Automatic phantom-less QCT system with high precision of BMD measurement for osteoporosis screening: Technique optimisation and clinical validation

Liu, Zhuo-jie; Cheng, Zhang; Ma, Chi; Qi, Huan; Yang, Zehong; Wu, Haoyu; Yang, Kaiyuan; Lin, Junyu; Tak-Man, Wong; Li, Zhaoyang; Li, Chunhai; Ding, Yuanyuan

doi:10.1016/j.jot.2021.11.008

Cited by 26 publications

(20 citation statements)

References 34 publications

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“…Unlike DXA, QCT has the benefits of higher accuracy and reproductivity ( Li et al, 2014 ). Another benefit of this patient-specific cage customization is the validated phantomless QCT system ( Liu et al, 2022 ) used for endplate vBMD (EP-vBMD) measurements.…”

Section: Introductionmentioning

confidence: 99%

Endplate volumetric bone mineral density biomechanically matched interbody cage

Weng

et al. 2022

Front. Bioeng. Biotechnol.

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Disc degenerative problems affect the aging population, globally, and interbody fusion is a crucial surgical treatment. The interbody cage is the critical implant in interbody fusion surgery; however, its subsidence risk becomes a remarkable clinical complication. Cage subsidence is caused due to a mismatch of material properties between the bone and implant, specifically, the higher elastic modulus of the cage relative to that of the spinal segments, inducing subsidence. Our recent observation has demonstrated that endplate volumetric bone mineral density (EP-vBMD) measured through the greatest cortex-occupied 1.25-mm height region of interest, using automatic phantomless quantitative computed tomography scanning, could be an independent cage subsidence predictor and a tool for cage selection instruction. Porous design on the metallic cage is a trend in interbody fusion devices as it provides a solution to the subsidence problem. Moreover, the superior osseointegration effect of the metallic cage, like the titanium alloy cage, is retained. Patient-specific customization of porous metallic cages based on the greatest subsidence-related EP-vBMD may be a good modification for the cage design as it can achieve biomechanical matching with the contacting bone tissue. We proposed a novel perspective on porous metallic cages by customizing the elastic modulus of porous metallic cages by modifying its porosity according to endplate elastic modulus calculated from EP-vBMD. A three-grade porosity customization strategy was introduced, and direct porosity-modulus customization was also available depending on the patient’s or doctor’s discretion.

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Section: Introductionmentioning

confidence: 99%

Endplate volumetric bone mineral density biomechanically matched interbody cage

Weng

et al. 2022

Front. Bioeng. Biotechnol.

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“…Feasibility studies of in vivo , phantomless BMD assessments were separately performed by Booz et al ( 22 ), who used dual-source DECT, and Liu et al ( 23 ), who used FSDECT. Michalski et al ( 24 ) and Bartenschlager et al ( 25 ) have demonstrated the accuracy of phantomless BMD measurement.…”

Section: Discussionmentioning

confidence: 99%

The new fast kilovoltage-switching dual-energy computed tomography for measuring bone mineral density

Wang¹,

Wu²,

Zhou³

et al. 2023

Quant Imaging Med Surg

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Background: The update in technology may impact the accuracy in measuring bone mineral density (BMD). However, the application of the new fast kilovoltage (kV)-switching dual-energy computed tomography (DECT) for BMD measurement has not yet been reported. This study aimed to examine the accuracy and precision of the new fast kV-switching DECT in measuring BMD and to evaluate its applicability in clinical BMD measurement.Methods: Forty sets of the new fast kV-switching DECT scans and one quantitative computed tomography (QCT) scan were performed on the European Spine Phantom. Their relative errors and relative standard deviations were compared. A retrospective analysis was performed on patients who underwent chest plain DECT and abdominal monoenergetic plain CT at the same time. The relationship between hydroxyapatitewater and hydroxyapatite-fat measured using DECT and BMD measured using QCT was analyzed by multivariate regression analysis. Results:The relative errors of the new fast kV-switching DECT with low tube speeds (0.8 and 1.0 s/r) were all less than 6% and were less than those of QCT, except for those at 515 mA. The relative standard deviation values with high tube rotation speeds (0.5 and 0.6 s/r) were higher than those with low tube speeds (0.8 and 1.0 s/r) under most tube current conditions. The new fast kV-switching DECT-derived BMD values corrected by multiple linear regression (predicted hydroxyapatite) were significantly positively correlated with the QCT-based BMD values (R 2 =0.912; P<0.001). The results of the Bland-Altman analysis demonstrated high consistency between the 2 measurement methods.Conclusions: Results of the phantom measurements indicated that the new fast kV-switching DECT could measure BMD with relatively high accuracy and precision. The results of a subsequent clinical in vivo experiment demonstrated that vertebral BMD measurements derived from DECT and QCT were mostly consistent and highly accurate. Therefore, patients who undergo DECT for other clinical indications can simultaneously have their BMD determined.

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“…Lu Yet al developed useful automatic QCT image analysis software based on the deep learning method in LDCT images, which eliminate the heavy manual operation in BMD measurement and liberate the radiologist from reduplicative tasks ( Pan et al, 2020 ). In a previous study, our group also developed an automatic phantom-less QCT system based on traditional machine learning methods in lumbar CT images, which shows high BMD measurement precision with the automatic selection of fat and muscle ROI ( Liu et al, 2021 ). In this study, we further validated the capability and precision of our automatic PL-QCT system in LDCT so as to enhance its possibility of being integrated into the CT workflow in large-scale osteoporosis screening.…”

Section: Discussionmentioning

confidence: 99%

“…This novel PL-QCT has the automatic function of selecting the vertebrae, hip, fat, and muscle ROI and calibrating the BMD with high precision. A detailed phantom-less QCT technology development process can be found in our last study ( Liu et al, 2021 ). Fat and muscle ROI CT values have been used to calibrate the BMD results ( Figure 2 ).…”

Section: Methodsmentioning

confidence: 99%

One Novel Phantom-Less Quantitative Computed Tomography System for Auto-Diagnosis of Osteoporosis Utilizes Low-Dose Chest Computed Tomography Obtained for COVID-19 Screening

Tang

Cheng

et al. 2022

Front. Bioeng. Biotechnol.

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Background: The diagnosis of osteoporosis is still one of the most critical topics for orthopedic surgeons worldwide. One research direction is to use existing clinical imaging data for accurate measurements of bone mineral density (BMD) without additional radiation.Methods: A novel phantom-less quantitative computed tomography (PL-QCT) system was developed to measure BMD and diagnose osteoporosis, as our previous study reported. Compared with traditional phantom-less QCT, this tool can conduct an automatic selection of body tissues and complete the BMD calibration with high efficacy and precision. The function has great advantages in big data screening and thus expands the scope of use of this novel PL-QCT. In this study, we utilized lung cancer or COVID-19 screening low-dose computed tomography (LDCT) of 649 patients for BMD calibration by the novel PL-QCT, and we made the BMD changes with age based on this PL-QCT.Results: The results show that the novel PL-QCT can predict osteoporosis with relatively high accuracy and precision using LDCT, and the AUC values range from 0.68 to 0.88 with DXA results as diagnosis reference. The relationship between PL-QCT BMD with age is close to the real trend population (from ∼160 mg/cc in less than 30 years old to ∼70 mg/cc in greater than 80 years old for both female and male groups). Additionally, the calculation results of Pearson’s r-values for correlation between CT values with BMD in different CT devices were 0.85–0.99.Conclusion: To our knowledge, it is the first time for automatic PL-QCT to evaluate the performance against dual-energy X-ray absorptiometry (DXA) in LDCT images. The results indicate that it may be a promising tool for individuals screened for low-dose chest computed tomography.

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Automatic phantom-less QCT system with high precision of BMD measurement for osteoporosis screening: Technique optimisation and clinical validation

Cited by 26 publications

References 34 publications

Endplate volumetric bone mineral density biomechanically matched interbody cage

Endplate volumetric bone mineral density biomechanically matched interbody cage

The new fast kilovoltage-switching dual-energy computed tomography for measuring bone mineral density

One Novel Phantom-Less Quantitative Computed Tomography System for Auto-Diagnosis of Osteoporosis Utilizes Low-Dose Chest Computed Tomography Obtained for COVID-19 Screening

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