Computed tomography derived bone density measurement in the diabetic foot

Barwick, Alex; Tessier, John; Mirow, James; Jonge, X. Janse de; Chuter, Vivienne

doi:10.1186/s13047-017-0192-7

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…A comparison of our findings to pre-existing reference values is therefore not possible at this point. Nonetheless, a recent investigation by Barwick et al [22] on derived bone densities in the diabetic foot presented average HU values of the calcaneus which are comparable to our findings, despite the underlying disease in the patient population.…”

Section: Discussionsupporting

confidence: 90%

Cancellous autografts of the calcaneus: an area-bound measurement of density values in Hounsfield units by use of computed tomography for enhanced bone graft harvest

Drosten¹,

Fuhrmann²,

Timmesfeld³

et al. 2018

J Transl Sci

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Background: In foot and ankle surgery, the calcaneus serves as an established harvest site for autogenous grafts. As described in current literature, the procedure is associated with a low complication rate of 0 to 13.8%. But, only small amounts of bony material are harvestable by a lateral approach that has not been standardized until now. Moreover, the current technique neither considers the material quantity nor the material quality within the calcaneus. Our study was designed to determine the calcaneal area providing the highest density values in Hounsfield units (HU) in order to harvest more material while causing less damage to the bone. Methods:In 402 eligible sagittal foot and ankle CT scans, the calcaneus was divided into areas I, II, III and IV on the basis of anatomical landmarks. HU values were obtained per area and per measuring slice. Additional peculiarities, such as the location of the neutral triangle, were also recorded. Results:The average density value was 284 HU for area I, 185 HU for area II, 183 HU for area III and 173 HU for area IV. Age-dependent as well as ageindependent density values were significantly higher in area I than in areas II to IV (all p < 0.0001). When comparing HU values of all males (215; 53.5 %) to HU values of all females (187; 46.5 %), no significant difference was found for areas I and II (both p = 0.9995). Conclusion:Our study revealed that area I is the best harvest site for the retrieval of cancellous autografts of the calcaneus, regarding the available material. Thus, the current lateral approach needs to be modified: a lateral-superior approach or a dorsal approach might be conceivable. Further research on consequential complications and biomechanical impacts is required.

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Section: Discussionsupporting

confidence: 90%

Cancellous autografts of the calcaneus: an area-bound measurement of density values in Hounsfield units by use of computed tomography for enhanced bone graft harvest

Drosten¹,

Fuhrmann²,

Timmesfeld³

et al. 2018

J Transl Sci

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“…There are several existing studies that use clinical CT to evaluate BMD in the midfoot 23 . A clinical CT study in the medial cuneiform showed the highest density in the distal‐dorsal‐lateral site with increasing density in the dorsal and distal directions, 17 matching the density trends seen in our study.…”

Section: Discussionsupporting

confidence: 86%

Micro‐CT analysis of the Lisfranc complex reveals higher bone mineral density in dorsal compared to plantar regions

Requist

Sripanich

Rolvien

et al. 2021

Journal Orthopaedic Research

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Injuries to the Lisfranc complex may require surgical fixation, the stability of which may be correlated with bone mineral density (BMD). However, there is limited research on regional BMD variations in the Lisfranc complex. This study used quantitative micro-CT to characterize regional BMD in the four bones (medial cuneiform, intermediate cuneiform, first metatarsal, and second metatarsal) of this complex.Twenty-four cadaveric specimens were imaged with a calibration phantom using micro-CT. Each bone was segmented and divided into eight regions based on an anatomical coordinate system. BMD for each octant was calculated using scanspecific calibration equations and average image intensity. Differences between regions were analyzed using ANOVA with post hoc analysis and differences between groups of four octants in each plane were analyzed with t-tests with significance level α = 0.05. The highest density region in the medial cuneiform was the distal-dorsal-lateral and dorsal regions showed significantly higher BMD than plantar regions. The intermediate cuneiform had the highest density in the distal-dorsal-medial region and the dorsal and medial regions had higher BMD than the plantar and lateral regions, respectively. The densest region of the first metatarsal was the distal-dorsal-lateral and distal regions had significantly higher BMD than proximal regions. In the second metatarsal, the distal-dorsal-medial region had the highest density, and the distal, dorsal, and medial regions had significantly higher BMD than the proximal, plantar, and lateral regions, respectively. The predominant finding was a pattern of increased density in the dorsal bone regions, which may be relevant in the surgical management of Lisfranc injuries.

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“…Five regions of interest (ROIs) for the five different mineral contents of the reference phantom (Mindways Inc., Austin, TX, USA) were recorded in the same CT images. For the CT image of each patient, the phantom-based calibration algorithm [28, 29] determined the linear correlation between the known mineral densities and their corresponding HU values as follows:BMDphantom=α×HU+β,where α and β are the patient-specific values that are to be determined. Thus, using equation (1) with the determined α and β , the voxelwise BMD values of the lumbar spine and hip of each patient were calculated as the ground truth.…”

Section: Methodsmentioning

confidence: 99%

Patient-Specific Phantomless Estimation of Bone Mineral Density and Its Effects on Finite Element Analysis Results: A Feasibility Study

Lee

Kim

Jang

2019

Computational and Mathematical Methods in Medicine

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Objectives This study proposes a regression model for the phantomless Hounsfield units (HU) to bone mineral density (BMD) conversion including patient physical factors and analyzes the accuracy of the estimated BMD values. Methods The HU values, BMDs, circumferences of the body, and cross-sectional areas of bone were measured from 39 quantitative computed tomography images of L2 vertebrae and hips. Then, the phantomless HU-to-BMD conversion was derived using a multiple linear regression model. For the statistical analysis, the correlation between the estimated BMD values and the reference BMD values was evaluated using Pearson's correlation test. Voxelwise BMD and finite element analysis (FEA) results were analyzed in terms of root-mean-square error (RMSE) and strain energy density, respectively. Results The HU values and circumferences were statistically significant (p < 0.05) for the lumbar spine, whereas only the HU values were statistically significant (p < 0.05) for the proximal femur. The BMD values estimated using the proposed HU-to-BMD conversion were significantly correlated with those measured using the reference phantom: Pearson's correlation coefficients of 0.998 and 0.984 for the lumbar spine and proximal femur, respectively. The RMSEs of the estimated BMD values for the lumbar spine and hip were 4.26 ± 0.60 (mg/cc) and 8.35 ± 0.57 (mg/cc), respectively. The errors of total strain energy were 1.06% and 0.91%, respectively. Conclusions The proposed phantomless HU-to-BMD conversion demonstrates the potential of precisely estimating BMD values from CT images without the reference phantom and being utilized as a viable tool for FEA-based quantitative assessment using routine CT images.

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Computed tomography derived bone density measurement in the diabetic foot

Cited by 12 publications

References 23 publications

Cancellous autografts of the calcaneus: an area-bound measurement of density values in Hounsfield units by use of computed tomography for enhanced bone graft harvest

Cancellous autografts of the calcaneus: an area-bound measurement of density values in Hounsfield units by use of computed tomography for enhanced bone graft harvest

Micro‐CT analysis of the Lisfranc complex reveals higher bone mineral density in dorsal compared to plantar regions

Patient-Specific Phantomless Estimation of Bone Mineral Density and Its Effects on Finite Element Analysis Results: A Feasibility Study

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