabled researchers to assess bone quantity (ie, bone mineral density) and bone quality (ie, bone architecture), which are two important and independent contributions to bone strength. Recent studies on sex differences in bone architecture indicate that a number of biomechanical variables lead to increased bone strength in males compared with females. Ethnic differences in bone architecture are less clear-cut, indicating a need to identify and test the social and biologic variables that race and ethnicity represent. New methods using magnetic resonance imaging technology may become important in creating efficient and reliable in vivo methods of assessing features of bone architecture that are relevant to fracture risk and contribute to the elucidation of sex and ethnic differences in osteoporosis.
Collapse
Affiliation(s)
- Dorothy A Nelson
- Department of Internal Medicine, Rheumatology UHC 4-H, 4201 St. Antoine Blvd., Detroit, MI 48201, USA.
| | | |
Collapse
|
40
|
Abstract
Structure and microarchitecture are determinant aspects of bone strength and essential elements for the assessment of bone mechanical properties. The main structural determinants of bone mechanical strength include width and porosity in the cortical bone; shape, width, connectivity, and anisotropy in the trabecular bone. There are several methods to assess bone architecture, particularly at the trabecular level. Two different approaches can be identified. The first is based on the use of optical microscopy and on the principles of quantitative histology, which evaluate microarchitecture two-dimensionally. The second applies the most modern diagnostic techniques, employing computed tomography and magnetic resonance to obtain and analyze three-dimensional images. From a clinical point of view, microarchitecture is an interesting aspect to study and define specific patterns, such as glucocorticoid-induced osteoporosis, or to evaluate bone alterations in transplanted patients. Microarchitecture seems to be a determinant of bone fragility independent of bone density. Moreover, bone microarchitecture seems to be important to understand the mechanisms of bone fragility as well as the action of the drugs used to prevent osteoporotic fractures. Several in vivo studies (on animals and humans) showed important findings on the effects of different treatments on microarchitecture. Bisphosphonates and parathyroid hormone seemed to preserve or even improve microarchitecture. These observations can provide an additional interpretation for the anti-fracture effect of drugs from a structural viewpoint. The challenge for the future will be to evaluate bone quality in vivo with the same or better resolution and accuracy than the invasive methods in use today.
Collapse
Affiliation(s)
- L Dalle Carbonare
- Department of Medical and Surgical Sciences, Medical Clinic I, University of Padova, Padova, Italy.
| | | |
Collapse
|
41
|
Abstract
Bone fragility is determined by bone mass and trabecular structure. While bone mass can be readily measured as bone density, bone trabecular structure cannot be easily assessed by currently available methods. The realization of the importance of bone structure in determining fracture risk has led to the development of several imaging modalities aimed at evaluating the contribution of bone quality to its biomechanical strength and fragility. High-resolution magnetic resonance imaging and computed tomography have limited spatial resolution and high cost but have a potential to generate true three-dimensional images of trabecular structure in vivo. Bone radiographs subjected to various forms of texture analysis have higher resolution and lower cost but provide only a two-dimensional representation of bone structure. Both two- and three-dimensional methods have been shown to predict biomechanical strength in vitro and to differentiate between subjects with and without fractures in vivo. Therefore, all of these methods deserve closer evaluation and also need further technical improvements before they can be considered for use in clinical practice.
Collapse
Affiliation(s)
- Tamara J Vokes
- Section of Endocrinology, Department of Medicine, University of Chicago, 5841 S. Maryland, MC1027, Chicago, IL 60637, USA.
| | | |
Collapse
|