Assessment of Lumbar Vertebrae Morphology by Computed Tomography in Older Adults with Osteoporosis

Impact of different 3D regions of interest on quantifying dynamic lumbar vertebral microstructure in ovariectomized rats-a micro-CT study

Introduction

The selection of regions of interest (ROIs) is crucial for accurate microcomputed tomography (micro-CT) analysis. Distinct ROI selection methods exist for lumbar vertebras in osteoporotic animal model research. However, whether different ROIs directly affect the results of quantitative micro-CT-based microarchitectural data is still unknown. This study aimed to compare the diagnostic accuracy of two commonly used ROIs of lumbar vertebras in ovariectomized (OVX) rats at different time points.

Methods

Rats were randomly divided into the baseline group, the sham/OVX-operated groups, with 12- or 24-weeks sham (Sham 12w or Sham 24w)/12- or 24-weeks (OVX 12w or OVX 24w)-operated group (n = 6 in every group). The fifth lumbar vertebras were collected and scanned using micro-CT. Quantitative analyses of bone microarchitecture parameters were conducted separately for the central ROI (ROI 1) and overall ROI (ROI 2).

Results

The results indicated that the Tb.N of baseline group rats for ROI 1 was significantly lower than that for ROI 2. The Tb.Th of rats of the Sham 12w and Sham 24w groups was significantly increased compared to that of the baseline group rats using the ROI 2 analysis. The bone mineral density (BMD) and bone volume fraction (BV/TV) were significantly lower by the ROI 1 than by the ROI 2 in all groups. The BMD and BV/TV also showed a significant reduction at 24 weeks postoperatively compared with those at 12 weeks postoperatively. Bland-Altman analysis showed good consistency between the two different ROI selection methods.

Conclusion

This study found that capturing peripheral trabeculas (overall ROI) does not explain the increased Tb.Th in healthy mice and decreased Tb.N in OVX mice; both findings indicate that this is evident in both ROI. Moreover, this study suggested the potential value of the central ROI (effective and quicker) for evaluating osteoporosis of the lumbar vertebras in OVX rats and provides a basis for analyzing the morphological changes of lumbar trabecular.

Using advanced imaging to measure bone density, compression fracture risk, and risk for construct failure after spine surgery

Low bone mineral density (BMD) can predispose to vertebral body compression fractures and postoperative instrumentation failure. DEXA is considered the gold standard for measurement of BMD, however it is not obtained for all spine surgery patients preoperatively. There is a growing body of evidence suggesting that more routinely acquired spine imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) can be opportunistically used to measure BMD. Here we review available studies that assess the validity of opportunistic screening with CT-derived Hounsfield Units (HU) and MRI-derived vertebral vone quality (VBQ) to measure BMD of the spine as well the utility of these measures in predicting postoperative outcomes. Additionally, we provide screening thresholds based on HU and VBQ for prediction of osteopenia/ osteoporosis and postoperative outcomes such as cage subsidence, screw loosening, proximal junctional kyphosis, and implant failure.