Prediction of Femoral Neck Strength in Patients with Diabetes Mellitus with Trabecular Bone Analysis and Tomosynthesis Images

Abstract

Purpose To determine trabecular bone analysis values by using tomosynthesis images in determining femoral neck strength in patients with diabetes mellitus and compare its parameters between vertebral compression fracture and nonfracture groups. Materials and Methods The institutional review board approved this study, and written informed consent was obtained from all patients. Forty-nine patients with diabetes mellitus were included. Within 1 week, patients underwent dual x-ray absorptiometry (DXA), tomosynthesis, and computed tomography (CT) covering the T10 vertebral body to the hip joints. The trabecular patterns of tomosynthesis images were extracted, and the total strut length, bone volume per tissue volume, and five textural features (homogeneity, entropy, correlation, contrast, and variance) were obtained as the indices of tomosynthesis images. Failure load of the femoral neck, which was determined with the CT-based finite-element method (FEM), was used as the reference standard for bone strength. A forward stepwise multiple regression analysis for evaluating the availability of the tomosynthesis image indices was performed. The bone mineral density (BMD) at DXA and tomosynthesis image indices were compared between the vertebral compression fracture (n = 16) and nonfracture groups (n = 33) according to Genant semiquantitative morphometry methods by using one-way analysis of variance. Results The combination of BMD with the bone volume per tissue volume at the principal tensile group and the correlation at the principal compressive group showed the highest correlation to the failure load at CT FEM, and the correlation (r = 0.83) was higher than that between the failure load and the BMD alone (r = 0.76; P < .001). The averages of the bone volume per tissue volume and entropy at the principal tensile group in the vertebral compression fracture group were lower than those in the nonfracture group (P = .017 and P = .029, respectively), but there was no difference in BMD. Conclusion Tomosynthesis-based trabecular bone analysis is technically feasible and, in combination with BMD measurements, can potentially be used to determine bone strength in patients with diabetes mellitus. RSNA, 2016 Online supplemental material is available for this article.

Digital tomosynthesis based digital volume correlation: A clinically viable noninvasive method for direct measurement of intravertebral displacements using images of the human spine under physiological load

“…[27][28][29] These parameters were shown to increase the explained variability in multiple regression models of vertebral stiffness and strength beyond that explained by bone density alone. In a recent work done by our group 30 and others, 31 DTS-derived image texture parameters have been shown to be associated with the presence of vertebral fracture in vivo. Tomosynthesis has also been demonstrated to provide reliable quantitative results for geometric and texture analysis in other thoracic and orthopedic applications.…”

“…Collectively, previous work supports the notion that DTS has sufficient resolution to measure quantitative information from vertebral bone. DTS has been shown to meet at least three key requirements for clinical use of the DVC method: (a) As mentioned above, it has sufficient resolution (150–300 μm) to resolve cancellous bone texture at a depth of interest, (b) it is able to acquire images of a patient in nonloaded (patient lying) and loaded (patient standing with body weight) conditions in a safe and comfortable manner within seconds, and (c) acquisition of images is performed with an acceptable radiation dose to the patient (0.5–1.1 mSv effective dose) …”

The added value of tomosynthesis in endoscopic retrograde cholangiography with radiography for the detection of choledocholithiasis

“…Tomosynthesis is used for the detection of pulmonary nodules, [15][16][17] urinary stones, 18 and breast cancer, 22 and in musculoskeletal radiography. [23][24][25] To the best of our knowledge, this is the first study to use and evaluate the diagnostic performance of tomosynthesis for the detection of choledocholithiasis. Tomosynthesis images can be obtained quite easily after radiographs for ERC and can be repeated immediately within a minute or two (this includes reading the images), since both tomosynthesis and radiography can be performed by the same device.…”

Effects of Hip Structure Analysis Variables on Hip Fracture: A Propensity Score Matching Study

“…The averages of bone volume per tissue volume and entropy at the principal tensile group in the vertebral compression fracture group were lower than those in the non-fracture group. Tomosynthesis-based trabecular bone analysis is technically feasible and combined with BMD measurements, can potentially be used to determine bone strength in patients with diabetes mellitus [32].…”