Trabecular bone structure analysis of the spine using clinical MDCT: can it predict vertebral bone strength?

Baum, Thomas; Gräbeldinger, Martin; Räth, C.; García, Eduardo Grande; Burgkart, Rainer; Patsch, Janina; Rummeny, Ernst J.; Link, Thomas M.; Bauer, Jan

doi:10.1007/s00774-013-0465-6

Cited by 27 publications

(33 citation statements)

References 45 publications

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“…Using a specific calibration phantom, these MDCT scans may also be used to predict bone strength equivalent to QCT and subsequently assess fracture risk omitting the need for separate density scans [21]. This would potentially reduce radiation exposure, healthcare cost, time and effort particularly for patients with cancer, who routinely undergo MDCT examinations for staging, as they are often at increased risk for developing treatment related osteoporosis [22,23].…”

Section: Introductionmentioning

confidence: 99%

In-Vivo Assessment of Femoral Bone Strength Using Finite Element Analysis (FEA) Based on Routine MDCT Imaging: A Preliminary Study on Patients with Vertebral Fractures

et al. 2015

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PurposeTo experimentally validate a non-linear finite element analysis (FEA) modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT) data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD) measurements as gold standard.MethodsOne fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects.ResultsIn-vitro simulations showed good correlation with the experimentally measured strains both in stance (R2 = 0.963) and fall configuration (R2 = 0.976). The simulated maximum stress overestimated the experimental failure load (4743 N) by 14.7% (5440 N) while the simulated maximum strain overestimated by 4.7% (4968 N). The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366), but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028).ConclusionFEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our data suggests, that MDCT derived FEA models may assess bone strength more accurately than BMD measurements alone, providing a valuable in-vivo fracture risk assessment tool.

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Section: Introductionmentioning

confidence: 99%

In-Vivo Assessment of Femoral Bone Strength Using Finite Element Analysis (FEA) Based on Routine MDCT Imaging: A Preliminary Study on Patients with Vertebral Fractures

et al. 2015

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“…Due to the large demographic affected and the current rates of aging in our population, osteoporosis is becoming a significant health problem. The diagnosis and treatment of osteoporosis creates a substantial financial burden [7]. Accurate prediction of osteoporotic fracture risk can be of significant clinical benefit when assessing and managing osteoporosis.…”

Section: Motivation/purposementioning

confidence: 99%

“…The image voxel intensities were converted from HU to BMD units using the following equation as previously outlined in [7]:

italicBMD = \frac{{HA}_{E} - {HA}_{A}}{{HU}_{E} - {HU}_{A}} * false({HU}_{voxel} - {HU}_{A} false)

…”

Section: Datamentioning

confidence: 99%

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Assessing vertebral fracture risk on volumetric quantitative computed tomography by geometric characterization of trabecular bone structure

et al. 2016

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The current clinical standard for measuring Bone Mineral Density (BMD) is dual X-ray absorptiometry, however more recently BMD derived from volumetric quantitative computed tomography has been shown to demonstrate a high association with spinal fracture susceptibility. In this study, we propose a method of fracture risk assessment using structural properties of trabecular bone in spinal vertebrae. Experimental data was acquired via axial multi-detector CT (MDCT) from 12 spinal vertebrae specimens using a whole-body 256-row CT scanner with a dedicated calibration phantom. Common image processing methods were used to annotate the trabecular compartment in the vertebral slices creating a circular region of interest (ROI) that excluded cortical bone for each slice. The pixels inside the ROI were converted to values indicative of BMD. High dimensional geometrical features were derived using the scaling index method (SIM) at different radii and scaling factors (SF). The mean BMD values within the ROI were then extracted and used in conjunction with a support vector machine to predict the failure load of the specimens. Prediction performance was measured using the root-mean-square error (RMSE) metric and determined that SIM combined with mean BMD features (RMSE = 0.82 ± 0.37) outperformed MDCT-measured mean BMD (RMSE = 1.11 ± 0.33) (p < 10−4). These results demonstrate that biomechanical strength prediction in vertebrae can be significantly improved through the use of SIM-derived texture features from trabecular bone.

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“…High-resolution trabecular bone imaging yields additional information beyond the areal BMD measurements obtained from DXA to predict bone strength [11], whereas HR-pQCT is limited to peripheral skeletal sites. On the other hand, although three reports have described microarchitectural analyses of wholebody CT obtained with conventional-resolution CT (CRCT) [12][13][14], no additional studies have suggested that the resolution of CRCT is critical for microarchitecture analysis. Two previous reports have described the relationship between microarchitectural parameters and spatial resolution using different CT scanners.…”

Section: Introductionmentioning

confidence: 99%

Bone microarchitectural analysis using ultra-high-resolution CT in tiger vertebra and human tibia

et al. 2020

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Background: To reveal trends in bone microarchitectural parameters with increasing spatial resolution on ultrahigh-resolution computed tomography (UHRCT) in vivo and to compare its performance with that of conventionalresolution CT (CRCT) and micro-CT ex vivo. Methods:We retrospectively assessed 5 tiger vertebrae ex vivo and 16 human tibiae in vivo. Seven-pattern and four-pattern resolution imaging were performed on tiger vertebra using CRCT, UHRCT, and micro-CT, and on human tibiae using UHRCT. We measured six microarchitectural parameters: volumetric bone mineral density (vBMD), trabecular bone volume fraction (bone volume/total volume, BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and connectivity density (ConnD). Comparisons between different imaging resolutions were performed using Tukey or Dunnett T3 test.Results: The vBMD, BV/TV, Tb.N, and ConnD parameters showed an increasing trend, while Tb.Sp showed a decreasing trend both ex vivo and in vivo. Ex vivo, UHRCT at the two highest resolutions (1024-and 2048-matrix imaging with 0.25-mm slice thickness) and CRCT showed significant differences (p ≤ 0.047) in vBMD (51.4 mg/cm 3 and 63.5 mg/cm 3 versus 20.8 mg/cm 3 ), BV/TV (26.5% and 29.5% versus 13.8 %), Tb.N (1.3 l/mm and 1.48 l/mm versus 0.47 l/mm), and ConnD (0.52 l/mm 3 and 0.74 l/mm 3 versus 0.02 l/mm 3 , respectively). In vivo, the 512-and 1024matrix imaging with 0.25-mm slice thickness showed significant differences in Tb.N (0.38 l/mm versus 0.67 l/mm, respectively) and ConnD (0.06 l/mm 3 versus 0.22 l/mm 3 , respectively). Conclusions:We observed characteristic trends in microarchitectural parameters and demonstrated the potential utility of applying UHRCT for microarchitectural analysis.

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Trabecular bone structure analysis of the spine using clinical MDCT: can it predict vertebral bone strength?

Cited by 27 publications

References 45 publications

In-Vivo Assessment of Femoral Bone Strength Using Finite Element Analysis (FEA) Based on Routine MDCT Imaging: A Preliminary Study on Patients with Vertebral Fractures

In-Vivo Assessment of Femoral Bone Strength Using Finite Element Analysis (FEA) Based on Routine MDCT Imaging: A Preliminary Study on Patients with Vertebral Fractures

Assessing vertebral fracture risk on volumetric quantitative computed tomography by geometric characterization of trabecular bone structure

Bone microarchitectural analysis using ultra-high-resolution CT in tiger vertebra and human tibia

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