MRI-based assessment of proximal femur strength compared to mechanical testing

Rajapakse, Chamith S.; Farid, Alexander R.; Kargilis, Daniel; Jones, Brandon C.; Lee, Jae‐Shin; Johncola, Alyssa; Batzdorf, Alexandra; Shetye, Snehal S.; Hast, Michael W.; Chang, Gregory

doi:10.1016/j.bone.2020.115227

Cited by 26 publications

(19 citation statements)

References 67 publications

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“…[65][66][67] In this regard, FEA applied to MRI data has shown to be a promising approach that can reliably provide fracture risk information and evaluation of bone strength with good reproducibility of FEA measurements, furthermore pointing at good agreement of the method against the gold standard of mechanical testing at the femur. 47,[68][69][70]…”

Section: Technical Principlesmentioning

confidence: 99%

MRI‐Based Quantitative Osteoporosis Imaging at the Spine and Femur

Sollmann

Löffler

Kronthaler

et al. 2020

Magnetic Resonance Imaging

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Osteoporosis is a systemic skeletal disease with a high prevalence worldwide, characterized by low bone mass and microarchitectural deterioration, predisposing an individual to fragility fractures. Dual-energy X-ray absorptiometry (DXA) has been the clinical reference standard for diagnosing osteoporosis and for assessing fracture risk for decades. However, other imaging modalities are of increasing importance to investigate the etiology, treatment, and fracture risk. The purpose of this work is to review the available literature on quantitative magnetic resonance imaging (MRI) methods and related findings in osteoporosis at the spine and proximal femur as the clinically most important fracture sites. Trabecular bone microstructure analysis at the proximal femur based on high-resolution MRI allows for a better prediction of osteoporotic fracture risk than DXA-based bone mineral density (BMD) alone. In the 1990s, T 2 * mapping was shown to correlate with the density and orientation of the trabecular bone. Recently, quantitative susceptibility mapping (QSM), which overcomes some of the limitations of T 2 * mapping, has been applied for trabecular bone quantifications at the spine, whereas ultrashort echo time (UTE) imaging provides valuable surrogate markers of cortical bone quantity and quality. Magnetic resonance spectroscopy (MRS) and chemical shift encoding-based water-fat MRI (CSE-MRI) enable the quantitative assessment of the nonmineralized bone compartment through extraction of the bone marrow fat fraction (BMFF). Furthermore, CSE-MRI allows for the differentiation of osteoporotic vs. pathologic fractures, which is of high clinical relevance. Lastly, advanced postprocessing and image analysis tools, particularly considering statistical parametric mapping and region-specific BMFF distributions, have high potential to further improve MRI-based fracture risk assessments at the spine and hip. Level of Evidence: 5 Technical Efficacy Stage: 2

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Section: Technical Principlesmentioning

confidence: 99%

MRI‐Based Quantitative Osteoporosis Imaging at the Spine and Femur

Sollmann

Löffler

Kronthaler

et al. 2020

Magnetic Resonance Imaging

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“…However, we used the same modeling approach as others 7,10,15 . A recent cadaver study demonstrated high consistency between experimentally measured and MRI‐FEA derived bone strength (and stiffness) of the proximal femur given a sideways loading configuration, strongly supporting the use of MRI‐FEA to reliably predict the mechanical competence of the human femur in clinical settings 14 . Second, due to limitations of computational resources, only linear elastic FEA was conducted and our results are thus limited to reports of whole‐bone stiffness and high‐risk tissue strains.…”

Section: Discussionmentioning

confidence: 72%

“…Thus, we speculate that the anisotropic feature of the elements might have limited effect on the overall mechanical performance of the proximal femur. Indeed, a recent cadaver study has shown strong agreements between experimentally measured values of the femoral stiffness (and strength) and predictions from both isotropic and anisotropic voxel‐based MRI‐FE models 14 …”

Section: Discussionmentioning

confidence: 96%

In Vivo Assessment of Age‐ and Loading Configuration‐Related Changes in Multiscale Mechanical Behavior of the Human Proximal Femur Using MRI‐Based Finite Element Analysis

Zhang

Wang

et al. 2020

Magnetic Resonance Imaging

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Background MRI‐based finite element analysis (MRI‐FEA) is the only method able to assess microstructural and whole‐bone mechanical properties of the hip in vivo. Purpose To examine whether MRI‐FEA is capable of discriminating age‐related changes in whole‐bone mechanical performance and micromechanical behavior of the proximal femur, particularly considering the most common hip fracture‐related sideways fall loading. Study Type Retrospective. Subjects A total of nine younger (27 ± 3.2 years) and nine elderly (61 ± 3.9 years) healthy volunteers. Field Strength/Sequence 3T; 3D fast field echo sequence. Assessment The left proximal femurs were scanned and FE models created. FEA was performed to simulate sideways fall and stance loading for each femoral model. Apparent stiffness and high‐risk (90th percentile) tensile and compressive strains of the proximal femur as well as the average strains within cubic regions of the femoral neck and greater trochanter were assessed. Statistical Tests Paired and unpaired t‐tests. Results Compared to the young group, the femoral stiffness of the elderly decreased by 39% and 40% (both P < 0.05) under the sideways fall and stance conditions, respectively. Accordingly, the high‐risk tensile and compressive stains were elevated with aging (40% and 23% for sideways fall, 23% and 11% for stance conditions; all P < 0.05). However, the loading configuration‐induced difference was only observed in the elderly group for the high‐risk strains (22% for tension and 12% for compression; both P < 0.05). Additionally, compared to the stance condition, the sideways fall increased the average tensile (young: 108%, elderly: 123%; both P < 0.05) and compressive strains (young: 631%, elderly: 617%, both P < 0.05) within the greater trochanter rather than the femoral neck region. Data Conclusion In vivo MRI‐FEA is capable of capturing age‐related changes in both apparent‐level stiffness and tissue‐level micromechanical behavior of the proximal femur. However, the effect of sideways fall loading might be better reflected by tissue‐level micromechanics rather than apparent stiffness. Level of Evidence 3 Technical Efficacy Stage 1

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“…These studies highlight the usefulness of FEA derived from micro-MRI for monitoring treatment response. FEA using specialised MRI algorithms have been validated for the distal tibia ( Rajapakse et al, 2018 ) and more recently for the femur ( Rajapakse and Chang, 2018 ; Rajapakse et al, 2020 ). FEA of the femur is especially useful for evaluating fracture risk in the hip as it can simulate forces experienced during a sideways fall, which accounts for the main orientation in which hip fractures occur ( Keyak et al, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Bone microarchitecture in patients undergoing parathyroidectomy for management of secondary hyperparathyroidism

et al. 2020

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Background Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) leads to complex bone disease, affecting both trabecular and cortical bone, and increased fracture risk. Optimal assessment of bone in patients with CKD is yet to be determined. High-resolution magnetic resonance imaging (MRI) can provide three-dimensional assessment of bone microarchitecture, as well as determination of mechanical strength with finite element analysis (FEA). Methods We conducted a single-centre, cross-sectional study to determine bone microarchitecture with MRI in CKD patients with SHPT undergoing parathyroidectomy. Within two weeks of surgery, MRI was performed at the distal tibia and biochemical markers of SHPT (parathyroid hormone [PTH] and alkaline phosphatase [ALP]) were collected. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Correlation of MRI findings of bone was made with biochemical markers. Results Twenty patients with CKD (15 male, 5 female) underwent MRI at the time of parathyroidectomy (16 on dialysis, 3 with functioning kidney transplant, one pre-dialysis with CKD stage 5). Median PTH at the time of surgery was 138.5 pmol/L [39.6–186.7 pmol/L]. MRI parameters in patients were consistent with trabecular deterioration, with erosion index (EI) 1.01 ± 0.3, and trabecular bone volume (BV/TV) 10.8 ± 2.9%, as well as poor trabecular network integrity with surface-to-curve ratio (S/C) 5.4 ± 2.3. There was also evidence of reduced cortical thickness, with CTh 2.698 ± 0.630 mm, and FEA demonstrated overall poor bone mechanical strength with mean elastic modulus of 2.07 ± 0.44. Conclusion Patients with severe SHPT requiring parathyroidectomy have evidence of significant changes in bone microarchitecture with trabecular deterioration, low trabecular and cortical bone volume, and reduced mechanical competence of bone.

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MRI-based assessment of proximal femur strength compared to mechanical testing

Cited by 26 publications

References 67 publications

MRI‐Based Quantitative Osteoporosis Imaging at the Spine and Femur

MRI‐Based Quantitative Osteoporosis Imaging at the Spine and Femur

In Vivo Assessment of Age‐ and Loading Configuration‐Related Changes in Multiscale Mechanical Behavior of the Human Proximal Femur Using MRI‐Based Finite Element Analysis

Bone microarchitecture in patients undergoing parathyroidectomy for management of secondary hyperparathyroidism

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