Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

Chaplais, Elodie; Greene, David; Hood, Anita; Telfer, Scott; Toit, Verona du; Singh‐Grewal, Davinder; Burns, Joshua; Rome, Keith; Schiferl, Daniel J.; Hendry, Gordon J

doi:10.1186/1471-2474-15-242

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…The method we proposed could set up nail tract and estimate the spatial BMD of the femoral head's nail tract. It is documented that a CV-RMSSD lower than 10% indicated good reproducibility [34]. Our findings demonstrate the high reproducibility of measurements using the BMD estimation tool with CV-RMSSD lower than 5%.…”

Section: Discussionsupporting

confidence: 64%

A novel method for estimating nail-tract bone density for intertrochanteric fractures

Zhang

Wang

Lin

et al. 2019

Journal of Orthopaedic Translation

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Summary A novel method based on voxel-based morphometry was proposed to investigate the average volumetric bone mineral density (vBMD) of femoral head nail tract in patients treated with intramedullary nails—proximal femoral nail antirotation (PFNA) and gamma nail (GN). The results showed that there was no significant difference in average vBMD between the two groups. Background For unstable intertrochanteric fractures, poor bone quality might be one of the most important causes of cut-out complications in the femoral head during surgical treatment. Bone quality is generally regarded as an equivalent of BMD. Thus, we develop a novel voxel-based morphometry–based method to quantify vBMD of the femoral head nail tract. Methods Automatic calculation of average vBMD of nail tracts requires three main steps. First, we built a standard nail tract in a proximal femur template. Then, we mapped the proximal femur structure of each patient to the template by B-spline and Demons registration so that the anatomical positions of the proximal femur of all patients spatially corresponded to the standard template. Finally, we calculated and visualized the average vBMD distribution of the nail tract of all patients. To verify the feasibility of the method, we enrolled 75 patients (52 women and 23 men) with hip fractures to our study to compare measurements. The root mean square of the standard deviation (RMSSD) was calculated, and the coefficient of variation (CV) of the RMSSD (CV-RMSSD) was used to evaluate the reproducibility of intraoperator and interscan measurements. The Mann–Whitney U test was used to compare the average vBMD of nail tracts for the PFNA and GN. Results The CV-RMSSD of intraoperator measurements ranged from 1.0% to 2.0%, and the CV-RMSSD of interscan measurements ranged from 3.6% to 4.5%. There was no significant difference in the average vBMD between patients with PFNAs and those with GNs ( p > 0.05). Conclusions The proposed method is reproducible for determining the average vBMD, which may provide a reference index for selection of appropriate intramedullary nails for individual patients. The current choice of intramedullary nail based on the experience of a surgeon may be biased. The translational potential of this article A novel method was proposed to measure the spatial average vBMD of nail tracts, which has good potential to provide a reference index for surgeons to choose appropriate implants.

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Section: Discussionsupporting

confidence: 64%

A novel method for estimating nail-tract bone density for intertrochanteric fractures

Zhang

Wang

Lin

et al. 2019

Journal of Orthopaedic Translation

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“…Commean et al 2009 [ 8 ] examined the precision of three-dimensional whole BMD of the tarsals and metatarsals after segmentation and obtained coefficients of variance ranging from 0.2% for the talus to 1.6% for the fifth metatarsal. Additionally, repeatability of pQCT BMD measurement has been found to be excellent in the second metatarsal in cadavers obtaining an ICC of 0.98 for both cortical and trabecular BMD (mg.cm 3 ) [ 12 ]. To the author’s knowledge this study is the first to assess reliability of foot bone measurements from multiple CT slices obtained from full foot scans in vivo.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral quantitative computed tomography (pQCT) provides volumetric analysis of individual bone slices, but is complicated by the need to replicate scan location based on bony landmarks. As such, it has been restricted to the radius and tibia [ 11 ], though it can also reliably be used to assess the second metatarsal [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography derived bone density measurement in the diabetic foot

Barwick

Tessier

Mirow

et al. 2017

Journal of Foot and Ankle Research

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BackgroundThe accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique. Such measurement is particularly valuable in populations at risk of foot bone pathology such as in those with long term diabetes. With research and development, computed tomography may prove to be a useful tool for this assessment. The aim of this study was to establish the reliability of a novel method of foot bone density measurement in people with diabetes using computed tomography.MethodsTen feet in people with diabetes were scanned with computed tomography twice with repositioning. Bone density (in Hounsfield units) was assessed in the trabecular and cortical bone in all tarsals and metatarsals. Reliability was assessed with intra-class correlation coefficients (95% confidence intervals), limits of agreement and standard error of measurement.ResultsThe reliability of the trabecular density of most bones was excellent with intra-class correlation coefficients ranging from 0.68 to 0.91. Additionally, cortical bone density showed fair to good reliability at the talus (0.52), calcaneus (0.59), navicular (0.70), cuboid (0.69), intermediate cuneiform (0.46) and first metatarsal (0.61).ConclusionsThe study established the reliability of a practical method of assessing the trabecular and cortical foot bone density using computed tomography scanning. This methodology may be useful in the investigation of foot bone disease occurring in diabetes and its early diagnosis, intervention and assessment of treatment efficacy. Further development of this method is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-017-0192-7) contains supplementary material, which is available to authorized users.

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“…Briefly, pQCT has emerged as an accurate technique for measuring bone quality with multiple advantages, including measured density-independent of overlying tissue, less susceptible to interference from bone size, relatively safe, higher accuracy, and 3D visualization [ 26 , 31 , 32 ]. Compared to the first-generation HR-pQCT with a nominal isotropic voxel size of 82 μm, the second-generation HR-pQCT has been improved to 61 μm, which allows a more accurate assessment of trabecular thickness (Tb.Th) [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Methods for bone quality assessment in human bone tissue: a systematic review

et al. 2022

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Background For biomechanical investigations on bone or bone implants, bone quality represents an important potential bias. Several techniques for assessing bone quality have been described in the literature. This study aims to systematically summarize the methods currently available for assessing bone quality in human bone tissue, and to discuss the advantages and limitations of these techniques. Methods A systematic review of the literature was carried out by searching the PubMed and Web of Science databases from January 2000 to April 2021. References will be screened and evaluated for eligibility by two independent reviewers as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies must apply to bone quality assessment with imaging techniques, mechanical testing modalities, and compositional characterization. The terms used for the systematic search were: “(bone quality”. Ti,ab.) AND “(human bone specimens)”. Results The systematic review identified 502 relevant articles in total. Sixty-eight articles met the inclusion criteria. Among them, forty-seven articles investigated several imaging modalities, including radiography, dual-energy X-ray absorptiometry (DEXA), CT-based techniques, and MRI-based methods. Nineteen articles dealt with mechanical testing approaches, including traditional testing modalities and novel indentation techniques. Nine articles reported the correlation between bone quality and compositional characterization, such as degree of bone mineralization (DBM) and organic composition. A total of 2898 human cadaveric bone specimens were included. Conclusions Advanced techniques are playing an increasingly important role due to their multiple advantages, focusing on the assessment of bone morphology and microarchitecture. Non-invasive imaging modalities and mechanical testing techniques, as well as the assessment of bone composition, need to complement each other to provide comprehensive and ideal information on the bone quality of human bone specimens.

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Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

Cited by 10 publications

References 27 publications

A novel method for estimating nail-tract bone density for intertrochanteric fractures

A novel method for estimating nail-tract bone density for intertrochanteric fractures

Computed tomography derived bone density measurement in the diabetic foot

Methods for bone quality assessment in human bone tissue: a systematic review

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