Multicenter precision of cortical and trabecular bone quality measures assessed by high-resolution peripheral quantitative computed tomography

Abstract

High-resolution peripheral quantitative computed tomography (HR-pQCT) has recently been introduced as a clinical research tool for in vivo assessment of bone quality. The utility of this technique to address important skeletal health questions requires translation to standardized multi-center data pools. Our goal was to evaluate the feasibility of pooling data in multi-center HR-pQCT imaging trials. Reproducibility imaging experiments were performed using structure and composition-realistic phantoms constructed from cadaveric radii. Single-center precision was determined by repeat scanning over short (<72hrs), intermediate (3–5mo), and long-term intervals (28mo). Multi-center precision was determined by imaging the phantoms at nine different HR-pQCT centers. Least significant change (LSC) and root mean squared coefficient of variation (RMSCV) for each interval and across centers was calculated for bone density, geometry, microstructure, and biomechanical parameters. Single-center short-term RMSCVs were <1% for all parameters except Ct.Th (1.1%), Ct.Th.SD (2.6%), Tb.Sp.SD (1.8%), and porosity measures (6–8%). Intermediate-term RMSCVs were generally not statistically different from short-term values. Long-term variability was significantly greater for all density measures (0.7–2.0%; p < 0.05 vs. short-term) and several structure measures: Ct.Th (3.4%; p < 0.01 vs. short-term), Ct.Po (15.4%; p < 0.01 vs. short-term), and Tb.Th (2.2%; p < 0.01 vs. short-term). Multi-center RMSCVs were also significantly higher than short-term values: 2–4% for density and µFE measures (p < 0.0001), 2.6–5.3% for morphometric measures (p < 0.001), while Ct.Po was 16.2% (p < 0.001). In the absence of subject motion, multi-center precision errors for HR-pQCT parameters were generally less than 5%. Phantom-based multi-center precision was comparable to previously reported in vivo single-center precision errors, although this was approximately 2–5 times worse than ex vivo short-term precision. The data generated from this study will contribute to the future design and validation of standardized procedures that are broadly translatable to multi-center study designs.

Challenges in longitudinal measurements with HR-pQCT: Evaluation of a 3D registration method to improve bone microarchitecture and strength measurement reproducibility

“…Using the same approach, we confirm that our reported reproducibility lies within the same range observed in other studies showing density CV rms ranging from 0.2% to 4.7% and microarchitectural parameters CV rms raging from 2% to 20% [19,30,35,44,[46][47][48][49][50].…”

“…The short-term reproducibility of CSA-based registered HR-pQCT measurements has previously been reported using the standard segmentation of the cortical and trabecular compartments [1,27,28] and using the method based on double contouring of the cortical compartment [35,46]. The reproducibility reported in these earlier studies for geometry, density and structural parameters was similar Significantly different between no registration and 3D registration.…”

“…The lower reproducibility of cortical microarchitecture is consistent with both ex vivo and in vivo studies. Burghardt et al [46] have demonstrated, using a cadaveric radius phantom, that the CV rms of bone density, microarchitecture and biomechanical parameters after CSA-based registration were b 1%, while they were greater for cortical porosity, up to 8% [46]. In their study, CSA-based registration led to significantly better reproducibility of geometry parameters and Tt.vBMD compared to the case without registration.…”

Bone three-dimensional microstructural features of the common osteoporotic fracture sites

“…Micro-computed tomography (CT) can provide excellent 3D spatial resolution of 10 m. A High-resolution peripheral quantitative CT (HR-pQCT) technique has been implemented on the XtremeCT scanner. The scanner provides 3D images with isotropic voxel size of 41 m or 82 m, the latter resulting in isotropic spatial resolution of about 130-150 m [12] . With these newly developed techniques, many studies have been carried out to investigate the variations of 3D cancellous bone microstructure, such as bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and trabecular separation (Tb.Sp).…”

Characterization of trabecular bone plate‐rod microarchitecture using multirow detector CT and the tensor scale: Algorithms, validation, and applications to pilot human studies

“…Although it provides the highest resolution while being nondestructive, µ-CT requires bone biopsy, which is rarely indicated clinically and is not suited for monitoring treatment response. Recent advancements in volumetric bone imaging, such as magnetic resonance (MR), 6,13,14 high resolution peripheral quantitative computed tomography (HR-pQCT), 15,16 and multirow detector computed tomography (MD-CT), 17,18 allow characterization of bone microarchitecture without the need for biopsy.…”