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Feng T, Li J, Xie W, Cheng Q, Ta D. Adaptively multi-scale microstructure characterization of cancellous bone via Photoacoustic signal decomposition. ULTRASONICS 2024; 144:107407. [PMID: 39173274 DOI: 10.1016/j.ultras.2024.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024]
Abstract
Osteoporosis is a systemic disease with a high incidence in the elderly and seriously affects the quality of life of patients. Photoacoustic (PA) technology, which combines the advantages of light and ultrasound, can provide information about the physiological structure and chemical information of biological tissues in a non-invasive and non-radiative way. Due to the complex structural characteristics of bone tissue, PA signals generated by bone tissue are non-stationary and nonlinear. However, conventional PA signal processing methods are not effective for non-stationary signal processing. In this study, an empirical mode decomposition (EMD)-based Hilbert-Huang transform (HHT) PA signal analysis method, called HHT PA signal analysis (HPSA), was developed to assess the microstructure information of bone tissue, which is closely related to bone health. The feasibility of the HPSA method in bone health assessment was proven by numerical simulation and experimental studies on animal samples with different bone volume/total volume (BV/TV) and bone mineral densities. First, based on adaptive EMD, the different modes correlated with multi-scale information were mined from the PA signal, the correlations between different intrinsic mode function (IMF) modes and BV/TVs were analyzed, and the optimal mode for more efficient PA time-frequency analysis was selected. Second, multi-wavelength HPSA was used to assess the changes in the chemical components of the bone tissue. The results demonstrate that the HPSA method can distinguish bones with different BV/TVs and microstructure conditions adaptively with high efficiency. They further emphasize the potential of PA techniques in characterizing biological tissues in bones for early and rapid detection of bone diseases.
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Affiliation(s)
- Ting Feng
- Institute of Biomedical Engineering & Technology, Academy for Engineering and Technology, Fudan University, Shanghai 200433, China.
| | - Jieshu Li
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Weiya Xie
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China; Qingdao innovation and development base, Harbin Engineering University, Qingdao 266000, China
| | - Qian Cheng
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China.
| | - Dean Ta
- Institute of Biomedical Engineering & Technology, Academy for Engineering and Technology, Fudan University, Shanghai 200433, China; Department of Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China.
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Zhang X, Nadeem SA, DiCamillo PA, Shibli-Rahhal A, Regan EA, Barr RG, Hoffman EA, Comellas AP, Saha PK. Ultra-low dose hip CT-based automated measurement of volumetric bone mineral density at proximal femoral subregions. Med Phys 2024. [PMID: 39042053 DOI: 10.1002/mp.17319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Forty to fifty percent of women and 13%-22% of men experience an osteoporosis-related fragility fracture in their lifetimes. After the age of 50 years, the risk of hip fracture doubles in every 10 years. x-Ray based DXA is currently clinically used to diagnose osteoporosis and predict fracture risk. However, it provides only 2-D representation of bone and is associated with other technical limitations. Thus, alternative methods are needed. PURPOSE To develop and evaluate an ultra-low dose (ULD) hip CT-based automated method for assessment of volumetric bone mineral density (vBMD) at proximal femoral subregions. METHODS An automated method was developed to segment the proximal femur in ULD hip CT images and delineate femoral subregions. The computational pipeline consists of deep learning (DL)-based computation of femur likelihood map followed by shape model-based femur segmentation and finite element analysis-based warping of a reference subregion labeling onto individual femur shapes. Finally, vBMD is computed over each subregion in the target image using a calibration phantom scan. A total of 100 participants (50 females) were recruited from the Genetic Epidemiology of COPD (COPDGene) study, and ULD hip CT imaging, equivalent to 18 days of background radiation received by U.S. residents, was performed on each participant. Additional hip CT imaging using a clinical protocol was performed on 12 participants and repeat ULD hip CT was acquired on another five participants. ULD CT images from 80 participants were used to train the DL network; ULD CT images of the remaining 20 participants as well as clinical and repeat ULD CT images were used to evaluate the accuracy, generalizability, and reproducibility of segmentation of femoral subregions. Finally, clinical CT and repeat ULD CT images were used to evaluate accuracy and reproducibility of ULD CT-based automated measurements of femoral vBMD. RESULTS Dice scores of accuracy (n = 20), reproducibility (n = 5), and generalizability (n = 12) of ULD CT-based automated subregion segmentation were 0.990, 0.982, and 0.977, respectively, for the femoral head and 0.941, 0.970, and 0.960, respectively, for the femoral neck. ULD CT-based regional vBMD showed Pearson and concordance correlation coefficients of 0.994 and 0.977, respectively, and a root-mean-square coefficient of variation (RMSCV) (%) of 1.39% with the clinical CT-derived reference measure. After 3-digit approximation, each of Pearson and concordance correlation coefficients as well as intraclass correlation coefficient (ICC) between baseline and repeat scans were 0.996 with RMSCV of 0.72%. Results of ULD CT-based bone analysis on 100 participants (age (mean ± SD) 73.6 ± 6.6 years) show that males have significantly greater (p < 0.01) vBMD at the femoral head and trochanteric regions than females, while females have moderately greater vBMD (p = 0.05) at the medial half of the femoral neck than males. CONCLUSION Deep learning, combined with shape model and finite element analysis, offers an accurate, reproducible, and generalizable algorithm for automated segmentation of the proximal femur and anatomic femoral subregions using ULD hip CT images. ULD CT-based regional measures of femoral vBMD are accurate and reproducible and demonstrate regional differences between males and females.
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Affiliation(s)
- Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Syed Ahmed Nadeem
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Paul A DiCamillo
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Amal Shibli-Rahhal
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Elizabeth A Regan
- Department of Medicine, Division of Rheumatology, National Jewish Health, Denver, Colorado, USA
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, New York, USA
| | - Eric A Hoffman
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Guha I, Nadeem SA, Zhang X, DiCamillo PA, Levy SM, Wang G, Saha PK. Deep learning-based harmonization of trabecular bone microstructures between high- and low-resolution CT imaging. Med Phys 2024; 51:4258-4270. [PMID: 38415781 PMCID: PMC11147700 DOI: 10.1002/mp.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Osteoporosis is a bone disease related to increased bone loss and fracture-risk. The variability in bone strength is partially explained by bone mineral density (BMD), and the remainder is contributed by bone microstructure. Recently, clinical CT has emerged as a viable option for in vivo bone microstructural imaging. Wide variations in spatial-resolution and other imaging features among different CT scanners add inconsistency to derived bone microstructural metrics, urging the need for harmonization of image data from different scanners. PURPOSE This paper presents a new deep learning (DL) method for the harmonization of bone microstructural images derived from low- and high-resolution CT scanners and evaluates the method's performance at the levels of image data as well as derived microstructural metrics. METHODS We generalized a three-dimensional (3D) version of GAN-CIRCLE that applies two generative adversarial networks (GANs) constrained by the identical, residual, and cycle learning ensemble (CIRCLE). Two GAN modules simultaneously learn to map low-resolution CT (LRCT) to high-resolution CT (HRCT) and vice versa. Twenty volunteers were recruited. LRCT and HRCT scans of the distal tibia of their left legs were acquired. Five-hundred pairs of LRCT and HRCT image blocks of64 × 64 × 64 $64 \times 64 \times 64 $ voxels were sampled for each of the twelve volunteers and used for training in supervised as well as unsupervised setups. LRCT and HRCT images of the remaining eight volunteers were used for evaluation. LRCT blocks were sampled at 32 voxel intervals in each coordinate direction and predicted HRCT blocks were stitched to generate a predicted HRCT image. RESULTS Mean ± standard deviation of structural similarity (SSIM) values between predicted and true HRCT using both 3DGAN-CIRCLE-based supervised (0.84 ± 0.03) and unsupervised (0.83 ± 0.04) methods were significantly (p < 0.001) higher than the mean SSIM value between LRCT and true HRCT (0.75 ± 0.03). All Tb measures derived from predicted HRCT by the supervised 3DGAN-CIRCLE showed higher agreement (CCC ∈ $ \in $ [0.956 0.991]) with the reference values from true HRCT as compared to LRCT-derived values (CCC ∈ $ \in $ [0.732 0.989]). For all Tb measures, except Tb plate-width (CCC = 0.866), the unsupervised 3DGAN-CIRCLE showed high agreement (CCC ∈ $ \in $ [0.920 0.964]) with the true HRCT-derived reference measures. Moreover, Bland-Altman plots showed that supervised 3DGAN-CIRCLE predicted HRCT reduces bias and variability in residual values of different Tb measures as compared to LRCT and unsupervised 3DGAN-CIRCLE predicted HRCT. The supervised 3DGAN-CIRCLE method produced significantly improved performance (p < 0.001) for all Tb measures as compared to the two DL-based supervised methods available in the literature. CONCLUSIONS 3DGAN-CIRCLE, trained in either unsupervised or supervised fashion, generates HRCT images with high structural similarity to the reference true HRCT images. The supervised 3DGAN-CIRCLE improves agreements of computed Tb microstructural measures with their reference values and outperforms the unsupervised 3DGAN-CIRCLE. 3DGAN-CIRCLE offers a viable DL solution to retrospectively improve image resolution, which may aid in data harmonization in multi-site longitudinal studies where scanner mismatch is unavoidable.
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Affiliation(s)
- Indranil Guha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Syed Ahmed Nadeem
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Paul A DiCamillo
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Steven M Levy
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Ge Wang
- Biomedical Imaging Center, BME/CBIS, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Capuani S, Maiuro A, Giampà E, Montuori M, Varrucciu V, Hagberg GE, Vinicola V, Colonna S. Assessment of Calcaneal Spongy Bone Magnetic Resonance Characteristics in Women: A Comparison between Measures Obtained at 0.3 T, 1.5 T, and 3.0 T. Diagnostics (Basel) 2024; 14:1050. [PMID: 38786348 PMCID: PMC11119204 DOI: 10.3390/diagnostics14101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND There is a growing interest in bone tissue MRI and an even greater interest in using low-cost MR scanners. However, the characteristics of bone MRI remain to be fully defined, especially at low field strength. This study aimed to characterize the signal-to-noise ratio (SNR), T2, and T2* in spongy bone at 0.3 T, 1.5 T, and 3.0 T. Furthermore, relaxation times were characterized as a function of bone-marrow lipid/water ratio content and trabecular bone density. METHODS Thirty-two women in total underwent an MR-imaging investigation of the calcaneus at 0.3 T, 1.5 T, and 3.0 T. MR-spectroscopy was performed at 3.0 T to assess the fat/water ratio. SNR, T2, and T2* were quantified in distinct calcaneal regions (ST, TC, and CC). ANOVA and Pearson correlation statistics were used. RESULTS SNR increase depends on the magnetic field strength, acquisition sequence, and calcaneal location. T2* was different at 3.0 T and 1.5 T in ST, TC, and CC. Relaxation times decrease as much as the magnetic field strength increases. The significant linear correlation between relaxation times and fat/water found in healthy young is lost in osteoporotic subjects. CONCLUSION The results have implications for the possible use of relaxation vs. lipid/water marrow content for bone quality assessment and the development of quantitative MRI diagnostics at low field strength.
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Affiliation(s)
- Silvia Capuani
- CNR-ISC c/o Physics Department, “Sapienza” University of Rome, P.zle Aldo Moro 5, 00185 Rome, Italy; (A.M.); (M.M.)
- Neuroimaging Laboratory, Santa Lucia Foundation, IRCCS Rome, Via Ardeatina 309, 00179 Rome, Italy
| | - Alessandra Maiuro
- CNR-ISC c/o Physics Department, “Sapienza” University of Rome, P.zle Aldo Moro 5, 00185 Rome, Italy; (A.M.); (M.M.)
- Physics Department, “Sapienza” University of Rome, P.zle Aldo Moro 5, 00185 Rome, Italy
| | - Emiliano Giampà
- Rehabilitation Hospital, Santa Lucia Foundation, IRCCS Rome, Via Ardeatina 309, 00179 Rome, Italy; (E.G.); (V.V.)
| | - Marco Montuori
- CNR-ISC c/o Physics Department, “Sapienza” University of Rome, P.zle Aldo Moro 5, 00185 Rome, Italy; (A.M.); (M.M.)
| | - Viviana Varrucciu
- Radiology Department, Santa Lucia Foundation, IRCCS Rome, Via Ardeatina 309, 00179 Rome, Italy; (V.V.); (S.C.)
| | - Gisela E. Hagberg
- High Field Magnetic Resonance, Max-Planck-Institute for Biological Cybernetics, 72076 Tübingen, Germany;
| | - Vincenzo Vinicola
- Rehabilitation Hospital, Santa Lucia Foundation, IRCCS Rome, Via Ardeatina 309, 00179 Rome, Italy; (E.G.); (V.V.)
| | - Sergio Colonna
- Radiology Department, Santa Lucia Foundation, IRCCS Rome, Via Ardeatina 309, 00179 Rome, Italy; (V.V.); (S.C.)
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Jia Y, Han S, Li B, Liu C, Ta D. Backscatter measurement of cancellous bone using the ultrasound transit time spectroscopy. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:2670-2686. [PMID: 38639562 DOI: 10.1121/10.0025689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
Recently, ultrasound transit time spectroscopy (UTTS) was proposed as a promising method for bone quantitative ultrasound measurement. Studies have showed that UTTS could estimate the bone volume fraction and other trabecular bone structure in ultrasonic through-transmission measurements. The goal of this study was to explore the feasibility of UTTS to be adapted in ultrasonic backscatter measurement and further evaluate the performance of backscattered ultrasound transit time spectrum (BS-UTTS) in the measurement of cancellous bone density and structure. First, taking ultrasonic attenuation into account, the concept of BS-UTTS was verified on ultrasonic backscatter signals simulated from a set of scatterers with different positions and intensities. Then, in vitro backscatter measurements were performed on 26 bovine cancellous bone specimens. After a logarithmic compression of the BS-UTTS, a linear fitting of the log-compressed BS-UTTS versus ultrasonic propagated distance was performed and the slope and intercept of the fitted line for BS-UTTS were determined. The associations between BS-UTTS parameters and cancellous bone features were analyzed using simple linear regression. The results showed that the BS-UTTS could make an accurate deconvolution of the backscatter signal and predict the position and intensity of the simulated scatterers eliminating phase interference, even the simulated backscatter signal was with a relatively low signal-to-noise ratio. With varied positions and intensities of the scatterers, the slope of the fitted line for the log-compressed BS-UTTS versus ultrasonic propagated distance (i.e., slope of BS-UTTS for short) yield a high agreement (r2 = 99.84%-99.96%) with ultrasonic attenuation in simulated backscatter signal. Compared with the high-density cancellous bone, the low-density specimen showed more abundant backscatter impulse response in the BS-UTTS. The slope of BS-UTTS yield a significant correlation with bone mineral density (r = 0.87; p < 0.001), BV/TV (r = 0.87; p < 0.001), and cancellous bone microstructures (r up to 0.87; p < 0.05). The intercept of BS-UTTS was also significantly correlated with bone densities (r = -0.87; p < 0.001) and trabecular structures (|r|=0.43-0.80; p < 0.05). However, the slope of the BS-UTTS underestimated attenuation when measurements were performed experimentally. In addition, a significant non-linear relationship was observed between the measured attenuation and the attenuation estimated by the slope of the BS-UTTS. This study demonstrated that the UTTS method could be adapted to ultrasonic backscatter measurement of cancellous bone. The derived slope and intercept of BS-UTTS could be used in the measurement of bone density and microstructure. The backscattered ultrasound transit time spectroscopy might have potential in the diagnosis of osteoporosis in the clinic.
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Affiliation(s)
- Yan Jia
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Shuai Han
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Boyi Li
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Chengcheng Liu
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai, 201203, China
| | - Dean Ta
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai, 201203, China
- Department of Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, 200438, China
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Surowiec RK, Does MD, Nyman JS. In Vivo Assessment of Bone Quality Without X-rays. Curr Osteoporos Rep 2024; 22:56-68. [PMID: 38227178 PMCID: PMC11050740 DOI: 10.1007/s11914-023-00856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW This review summarizes recent advances in the assessment of bone quality using non-X-ray techniques. RECENT FINDINGS Quantitative ultrasound (QUS) provides multiple measurements of bone characteristics based on the propagation of sound through bone, the attenuation of that sound, and different processing techniques. QUS parameters and model predictions based on backscattered signals can discriminate non-fracture from fracture cases with accuracy comparable to standard bone mineral density (BMD). With advances in magnetic resonance imaging (MRI), bound water and pore water, or a porosity index, can be quantified in several long bones in vivo. Since such imaging-derived measurements correlate with the fracture resistance of bone, they potentially provide new BMD-independent predictors of fracture risk. While numerous measurements of mineral, organic matrix, and bound water by Raman spectroscopy correlate with the strength and toughness of cortical bone, the clinical assessment of person's bone quality using spatially offset Raman spectroscopy (SORS) requires advanced spectral processing techniques that minimize contaminating signals from fat, skin, and blood. Limiting exposure of patients to ionizing radiation, QUS, MRI, and SORS has the potential to improve the assessment of fracture risk and track changes of new therapies that target bone matrix and micro-structure.
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Affiliation(s)
- Rachel K Surowiec
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd., Indianapolis, IN, 46202, USA
| | - Mark D Does
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN, 37232, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN, 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN, 37232, USA
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 400 24th Ave. S., Nashville, TN, 37212, USA
| | - Jeffry S Nyman
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN, 37232, USA.
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S., Suite 4200, Nashville, TN, 37232, USA.
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN, 37212, USA.
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, 37212, USA.
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Martel D, Monga A, Chang G. Radiomic analysis of the proximal femur in osteoporosis women using 3T MRI. FRONTIERS IN RADIOLOGY 2023; 3:1293865. [PMID: 38077634 PMCID: PMC10702560 DOI: 10.3389/fradi.2023.1293865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
Introduction Osteoporosis (OP) results in weak bone and can ultimately lead to fracture. MRI assessment of bone structure and microarchitecture has been proposed as method to assess bone quality and fracture risk in vivo. Radiomics provides a framework to analyze the textural information of MR images. The purpose of this study was to analyze the radiomic features and its abilityto differentiate between subjects with and without prior fragility fracture. Methods MRI acquisition was performed on n = 45 female OP subjects: 15 with fracture history (Fx) and 30 without fracture history (nFx) using a high-resolution 3D Fast Low Angle Shot (FLASH) sequence at 3T. Second and first order radiomic features were calculated in the trabecular region of the proximal femur on T1-weighted MRI signal of a matched dataset. Significance of the feature's predictive ability was measured using Wilcoxon test and Area Under the ROC (AUROC) curve analysis. The features were correlated DXA and FRAX score. Result A set of three independent radiomic features (Dependence Non-Uniformity (DNU), Low Gray Level Emphasis (LGLE) and Kurtosis) showed significant ability to predict fragility fracture (AUROC DNU = 0.751, p < 0.05; AUROC LGLE = 0.729, p < 0.05; AUROC Kurtosis = 0.718, p < 0.05) with low to moderate correlation with FRAX and DXA. Conclusion Radiomic features can measure bone health in MRI of proximal femur and has the potential to predict fracture.
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Affiliation(s)
- Dimitri Martel
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
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He T, Pang Z, Yin Y, Xue H, Pang Y, Song H, Li J, Bai R, Qin A, Kong X. Micron-resolution Imaging of Cortical Bone under 14 T Ultrahigh Magnetic Field. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2300959. [PMID: 37339792 PMCID: PMC10460861 DOI: 10.1002/advs.202300959] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/11/2023] [Indexed: 06/22/2023]
Abstract
Compact, mineralized cortical bone tissues are often concealed on magnetic resonance (MR) images. Recent development of MR instruments and pulse techniques has yielded significant advances in acquiring anatomical and physiological information from cortical bone despite its poor 1 H signals. This work demonstrates the first MR research on cortical bones under an ultrahigh magnetic field of 14 T. The 1 H signals of different mammalian species exhibit multi-exponential decays of three characteristic T2 or T2 * values: 0.1-0.5 ms, 1-4 ms, and 4-8 ms. Systematic sample comparisons attribute these T2 /T2 * value ranges to collagen-bound water, pore water, and lipids, respectively. Ultrashort echo time (UTE) imaging under 14 T yielded spatial resolutions of 20-80 microns, which resolves the 3D anatomy of the Haversian canals. The T2 * relaxation characteristics further allow spatial classifications of collagen, pore water and lipids in human specimens. The study achieves a record of the spatial resolution for MR imaging in bone and shows that ultrahigh-field MR has the unique ability to differentiate the soft and organic compartments in bone tissues.
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Affiliation(s)
- Tian He
- Department of ChemistryZhejiang UniversityHangzhou310027China
| | - Zhenfeng Pang
- Department of ChemistryZhejiang UniversityHangzhou310027China
| | - Yu Yin
- Department of ChemistryZhejiang UniversityHangzhou310027China
| | - Huadong Xue
- Department of ChemistryZhejiang UniversityHangzhou310027China
- Department of RehabilitationSir Run Run Shaw HospitalCollege of MedicineZhejiang UniversityHangzhou310016China
| | - Yichuan Pang
- Shanghai Key Laboratory of Orthopedic ImplantsDepartment of OrthopaedicsShanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghai200011China
| | - Haixin Song
- Department of RehabilitationSir Run Run Shaw HospitalCollege of MedicineZhejiang UniversityHangzhou310016China
| | - Jianhua Li
- Department of RehabilitationSir Run Run Shaw HospitalCollege of MedicineZhejiang UniversityHangzhou310016China
| | - Ruiliang Bai
- Interdisciplinary Institute of Neuroscience and Technology (ZIINT)College of Biomedical Engineering and Instrument ScienceZhejiang UniversityHangzhou310027China
- School of MedicineZhejiang UniversityHangzhou310058China
| | - An Qin
- Shanghai Key Laboratory of Orthopedic ImplantsDepartment of OrthopaedicsShanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghai200011China
| | - Xueqian Kong
- Department of ChemistryZhejiang UniversityHangzhou310027China
- Department of RehabilitationSir Run Run Shaw HospitalCollege of MedicineZhejiang UniversityHangzhou310016China
- Institute of Translational MedicineShanghai Jiaotong UniversityShanghai200240China
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Sadoughi S, Bevill G, Morgan EF, Palepu V, Keaveny TM, Wear KA. Biomechanical structure-function relations for human trabecular bone - comparison of calcaneus, femoral neck, greater trochanter, proximal tibia, and vertebra. Comput Methods Biomech Biomed Engin 2023; 26:508-516. [PMID: 35579530 PMCID: PMC9669279 DOI: 10.1080/10255842.2022.2069465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/03/2022]
Abstract
MicroCT-based finite element models were used to compute power law relations for uniaxial compressive yield stress versus bone volume fraction for 78 cores of human trabecular bone from five anatomic sites. The leading coefficient of the power law for calcaneus differed from those for most of the other sites (p < 0.05). However, after normalizing by site-specific mean values, neither the leading coefficient (p > 0.5) nor exponent (p > 0.5) differed among sites, suggesting that a given percentage deviation from mean bone volume fraction has the same mechanical consequence for all sites investigated. These findings help explain the success of calcaneal x-ray and ultrasound measurements for predicting hip fracture risk.
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Affiliation(s)
- Saghi Sadoughi
- Department of Mechanical Engineering, University of California, Berkeley, CA
| | - Grant Bevill
- Mechanical Engineering Department, University of North Florida, Jacksonville, FL
| | - Elise F Morgan
- Departments of Mechanical Engineering and Biomedical Engineering, Boston University, Boston, MA
| | - Vivek Palepu
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | - Tony M Keaveny
- Department of Mechanical Engineering, University of California, Berkeley, CA
- Department of Bioengineering, University of California, Berkeley, CA
| | - Keith A Wear
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
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10
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Biomechanical properties and clinical significance of cancellous bone in proximal femur: A review. Injury 2023:S0020-1383(23)00251-6. [PMID: 36922271 DOI: 10.1016/j.injury.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/26/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
Trabecular bone plays an important role in the load-bearing capacity of the femur. Understanding the structural characteristics, biomechanics, and mechanical conduction of the trabecular bone is of great value in studying the mechanism of fractures and formulating surgical plans. The past decade has witnessed unprecedented progress in imaging, biomechanics and finite element analysis techniques, translating into a better understanding of trabecular bone. This article reviews the research progress achieved over the years regarding femoral trabecular bone, especially on factors influencing the strength of the proximal femoral cancellous bone and cancellous bone microfractures and provides a comprehensive overview of the latest findings on proximal femoral trabecular bone and their clinical significance.
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11
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Martel D, Monga A, Chang G. Osteoporosis Imaging. Radiol Clin North Am 2022; 60:537-545. [DOI: 10.1016/j.rcl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Zaworski C, Cheah J, Koff MF, Breighner R, Lin B, Harrison J, Donnelly E, Stein EM. MRI-based Texture Analysis of Trabecular Bone for Opportunistic Screening of Skeletal Fragility. J Clin Endocrinol Metab 2021; 106:2233-2241. [PMID: 33999148 DOI: 10.1210/clinem/dgab342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Many individuals at high risk for osteoporosis and fragility fracture are never screened by traditional methods. Opportunistic use of imaging obtained for other clinical purposes is required to foster identification of these patients. OBJECTIVE The aim of this pilot study was to evaluate texture features as a measure of bone fragility, by comparing clinically acquired magnetic resonance imaging (MRI) scans from individuals with and without a history of fragility fracture. METHODS This study retrospectively investigated 100 subjects who had lumbar spine MRI performed at our institution. Cases (n = 50) were postmenopausal women with osteoporosis and a confirmed history of fragility fracture. Controls (n = 50) were age- and race-matched postmenopausal women with no known fracture history. Trabecular bone from the lumbar vertebrae was segmented to create regions of interest within which a gray level co-occurrence matrix was used to quantify the distribution and spatial organization of voxel intensity. Heterogeneity in the trabecular bone texture was assessed by several features, including contrast (variability), entropy (disorder), and angular second moment (homogeneity). RESULTS Texture analysis revealed that trabecular bone was more heterogeneous in fracture patients. Specifically, fracture patients had greater texture variability (+76% contrast; P = 0.005), greater disorder (+10% entropy; P = 0.005), and less homogeneity (-50% angular second moment; P = 0.005) compared with controls. CONCLUSIONS MRI-based textural analysis of trabecular bone discriminated between patients with known osteoporotic fractures and controls. Further investigation is required to validate this promising methodology, which could greatly expand the number of patients screened for skeletal fragility.
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Affiliation(s)
- Caroline Zaworski
- Department of Medicine, Endocrinology and Metabolic Bone Service, Hospital for Special Surgery, NY, NY 10021, USA
| | - Jonathan Cheah
- Department of Medicine, Endocrinology and Metabolic Bone Service, Hospital for Special Surgery, NY, NY 10021, USA
| | - Matthew F Koff
- Department of Radiology and Imaging - MRI, Hospital for Special Surgery, NY, NY 10021, USA
| | - Ryan Breighner
- Department of Radiology and Imaging - MRI, Hospital for Special Surgery, NY, NY 10021, USA
| | - Bin Lin
- Department of Radiology and Imaging - MRI, Hospital for Special Surgery, NY, NY 10021, USA
| | - Jonathan Harrison
- Department of Medicine, Endocrinology and Metabolic Bone Service, Hospital for Special Surgery, NY, NY 10021, USA
| | - Eve Donnelly
- Materials Science and Engineering, Cornell University, Ithaca NY 14853, USA
| | - Emily M Stein
- Department of Medicine, Endocrinology and Metabolic Bone Service, Hospital for Special Surgery, NY, NY 10021, USA
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13
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Saha PK, Oweis RR, Zhang X, Letuchy E, Eichenberger-Gilmore JM, Burns TL, Warren JJ, Janz KF, Torner JC, Snetselaar LG, Levy SM. Effects of fluoride intake on cortical and trabecular bone microstructure at early adulthood using multi-row detector computed tomography (MDCT). Bone 2021; 146:115882. [PMID: 33578032 PMCID: PMC8009824 DOI: 10.1016/j.bone.2021.115882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/28/2021] [Accepted: 02/07/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to examine the effects of period-specific and cumulative fluoride (F) intake on bone at the levels of cortical and trabecular bone microstructural outcomes at early adulthood using emerging multi-row detector computed tomography (MDCT)-based novel techniques. METHODS Ultra-high resolution MDCT distal tibia scans were collected at age 19 visits under the Iowa Bone Development Study (IBDS), and cortical and trabecular bone microstructural outcomes were computed at the distal tibia using previously validated methods. CT scans of a tissue characterization phantom were used to calibrate CT numbers (Hounsfield units) into bone mineral density (mg/cc). Period-specific and cumulative F intakes from birth up to the age of 19 years were assessed for IBDS participants through questionnaire, and their relationships with MDCT-derived bone microstructural outcomes were examined using bivariable and multivariable analyses, adjusting for height, weight, maturity offset (years since age of peak height velocity (PHV)), physical activity (questionnaire for adolescents (PAQ-A)), healthy eating index version 2010 (HEI-2010) scores, and calcium and protein intakes. RESULTS MDCT distal tibia scans were acquired for 324 participants from among the total of 329 participants at age 19 visits. No motion artifacts were observed in any MDCT scans, and all images were successfully processed to measure cortical and trabecular bone microstructural outcomes. At early adulthood, males were observed to have stronger trabecular bone microstructural features, as well as thicker cortical bone (p < 0.01), as compared to age-similar females; however, females were found to have less cortical bone porosity as compared to males. Among participants with available F intake estimates (75 to 91% of the 324 with MDCT scans, depending on the period-specific F intake measure), no statistically significant associations were detected between any period-specific or cumulative F intake and bone microstructural outcomes of the tibia at the p < 0.01 level. Only for females, statistically suggestive associations (p < 0.05) were found between recent F intake (from 14 to 19 years) and trabecular mean plate width and trabecular thickness at the tibia. Those associations became somewhat weaker, but still statistically suggestive, for trabecular thickness in fully adjusted analysis with height, weight, PHV, calcium and protein intake, and HEI-2010 and PAQ-A scores as covariates. CONCLUSION The findings show that the effects of lifelong or period-specific F intake from combined sources for adolescents typical to the United States Midwest region are not strongly associated with bone microstructural outcomes at age 19 years. These findings are generally consistent with previously reported results of IBDS analyses, which further confirms that effects of lifelong or period-specific F intake on skeletons in early adulthood are absent or weak, even at the levels of cortical and trabecular bone microstructural details.
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Affiliation(s)
- Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, The University of Iowa, Iowa City, IA, USA; Department of Radiology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
| | - Reem Reda Oweis
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA
| | - Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering, The University of Iowa, Iowa City, IA, USA
| | - Elena Letuchy
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
| | - Julie M Eichenberger-Gilmore
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA; Formerly with Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA; Nutrition and Food Services, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
| | - John J Warren
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA
| | - Kathleen F Janz
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, Iowa City, IA, USA
| | - James C Torner
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
| | - Steven M Levy
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA; Department of Epidemiology, College of Public Health, Iowa City, IA, USA
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14
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Zhang X, Comellas AP, Regan EA, Guha I, Shibli-Rahhal A, Rubin MR, DiCamillo PA, Letuchy EM, Barr RG, Hoffman EA, Saha PK. Quantitative CT-Based Methods for Bone Microstructural Measures and Their Relationships With Vertebral Fractures in a Pilot Study on Smokers. JBMR Plus 2021; 5:e10484. [PMID: 33977202 PMCID: PMC8101620 DOI: 10.1002/jbm4.10484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 11/05/2022] Open
Abstract
Osteoporosis causes fragile bone, and bone microstructural quality is a critical determinant of bone strength and fracture risk. This study pursues technical validation of novel CT-based methods for assessment of peripheral bone microstructure together with a human pilot study examining relationships between bone microstructure and vertebral fractures in smokers. To examine the accuracy and reproducibility of the methods, repeat ultra-high-resolution (UHR) CT and micro-CT scans of cadaveric ankle specimens were acquired. Thirty smokers from the University of Iowa COPDGene cohort were recruited at their 5-year follow-up visits. Chest CT scans, collected under the parent study, were used to assess vertebral fractures. UHR CT scans of distal tibia were acquired for this pilot study to obtain peripheral cortical and trabecular bone (Cb and Tb) measures. UHR CT-derived Tb measures, including volumetric bone mineral density (BMD), network area, transverse trabecular density, and mean plate width, showed high correlation (r > 0.901) with their micro-CT-derived values over small regions of interest (ROIs). Both Cb and Tb measures showed high reproducibility-intra-class correlation (ICC) was greater than 0.99 for all Tb measures except erosion index and greater than 0.97 for all Cb measures. Female sex was associated with lower transverse Tb density (p < 0.1), higher Tb spacing (p < 0.05), and lower cortical thickness (p < 0.001). Participants with vertebral fractures had significantly degenerated values (p < 0.05) for all Tb measures except thickness. There were no statistically significant differences for Cb measures between non-fracture and fracture groups. Vertebral fracture-group differences of Tb measures remained significant after adjustment with chronic obstructive pulmonary disease (COPD) status. Although current smokers at baseline had more fractures-81.8% versus 63.2% for former smokers-the difference was not statistically significant. This pilot cross-sectional human study demonstrates CT-based peripheral bone microstructural differences among smokers with and without vertebral fractures. © 2021 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering University of Iowa Iowa City IA USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Carver College of Medicine University of Iowa Iowa City IA USA
| | - Elizabeth A Regan
- Division of Rheumatology, Department of Medicine National Jewish Health Denver CO USA
| | - Indranil Guha
- Department of Electrical and Computer Engineering, College of Engineering University of Iowa Iowa City IA USA
| | - Amal Shibli-Rahhal
- Department of Internal Medicine, Carver College of Medicine University of Iowa Iowa City IA USA
| | - Mishaela R Rubin
- Department of Clinical Medicine Columbia University New York NY USA
| | - Paul A DiCamillo
- Department of Radiology, Carver College of Medicine University of Iowa Iowa City IA USA
| | - Elena M Letuchy
- Department of Epidemiology, College of Public Health University of Iowa Iowa City IA USA
| | - R Graham Barr
- Department of Medicine Columbia University New York NY USA
| | - Eric A Hoffman
- Department of Radiology, Carver College of Medicine University of Iowa Iowa City IA USA.,Department of Biomedical Engineering, College of Engineering University of Iowa Iowa City IA USA
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering University of Iowa Iowa City IA USA.,Department of Radiology, Carver College of Medicine University of Iowa Iowa City IA USA
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15
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Soldati E, Rossi F, Vicente J, Guenoun D, Pithioux M, Iotti S, Malucelli E, Bendahan D. Survey of MRI Usefulness for the Clinical Assessment of Bone Microstructure. Int J Mol Sci 2021; 22:2509. [PMID: 33801539 PMCID: PMC7958958 DOI: 10.3390/ijms22052509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
Bone microarchitecture has been shown to provide useful information regarding the evaluation of skeleton quality with an added value to areal bone mineral density, which can be used for the diagnosis of several bone diseases. Bone mineral density estimated from dual-energy X-ray absorptiometry (DXA) has shown to be a limited tool to identify patients' risk stratification and therapy delivery. Magnetic resonance imaging (MRI) has been proposed as another technique to assess bone quality and fracture risk by evaluating the bone structure and microarchitecture. To date, MRI is the only completely non-invasive and non-ionizing imaging modality that can assess both cortical and trabecular bone in vivo. In this review article, we reported a survey regarding the clinically relevant information MRI could provide for the assessment of the inner trabecular morphology of different bone segments. The last section will be devoted to the upcoming MRI applications (MR spectroscopy and chemical shift encoding MRI, solid state MRI and quantitative susceptibility mapping), which could provide additional biomarkers for the assessment of bone microarchitecture.
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Affiliation(s)
- Enrico Soldati
- CRMBM, CNRS, Aix Marseille University, 13385 Marseille, France;
- IUSTI, CNRS, Aix Marseille University, 13013 Marseille, France;
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
| | - Francesca Rossi
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
| | - Jerome Vicente
- IUSTI, CNRS, Aix Marseille University, 13013 Marseille, France;
| | - Daphne Guenoun
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Radiology, Institute for Locomotion, Saint-Marguerite Hospital, ISM, CNRS, APHM, Aix Marseille University, 13274 Marseille, France
| | - Martine Pithioux
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Orthopedics and Traumatology, Institute for Locomotion, Saint-Marguerite Hospital, ISM, CNRS, APHM, Aix Marseille University, 13274 Marseille, France
| | - Stefano Iotti
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
- National Institute of Biostructures and Biosystems, 00136 Rome, Italy
| | - Emil Malucelli
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
| | - David Bendahan
- CRMBM, CNRS, Aix Marseille University, 13385 Marseille, France;
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16
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Lems WF, Paccou J, Zhang J, Fuggle NR, Chandran M, Harvey NC, Cooper C, Javaid K, Ferrari S, Akesson KE. Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services. Osteoporos Int 2021; 32:399-411. [PMID: 33475820 PMCID: PMC7929949 DOI: 10.1007/s00198-020-05804-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS. • Vertebral fracture assessment is a tool available on modern DXA instruments and has proven ability to detect vertebral fractures, the majority of which occur without a fall and without the signs and symptoms of an acute fracture. • Most osteoporosis guidelines internationally suggest that treatment with antiosteoporosis medications should be considered for older individuals (e.g., 65 years +) with a recent low trauma fracture without the need for DXA. • Younger individuals postfracture may be risk-assessed on the basis of FRAX® probability including DXA and associated treatment thresholds. • Future fracture risk is markedly influenced by both site, number, severity, and recency of prior fracture; awareness of baseline vertebral fractures facilitates definition of true incident vertebral fracture events occurring during antiosteoporosis treatment. • Detection of previously clinically silent vertebral fractures, defining site of prior fracture, might alter treatment decisions in younger or older FLS patients, consistent with recent IOF-ESCEO guidance on baseline-risk-stratified therapy, and provides a reliable baseline from which to define new, potentially therapy-altering, vertebral fracture events.
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Affiliation(s)
- W F Lems
- Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
| | - J Paccou
- Department of Rheumatology, Univ. Lille, CHU Lille, MABLab ULR 4490, 59000, Lille, France
| | - J Zhang
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - N R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Nuffield Department of Orthopaedics, Rheumatology and Orthopaedic Sciences, University of Oxford, Oxford, UK
| | - K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Orthopaedic Sciences, University of Oxford, Oxford, UK
| | - S Ferrari
- Clinical Service and Research Laboratory of Bone Diseases, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - K E Akesson
- Department of Clinical Sciences and Department of Orthopaedics, Skane University Hospital, Lund University, Malmö, Sweden
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17
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Bennison MBL, Pilkey AK, Lievers WB. Misalignment Error in Cancellous Bone Apparent Elastic Modulus Depends on Bone Volume Fraction and Degree of Anisotropy. J Biomech Eng 2021; 143:021005. [PMID: 32601664 DOI: 10.1115/1.4047679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Indexed: 07/25/2024]
Abstract
Cancellous bone is an anisotropic structure with architectural and mechanical properties that vary due to both skeletal site and disease state. This anisotropy means that, in order to accurately and consistently measure the mechanical properties of cancellous bone, experiments should be performed along the primary mechanical axis (PMA), that is, the orientation in which the mechanical properties are at their maximum value. Unfortunately, some degree of misalignment will always be present, and the magnitude of the resulting error is expected to be architecture dependent. The goal of this work is to quantify the dependence of the misalignment error, expressed in terms of change in apparent elastic modulus (ΔE), on both the bone volume fraction (BV/TV) and the degree of anisotropy (DA). Finite element method (FEM) models of bovine cancellous bone from five different skeletal sites were created at 5 deg and 20 deg from the PMA determined for each region. An additional set of models was created using image dilation/erosion steps in order to control for BV/TV and better isolate the effect of DA. Misalignment error was found to increase with increasing DA and decreasing BV/TV. At 5 deg misaligned from the PMA, error is relatively low (<5%) in all cases but increases to 8-24% error at 20 deg. These results suggest that great care is needed to avoid introducing misalignment error into experimental studies, particularly when studying regions with high anisotropy and/or low bone volume fraction, such as vertebral or osteoporotic bone.
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Affiliation(s)
- Matthew B L Bennison
- Bharti School of Engineering, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - A Keith Pilkey
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON K7L 3N6, Canada
| | - W Brent Lievers
- Bharti School of Engineering, Laurentian University, Sudbury, ON P3E 2C6, Canada
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18
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Chaudhari AJ, Raynor WY, Gholamrezanezhad A, Werner TJ, Rajapakse CS, Alavi A. Total-Body PET Imaging of Musculoskeletal Disorders. PET Clin 2021; 16:99-117. [PMID: 33218607 PMCID: PMC7684980 DOI: 10.1016/j.cpet.2020.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Imaging of musculoskeletal disorders, including arthritis, infection, osteoporosis, sarcopenia, and malignancies, is often limited when using conventional modalities such as radiography, computed tomography (CT), and MR imaging. As a result of recent advances in Positron Emission Tomography (PET) instrumentation, total-body PET/CT offers a longer axial field-of-view, higher geometric sensitivity, and higher spatial resolution compared with standard PET systems. This article discusses the potential applications of total-body PET/CT imaging in the assessment of musculoskeletal disorders.
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Affiliation(s)
- Abhijit J Chaudhari
- Department of Radiology, University of California Davis, 4860 Y Street, Sacramento, CA 95825, USA.
| | - William Y Raynor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Ali Gholamrezanezhad
- Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Los Angeles, CA 90033, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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19
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Zhang C, McCully KK. The Case for Measuring Long Bone Hemodynamics With Near-Infrared Spectroscopy. Front Physiol 2020; 11:615977. [PMID: 33391034 PMCID: PMC7775486 DOI: 10.3389/fphys.2020.615977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/30/2020] [Indexed: 01/12/2023] Open
Abstract
Diseases and associated fragility of bone is an important medical issue. There is increasing evidence that bone health is related to blood flow and oxygen delivery. The development of non-invasive methods to evaluate bone blood flow and oxygen delivery promise to improve the detection and treatment of bone health in human. Near-infrared spectroscopy (NIRS) has been used to evaluate oxygen levels, blood flow, and metabolism in skeletal muscle and brain. While the limited penetration depth of NIRS restricts its application, NIRS studies have been performed on the medial aspect of the tibia and some other prominent bone sites. Two approaches using NIRS to evaluate bone health are discussed: (1) the rate of re-oxygenation of bone after a short bout of ischemia, and (2) the dynamics of oxygen levels during an intervention such as resistance exercise. Early studies have shown these approaches to have the potential to evaluate bone vascular health as well as the predicted efficacy of an intervention before changes in bone composition are detectable. Future studies are needed to fully develop and exploit the use of NIRS technology for the study of bone health.
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Affiliation(s)
- Chuan Zhang
- Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Kevin K McCully
- Department of Kinesiology, University of Georgia, Athens, GA, United States
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20
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Zhang V, Koa B, Borja AJ, Padmanhabhan S, Bhattaru A, Raynor WY, Rojulpote C, Seraj SM, Werner TJ, Rajapakse C, Alavi A, Revheim ME. Diagnosis and Monitoring of Osteoporosis with Total-Body 18F-Sodium Fluoride-PET/CT. PET Clin 2020; 15:487-496. [PMID: 32768370 DOI: 10.1016/j.cpet.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In recent years, 18F-Sodium Fluoride (NaF)-PET/CT has seen its role in the detection and management of osteoporosis increase. This article reviews the extent of this application in the literature, its efficacy compared with other comparable imaging tools, and how total-body PET/CT combined with global disease assessment can revolutionize measurement of total osteoporotic disease activity. NaF-PET/CT eventually can be the modality of choice for metabolic bone disorders, especially with these advances in technology and computation.
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Affiliation(s)
- Vincent Zhang
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Koa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanhabhan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chaitanya Rojulpote
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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21
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Abstract
PURPOSE OF REVIEW Patients with inflammatory arthropathies have a high rate of fragility fractures. Diagnostic assessment and monitoring of bone density and quality are therefore critically important. Here, we review standard and advanced techniques to measure bone density and quality, specifically focusing on patients with inflammatory arthropathies. RECENT FINDINGS Current standard procedures are dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). DXA-based newer methods include trabecular bone score (TBS) and vertebral fracture assessment (VFA). More advanced imaging methods to measure bone quality include high-resolution peripheral quantitative computed tomography (HR-pQCT) as well as multi-detector CT (MD-CT) and magnetic resonance imaging (MRI). Quantitative ultrasound has shown promise but is not standard to assess bone fragility. While there are limitations, DXA remains the standard technique to measure density in patients with rheumatological disorders. Newer modalities to measure bone quality may allow better characterization of bone fragility but currently are not standard of care procedures.
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Guha I, Nadeem SA, You C, Zhang X, Levy SM, Wang G, Torner JC, Saha PK. Deep Learning Based High-Resolution Reconstruction of Trabecular Bone Microstructures from Low-Resolution CT Scans using GAN-CIRCLE. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11317:113170U. [PMID: 32201450 PMCID: PMC7085412 DOI: 10.1117/12.2549318] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteoporosis is a common age-related disease characterized by reduced bone density and increased fracture-risk. Microstructural quality of trabecular bone (Tb), commonly found at axial skeletal sites and at the end of long bones, is an important determinant of bone-strength and fracture-risk. High-resolution emerging CT scanners enable in vivo measurement of Tb microstructures at peripheral sites. However, resolution-dependence of microstructural measures and wide resolution-discrepancies among various CT scanners together with rapid upgrades in technology warrant data harmonization in CT-based cross-sectional and longitudinal bone studies. This paper presents a deep learning-based method for high-resolution reconstruction of Tb microstructures from low-resolution CT scans using GAN-CIRCLE. A network was developed and evaluated using post-registered ankle CT scans of nineteen volunteers on both low- and high-resolution CT scanners. 9,000 matching pairs of low- and high-resolution patches of size 64×64 were randomly harvested from ten volunteers for training and validation. Another 5,000 matching pairs of patches from nine other volunteers were used for evaluation. Quantitative comparison shows that predicted high-resolution scans have significantly improved structural similarity index (p < 0.01) with true high-resolution scans as compared to the same metric for low-resolution data. Different Tb microstructural measures such as thickness, spacing, and network area density are also computed from low- and predicted high-resolution images, and compared with the values derived from true high-resolution scans. Thickness and network area measures from predicted images showed higher agreement with true high-resolution CT (CCC = [0.95, 0.91]) derived values than the same measures from low-resolution images (CCC = [0.72, 0.88]).
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Affiliation(s)
- Indranil Guha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA 52242
| | - Syed Ahmed Nadeem
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA 52242
| | - Chenyu You
- Department of Computer Science, Yale University, New Haven, CT 05620
| | - Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA 52242
| | - Steven M Levy
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA 52242
| | - Ge Wang
- Biomedical Imaging Center, BME/CBIS, Rensselaer Polytechnic Institute, Troy, New York, NY 12180
| | - James C Torner
- Department of Epidemiology, University of Iowa, Iowa City, IA 52242
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA 52242
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
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23
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Guenoun D, Pithioux M, Souplet JC, Guis S, Le Corroller T, Fouré A, Pauly V, Mattei JP, Bernard M, Guye M, Chabrand P, Champsaur P, Bendahan D. Assessment of proximal femur microarchitecture using ultra-high field MRI at 7 Tesla. Diagn Interv Imaging 2019; 101:45-53. [PMID: 31331831 DOI: 10.1016/j.diii.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/07/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate bone microarchitecture of cadaveric proximal femurs using ultra-high field (UHF) 7-Tesla magnetic resonance imaging (MRI) and to compare the corresponding metrics with failure load assessed during mechanical compression test and areal bone mineral density (ABMD) measured using dual-energy X-ray absorptiometry. MATERIALS AND METHODS ABMD of ten proximal femurs from five cadavers (5 women; mean age=86.2±3.8 (SD) years; range: 82.5-90 years) were investigated using dual-energy X-ray absorptiometry and the bone volume fraction, trabecular thickness, trabecular spacing, fractal dimension, Euler characteristics, connectivity density and degree of anisotropy of each femur was quantified using UHF MRI. The whole set of specimens underwent mechanical compression tests to failure. The inter-rater reliability of microarchitecture characterization was assessed with the intraclass correlation coefficient (ICC). Associations were searched using correlation tests and multiple regression analysis. RESULTS The inter-rater reliability for bone microarchitecture parameters measurement was good with ICC ranging from 0.80 and 0.91. ABMD and the whole set of microarchitecture metrics but connectivity density significantly correlated with failure load. Microarchitecture metrics correlated to each other but did not correlate with ABMD. Multiple regression analysis disclosed that the combination of microarchitecture metrics and ABMD improved the association with failure load. CONCLUSION Femur bone microarchitecture metrics quantified using UHF MRI significantly correlated with biomechanical parameters. The multimodal assessment of ABMD and trabecular bone microarchitecture using UHF MRI provides more information about fracture risk of femoral bone and might be of interest for future investigations of patients with undetected osteoporosis.
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Affiliation(s)
- D Guenoun
- Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, APHM, 13009 Marseille, France; CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France.
| | - M Pithioux
- CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - J-C Souplet
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - S Guis
- CNRS, CRMBM UMR 7339, Department of Rheumatology, Aix-Marseille Université, AP-HM, 13000 Marseille, France
| | - T Le Corroller
- Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, APHM, 13009 Marseille, France; CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - A Fouré
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - V Pauly
- Unité de recherche EA3279, santé publique et maladies chroniques: qualité de vie concepts, usages et limites, déterminants, Aix-Marseille Université, 13005 Marseille, France; Service de santé publique et d'information médicale, Hôpital de la Conception, APHM, 13000 Marseille, France
| | - J-P Mattei
- CNRS, CRMBM UMR 7339, Department of Rheumatology, Aix-Marseille Université, AP-HM, 13000 Marseille, France
| | - M Bernard
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - M Guye
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - P Chabrand
- CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - P Champsaur
- Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, APHM, 13009 Marseille, France; CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - D Bendahan
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
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24
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Austin AG, Raynor WY, Reilly CC, Zadeh MZ, Werner TJ, Zhuang H, Alavi A, Rajapakse CS. Evolving Role of MR Imaging and PET in Assessing Osteoporosis. PET Clin 2019; 14:31-41. [DOI: 10.1016/j.cpet.2018.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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25
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Rajapakse CS, Chang G. Micro-Finite Element Analysis of the Proximal Femur on the Basis of High-Resolution Magnetic Resonance Images. Curr Osteoporos Rep 2018; 16:657-664. [PMID: 30232586 PMCID: PMC6234089 DOI: 10.1007/s11914-018-0481-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Hip fractures have catastrophic consequences. The purpose of this article is to review recent developments in high-resolution magnetic resonance imaging (MRI)-guided finite element analysis (FEA) of the hip as a means to determine subject-specific bone strength. RECENT FINDINGS Despite the ability of DXA to predict hip fracture, the majority of fractures occur in patients who do not have BMD T scores less than - 2.5. Therefore, without other detection methods, these individuals go undetected and untreated. Of methods available to image the hip, MRI is currently the only one capable of depicting bone microstructure in vivo. Availability of microstructural MRI allows generation of patient-specific micro-finite element models that can be used to simulate real-life loading conditions and determine bone strength. MRI-based FEA enables radiation-free approach to assess hip fracture strength. With further validation, this technique could become a potential clinical tool in managing hip fracture risk.
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Affiliation(s)
- Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, 1 Founders Building, Philadelphia, PA, 19104, USA.
| | - Gregory Chang
- Department of Radiology, New York University, 426 1st Avenue, New York, NY, 10010, USA
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26
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Damasiewicz MJ, Nickolas TL. Rethinking Bone Disease in Kidney Disease. JBMR Plus 2018; 2:309-322. [PMID: 30460334 PMCID: PMC6237213 DOI: 10.1002/jbm4.10117] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/05/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022] Open
Abstract
Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD-MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population. Furthermore, at a population level, fractures are at historically high levels in patients with end-stage kidney disease (ESKD), whereas in contrast the general population has experienced a steady decline in fracture incidence rates. Based on these findings, it is clear that a paradigm shift is needed in our approach to diagnosing and managing ROD. In clinical practice, our ability to diagnose ROD and initiate antifracture treatments is impeded by the lack of accurate noninvasive methods that identify ROD type. The past decade has seen advances in the noninvasive measurement of bone quality and strength that have been studied in kidney disease patients. Below we review the current literature pertaining to the epidemiology, pathology, diagnosis, and management of ROD. We aim to highlight the pressing need for a greater awareness of this condition and the need for the implementation of strategies that prevent fractures in kidney disease patients. Research is needed for more accurate noninvasive assessment of ROD type, clinical studies of existing osteoporosis therapies in patients across the spectrum of kidney disease, and the development of CKD-specific treatments. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Matthew J Damasiewicz
- Department of NephrologyMonash HealthClaytonAustralia
- Department of MedicineMonash UniversityClaytonAustralia
| | - Thomas L Nickolas
- Columbia University Medical CenterDepartment of MedicineDivision of NephrologyNew YorkNYUSA
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27
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Sharma AK, Toussaint ND, Elder GJ, Masterson R, Holt SG, Robertson PL, Ebeling PR, Baldock P, Miller RC, Rajapakse CS. Magnetic resonance imaging based assessment of bone microstructure as a non-invasive alternative to histomorphometry in patients with chronic kidney disease. Bone 2018; 114:14-21. [PMID: 29860153 DOI: 10.1016/j.bone.2018.05.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) adversely affects bone microarchitecture and increases fracture risk. Historically, bone biopsy has been the 'gold standard' for evaluating renal bone disease but is invasive and infrequently performed. High-resolution magnetic resonance imaging (MRI) quantifies bone microarchitecture noninvasively. In patients with CKD, it has not been compared with results derived from bone biopsy or with imaging using dual energy X-ray absorptiometry (DXA). METHODS Fourteen patients with end-stage kidney disease (ESKD) underwent MRI at the distal tibia, bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA; hip and spine) and transiliac bone biopsies with histomorphometry and microcomputed tomography (micro-CT). All patients had biomarkers of mineral metabolism. Associations were determined by Spearman's or Pearson's rank correlation coefficients. RESULTS MRI indices of trabecular network integrity, surface to curve ratio (S/C) and erosion index (EI), correlated to histomorphometric trabecular bone volume (S/C r = 0.85, p = 0.0003; EI r = -0.82, p = 0.001), separation (S/C r = -0.58, p = 0.039; EI r = 0.79, p = 0.0012) and thickness (S/C, r = 0.65, p = 0.017). MRI EI and trabecular thickness (TbTh) also correlated to micro-CT trabecular separation (EI r = 0.63, p = 0.02; TbTh r = -0.60, p = 0.02). Significant correlations were observed between histomorphometric mineralization and turnover indices and various MRI parameters. MRI-derived trabecular parameters were also significantly related to femoral neck BMD. CONCLUSIONS This study highlights the heterogeneity of bone microarchitecture at differing skeletal sites. MRI demonstrates significant, relevant associations to important bone biopsy and DXA indices and warrants further investigation to assess its potential to non-invasively evaluate changes in bone structure and quality over time.
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Affiliation(s)
- Ashish K Sharma
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia; Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Rosemary Masterson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Patricia L Robertson
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia; Department of Radiology, The Royal Melbourne Hospital, Parkville, Australia
| | | | - Paul Baldock
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Rhiannon C Miller
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
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Guerri S, Mercatelli D, Aparisi Gómez MP, Napoli A, Battista G, Guglielmi G, Bazzocchi A. Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia. Quant Imaging Med Surg 2018. [PMID: 29541624 DOI: 10.21037/qims.2018.01.05] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bone and muscle are two deeply interconnected organs and a strong relationship between them exists in their development and maintenance. The peak of both bone and muscle mass is achieved in early adulthood, followed by a progressive decline after the age of 40. The increase in life expectancy in developed countries resulted in an increase of degenerative diseases affecting the musculoskeletal system. Osteoporosis and sarcopenia represent a major cause of morbidity and mortality in the elderly population and are associated with a significant increase in healthcare costs. Several imaging techniques are currently available for the non-invasive investigation of bone and muscle mass and quality. Conventional radiology, dual energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound often play a complementary role in the study of osteoporosis and sarcopenia, depicting different aspects of the same pathology. This paper presents the different imaging modalities currently used for the investigation of bone and muscle mass and quality in osteoporosis and sarcopenia with special emphasis on the clinical applications and limitations of each technique and with the intent to provide interesting insights into recent advances in the field of conventional imaging, novel high-resolution techniques and fracture risk.
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Affiliation(s)
- Sara Guerri
- The Unit of Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Division of Radiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Daniele Mercatelli
- The Unit of Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Grafton, Auckland, New Zealand.,Department of Radiology, Hospital Nueve de Octubre, Valencia, Spain
| | - Alessandro Napoli
- Radiology Section, Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Battista
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Radiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy.,Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Bazzocchi
- The Unit of Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
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29
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Mattera M, Reginelli A, Bartollino S, Russo C, Barile A, Albano D, Mauri G, Messina C, Cappabianca S, Guglielmi G. Imaging of metabolic bone disease. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:197-207. [PMID: 29350648 PMCID: PMC6179066 DOI: 10.23750/abm.v89i1-s.7023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/25/2022]
Abstract
Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures. (www.actabiomedica.it)
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30
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Chen C, Zhang X, Guo J, Jin D, Letuchy EM, Burns TL, Levy SM, Hoffman EA, Saha PK. Quantitative imaging of peripheral trabecular bone microarchitecture using MDCT. Med Phys 2017; 45:236-249. [PMID: 29064579 DOI: 10.1002/mp.12632] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Osteoporosis associated with reduced bone mineral density (BMD) and microarchitectural changes puts patients at an elevated risk of fracture. Modern multidetector row CT (MDCT) technology, producing high spatial resolution at increasingly lower dose radiation, is emerging as a viable modality for trabecular bone (Tb) imaging. Wide variation in CT scanners raises concerns of data uniformity in multisite and longitudinal studies. A comprehensive cadaveric study was performed to evaluate MDCT-derived Tb microarchitectural measures. A human pilot study was performed comparing continuity of Tb measures estimated from two MDCT scanners with significantly different image resolution features. METHOD Micro-CT imaging of cadaveric ankle specimens (n=25) was used to examine the validity of MDCT-derived Tb microarchitectural measures. Repeat scan reproducibility of MDCT-based Tb measures and their ability to predict mechanical properties were examined. To assess multiscanner data continuity of Tb measures, the distal tibias of 20 volunteers (age:26.2±4.5Y,10F) were scanned using the Siemens SOMATOM Definition Flash and the higher resolution Siemens SOMATOM Force scanners with an average 45-day time gap between scans. The correlation of Tb measures derived from the two scanners over 30% and 60% peel regions at the 4% to 8% of distal tibia was analyzed. RESULTS MDCT-based Tb measures characterizing bone network area density, plate-rod microarchitecture, and transverse trabeculae showed good correlations (r∈0.85,0.92) with the gold standard micro-CT-derived values of matching Tb measures. However, other MDCT-derived Tb measures characterizing trabecular thickness and separation, erosion index, and structure model index produced weak correlation (r<0.8) with their micro-CT-derived values. Most MDCT Tb measures were found repeatable (ICC∈0.94,0.98). The Tb plate-width measure showed a strong correlation (r = 0.89) with experimental yield stress, while the transverse trabecular measure produced the highest correlation (r = 0.81) with Young's modulus. The data continuity experiment showed that, despite significant differences in image resolution between two scanners (10% MTF along xy-plane and z-direction - Flash: 16.2 and 17.9 lp/cm; Force: 24.8 and 21.0 lp/cm), most Tb measures had high Pearson correlations (r > 0.95) between values estimated from the two scanners. Relatively lower correlation coefficients were observed for the bone network area density (r = 0.91) and Tb separation (r = 0.93) measures. CONCLUSION Most MDCT-derived Tb microarchitectural measures are reproducible and their values derived from two scanners strongly correlate with each other as well as with bone strength. This study has highlighted those MDCT-derived measures which show the greatest promise for characterization of bone network area density, plate-rod and transverse trabecular distributions with a good correlation (r ≥ 0.85) compared with their micro-CT-derived values. At the same time, other measures representing trabecular thickness and separation, erosion index, and structure model index produced weak correlations (r < 0.8) with their micro-CT-derived values, failing to accurately portray the projected trabecular microarchitectural features. Strong correlations of Tb measures estimated from two scanners suggest that image data from different scanners can be used successfully in multisite and longitudinal studies with linear calibration required for some measures. In summary, modern MDCT scanners are suitable for effective quantitative imaging of peripheral Tb microarchitecture if care is taken to focus on appropriate quantitative metrics.
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Affiliation(s)
- Cheng Chen
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA
| | - Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA
| | - Junfeng Guo
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA
| | - Dakai Jin
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA
| | - Elena M Letuchy
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Steven M Levy
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.,Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Eric A Hoffman
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA.,Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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31
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Correlative Analysis of Vertebral Trabecular Bone Microarchitecture and Mechanical Properties: A Combined Ultra-high Field (7 Tesla) MRI and Biomechanical Investigation. Spine (Phila Pa 1976) 2017; 42:E1165-E1172. [PMID: 28338579 DOI: 10.1097/brs.0000000000002163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN High-resolution imaging and biomechanical investigation of ex-vivo vertebrae. OBJECTIVE The aim of this study was to assess bone microarchitecture of cadaveric vertebrae using ultra-high field (UHF) 7 Tesla magnetic resonance imaging (MRI) and to determine whether the corresponding microarchitecture parameters were related to bone mineral density (BMD) and bone strength assessed by dual-energy x-ray absorptiometry (DXA) and mechanical compression tests. SUMMARY OF BACKGROUND DATA Limitations of DXA for the assessment of bone fragility and osteoporosis have been recognized and criteria of microarchitecture alteration have been included in the definition of osteoporosis. Although vertebral fracture is the most common osteoporotic fracture, no study has assessed directly vertebral trabecular bone microarchitecture. METHODS BMD of 24 vertebrae (L2, L3, L4) from eight cadavers was investigated using DXA. The bone volume fraction (BVF), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp) of each vertebra were quantified using UHF MRI. Measurements were performed by two operators to characterize the inter-rater reliability. The whole set of specimens underwent mechanical compression tests to failure and the corresponding failure stress was calculated. RESULTS The inter-rater reliability for bone microarchitecture parameters was good with intraclass correlation coefficients ranging from 0.82 to 0.94. Failure load and stress were significantly correlated with BVF, Tb.Sp, and BMD (P < 0.05). Tb.Th was only correlated with the failure stress (P < 0.05). Multiple regression analysis demonstrated that the combination of BVF and BMD improved the prediction of the failure stress from an adjusted R = 0.384 for BMD alone to an adjusted R = 0.414. CONCLUSION We demonstrated for the first time that the vertebral bone microarchitecture assessed with UHF MRI was significantly correlated with biomechanical parameters. Our data suggest that the multimodal assessment of BMD and trabecular bone microarchitecture with UHF MRI provides additional information on the risk of vertebral bone fracture and might be of interest for the future investigation of selected osteoporotic patients. LEVEL OF EVIDENCE N /A.
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32
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Chang G, Boone S, Martel D, Rajapakse CS, Hallyburton RS, Valko M, Honig S, Regatte RR. MRI assessment of bone structure and microarchitecture. J Magn Reson Imaging 2017; 46:323-337. [PMID: 28165650 PMCID: PMC5690546 DOI: 10.1002/jmri.25647] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis is a disease of weak bone and increased fracture risk caused by low bone mass and microarchitectural deterioration of bone tissue. The standard-of-care test used to diagnose osteoporosis, dual-energy x-ray absorptiometry (DXA) estimation of areal bone mineral density (BMD), has limitations as a tool to identify patients at risk for fracture and as a tool to monitor therapy response. Magnetic resonance imaging (MRI) assessment of bone structure and microarchitecture has been proposed as another method to assess bone quality and fracture risk in vivo. MRI is advantageous because it is noninvasive, does not require ionizing radiation, and can evaluate both cortical and trabecular bone. In this review article, we summarize and discuss research progress on MRI of bone structure and microarchitecture over the last decade, focusing on in vivo translational studies. Single-center, in vivo studies have provided some evidence for the added value of MRI as a biomarker of fracture risk or treatment response. Larger, prospective, multicenter studies are needed in the future to validate the results of these initial translational studies. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:323-337.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Sean Boone
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Dimitri Martel
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert S Hallyburton
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Mitch Valko
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Stephen Honig
- Osteoporosis Center, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York, USA
| | - Ravinder R Regatte
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
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Irisin prevents and restores bone loss and muscle atrophy in hind-limb suspended mice. Sci Rep 2017; 7:2811. [PMID: 28588307 PMCID: PMC5460172 DOI: 10.1038/s41598-017-02557-8] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 04/13/2017] [Indexed: 01/12/2023] Open
Abstract
We previously showed that Irisin, a myokine released from skeletal muscle after physical exercise, plays a central role in the control of bone mass. Here we report that treatment with recombinant Irisin prevented bone loss in hind-limb suspended mice when administered during suspension (preventive protocol) and induced recovery of bone mass when mice were injected after bone loss due to a suspension period of 4 weeks (curative protocol). MicroCT analysis of femurs showed that r-Irisin preserved both cortical and trabecular bone mineral density, and prevented a dramatic decrease of the trabecular bone volume fraction. Moreover, r-Irisin protected against muscle mass decline in the hind-limb suspended mice, and maintained the fiber cross-sectional area. Notably, the decrease of myosin type II expression in unloaded mice was completely prevented by r-Irisin administration. Our data reveal for the first time that Irisin retrieves disuse‐induced bone loss and muscle atrophy. These findings may lead to development of an Irisin-based therapy for elderly immobile osteoporotic and physically disable patients, and might represent a countermeasure for astronauts subjected to microgravity-induced bone and muscle losses.
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Konugolu Venkata Sekar S, Pagliazzi M, Negredo E, Martelli F, Farina A, Dalla Mora A, Lindner C, Farzam P, Pérez-Álvarez N, Puig J, Taroni P, Pifferi A, Durduran T. In Vivo, Non-Invasive Characterization of Human Bone by Hybrid Broadband (600-1200 nm) Diffuse Optical and Correlation Spectroscopies. PLoS One 2016; 11:e0168426. [PMID: 27997565 PMCID: PMC5172608 DOI: 10.1371/journal.pone.0168426] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/30/2016] [Indexed: 11/19/2022] Open
Abstract
Non-invasive in vivo diffuse optical characterization of human bone opens a new possibility of diagnosing bone related pathologies. We present an in vivo characterization performed on seventeen healthy subjects at six different superficial bone locations: radius distal, radius proximal, ulna distal, ulna proximal, trochanter and calcaneus. A tailored diffuse optical protocol for high penetration depth combined with the rather superficial nature of considered tissues ensured the effective probing of the bone tissue. Measurements were performed using a broadband system for Time-Resolved Diffuse Optical Spectroscopy (TRS) to assess mean absorption and reduced scattering spectra in the 600-1200 nm range and Diffuse Correlation Spectroscopy (DCS) to monitor microvascular blood flow. Significant variations among tissue constituents were found between different locations; with radius distal rich of collagen, suggesting it as a prominent location for bone related measurements, and calcaneus bone having highest blood flow among the body locations being considered. By using TRS and DCS together, we are able to probe the perfusion and oxygen consumption of the tissue without any contrast agents. Therefore, we predict that these methods will be able to evaluate the impairment of the oxygen metabolism of the bone at the point-of-care.
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Affiliation(s)
| | - Marco Pagliazzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Eugènia Negredo
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, Spain
| | - Fabrizio Martelli
- Dipartimento di Fisica e Astronomia, Università degli Studi di Firenze, Sesto Fiorentino, Firenze, Italy
| | - Andrea Farina
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
- Consiglio Nazionale delle Ricerche - Istituto di Fotonica e Nanotecnologie, Milano, Italy
| | | | - Claus Lindner
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Parisa Farzam
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Núria Pérez-Álvarez
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
- Statistics and Operations Research Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordi Puig
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paola Taroni
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
| | - Antonio Pifferi
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Oei L, Koromani F, Rivadeneira F, Zillikens MC, Oei EHG. Quantitative imaging methods in osteoporosis. Quant Imaging Med Surg 2016; 6:680-698. [PMID: 28090446 DOI: 10.21037/qims.2016.12.13] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteoporosis is characterized by a decreased bone mass and quality resulting in an increased fracture risk. Quantitative imaging methods are critical in the diagnosis and follow-up of treatment effects in osteoporosis. Prior radiographic vertebral fractures and bone mineral density (BMD) as a quantitative parameter derived from dual-energy X-ray absorptiometry (DXA) are among the strongest known predictors of future osteoporotic fractures. Therefore, current clinical decision making relies heavily on accurate assessment of these imaging features. Further, novel quantitative techniques are being developed to appraise additional characteristics of osteoporosis including three-dimensional bone architecture with quantitative computed tomography (QCT). Dedicated high-resolution (HR) CT equipment is available to enhance image quality. At the other end of the spectrum, by utilizing post-processing techniques such as the trabecular bone score (TBS) information on three-dimensional architecture can be derived from DXA images. Further developments in magnetic resonance imaging (MRI) seem promising to not only capture bone micro-architecture but also characterize processes at the molecular level. This review provides an overview of various quantitative imaging techniques based on different radiological modalities utilized in clinical osteoporosis care and research.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Mandl P, Kainberger F, Friberg Hitz M. Imaging in osteoporosis in rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:751-765. [PMID: 27931966 DOI: 10.1016/j.berh.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/06/2016] [Accepted: 08/04/2016] [Indexed: 12/25/2022]
Abstract
Osteoporosis is a common comorbidity of all major rheumatic diseases, and manifests itself both systemically and locally. Systemic bone loss manifests because of several factors, primarily inflammation, immobility, and commonly used medical treatment for rheumatic diseases. Local bone loss manifests as periarticular demineralization and bone erosion due to local release of inflammatory agents and cytokines, which promote bone resorption. All these factors contribute to the phenomenon of arthritis-associated osteoporosis. This review summarized the currently available and used methods that play a role in the diagnosis and monitoring of osteoporosis and in the detection of osteoporotic fractures.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, 3rd Department of Internal Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, 1090 Vienna, Austria.
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Radiology and Nuclear Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, 1090 Vienna, Austria.
| | - Mette Friberg Hitz
- Department of Medicine, Endocrinology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark.
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Assessment of bone turnover and bone quality in type 2 diabetic bone disease: current concepts and future directions. Bone Res 2016; 4:16001. [PMID: 27019762 PMCID: PMC4802604 DOI: 10.1038/boneres.2016.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/21/2015] [Indexed: 12/25/2022] Open
Abstract
Substantial evidence exists that in addition to the well-known complications of diabetes, increased fracture risk is an important morbidity. This risk is probably due to altered bone properties in diabetes. Circulating biochemical markers of bone turnover have been found to be decreased in type 2 diabetes (T2D) and may be predictive of fractures independently of bone mineral density (BMD). Serum sclerostin levels have been found to be increased in T2D and appear to be predictive of fracture risk independent of BMD. Bone imaging technologies, including trabecular bone score (TBS) and quantitative CT testing have revealed differences in diabetic bone as compared to non-diabetic individuals. Specifically, high resolution peripheral quantitative CT (HRpQCT) imaging has demonstrated increased cortical porosity in diabetic postmenopausal women. Other factors such as bone marrow fat saturation and advanced glycation endproduct (AGE) accumulation might also relate to bone cell function and fracture risk in diabetes. These data have increased our understanding of how T2D adversely impacts both bone metabolism and fracture risk.
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Wong AKO, Beattie KA, Min KKH, Merali Z, Webber CE, Gordon CL, Papaioannou A, Cheung AMW, Adachi JD. A Trimodality Comparison of Volumetric Bone Imaging Technologies. Part III: SD, SEE, LSC Association With Fragility Fractures. J Clin Densitom 2015; 18:408-18. [PMID: 25129407 PMCID: PMC5092155 DOI: 10.1016/j.jocd.2014.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/13/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022]
Abstract
Part II of this 3-part series demonstrated 1-yr precision, standard error of the estimate, and 1-yr least significant change for volumetric bone outcomes determined using peripheral (p) quantitative computed tomography (QCT) and peripheral magnetic resonance imaging (pMRI) modalities in vivo. However, no clinically relevant outcomes have been linked to these measures of change. This study examined 97 women with mean age of 75 ± 9 yr and body mass index of 26.84 ± 4.77 kg/m(2), demonstrating a lack of association between fragility fractures and standard deviation, least significant change and standard error of the estimate-based unit differences in volumetric bone outcomes derived from both pMRI and pQCT. Only cortical volumetric bone mineral density and cortical thickness derived from high-resolution pQCT images were associated with an increased odds for fractures. The same measures obtained by pQCT erred toward significance. Despite the smaller 1-yr and short-term precision error for measures at the tibia vs the radius, the associations with fractures observed at the radius were larger than at the tibia for high-resolution pQCT. Unit differences in cortical thickness and cortical volumetric bone mineral density able to yield a 50% increase in odds for fractures were quantified here and suggested as a reference for future power computations.
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Affiliation(s)
- Andy K O Wong
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Karen A Beattie
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kevin K H Min
- Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Zamir Merali
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Colin E Webber
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Angela M W Cheung
- Osteoporosis Program, University Health Network, Toronto, ON, Canada
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Chang G, Honig S, Liu Y, Chen C, Chu KK, Rajapakse CS, Egol K, Xia D, Saha PK, Regatte RR. 7 Tesla MRI of bone microarchitecture discriminates between women without and with fragility fractures who do not differ by bone mineral density. J Bone Miner Metab 2015; 33:285-93. [PMID: 24752823 PMCID: PMC4363287 DOI: 10.1007/s00774-014-0588-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 03/17/2014] [Indexed: 01/23/2023]
Abstract
Osteoporosis is a disease of poor bone quality. Bone mineral density (BMD) has limited ability to discriminate between subjects without and with poor bone quality, and assessment of bone microarchitecture may have added value in this regard. Our goals were to use 7 T MRI to: (1) quantify and compare distal femur bone microarchitecture in women without and with poor bone quality (defined clinically by presence of fragility fractures); and (2) determine whether microarchitectural parameters could be used to discriminate between these two groups. This study had institutional review board approval, and we obtained written informed consent from all subjects. We used a 28-channel knee coil to image the distal femur of 31 subjects with fragility fractures and 25 controls without fracture on a 7 T MRI scanner using a 3-D fast low angle shot sequence (0.234 mm × 0.234 mm × 1 mm, parallel imaging factor = 2, acquisition time = 7 min 9 s). We applied digital topological analysis to quantify parameters of bone microarchitecture. All subjects also underwent standard clinical BMD assessment in the hip and spine. Compared to controls, fracture cases demonstrated lower bone volume fraction and markers of trabecular number, plate-like structure, and plate-to-rod ratio, and higher markers of trabecular isolation, rod disruption, and network resorption (p < 0.05 for all). There were no differences in hip or spine BMD T-scores between groups (p > 0.05). In receiver-operating-characteristics analyses, microarchitectural parameters could discriminate cases and controls (AUC = 0.66-0.73, p < 0.05). Hip and spine BMD T-scores could not discriminate cases and controls (AUC = 0.58-0.64, p ≥ 0.08). We conclude that 7 T MRI can detect bone microarchitectural deterioration in women with fragility fractures who do not differ by BMD. Microarchitectural parameters might some day be used as an additional tool to detect patients with poor bone quality who cannot be detected by dual-energy X-ray absorptiometry (DXA).
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Affiliation(s)
- Gregory Chang
- Department of Radiology, NYU Langone Medical Center, Center for Musculoskeletal Care, 333 E. 38th Street, 6th Floor, Room 6-210, New York, NY, 10016, USA,
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Liu Y, Jin D, Li C, Janz KF, Burns TL, Torner JC, Levy SM, Saha PK. A robust algorithm for thickness computation at low resolution and its application to in vivo trabecular bone CT imaging. IEEE Trans Biomed Eng 2015; 61:2057-69. [PMID: 24686226 DOI: 10.1109/tbme.2014.2313564] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adult bone diseases, especially osteoporosis, lead to increased risk of fracture which in turn is associated with substantial morbidity, mortality, and financial costs. Clinically, osteoporosis is defined by low bone mineral density; however, increasing evidence suggests that the microarchitectural quality of trabecular bone (TB) is an important determinant of bone strength and fracture risk. Accurate measures of TB thickness and marrow spacing is of significant interest for early diagnosis of osteoporosis or treatment effects. Here, we present a new robust algorithm for computing TB thickness and marrow spacing at a low resolution achievable in vivo. The method uses a star-line tracing technique that effectively deals with partial voluming effects of in vivo imaging with voxel size comparable to TB thickness. Also, the method avoids the problem of digitization associated with conventional algorithms based on sampling distance transform along skeletons. Accuracy of the method was examined using computer-generated phantom images, while the robustness of the method was evaluated on human ankle specimens in terms of stability across a wide range of voxel sizes, repeat scan reproducibility under in vivo conditions, and correlation between thickness values computed at ex vivo and in vivo imaging resolutions. Also, the sensitivity of the method was examined by evaluating its ability to predict the bone strength of cadaveric specimens. Finally, the method was evaluated in a human study involving 40 healthy young-adult volunteers (age: 19-21 years; 20 males and 20 females) and ten athletes (age: 19-21 years; six males and four females). Across a wide range of voxel sizes, the new method is significantly more accurate and robust as compared to conventional methods. Both TB thickness and marrow spacing measures computed using the new method demonstrated strong associations (R2 ∈ [0.83, 0.87]) with bone strength. Also, the TB thickness and marrow spacing measures allowed discrimination between male and female volunteers (p ∈ [0.01, 0.04]) as well as between athletes and nonathletes (p ∈ [0.005, 0.03]).
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Hotca A, Ravichandra S, Mikheev A, Rusinek H, Chang G. Precision of volumetric assessment of proximal femur microarchitecture from high-resolution 3T MRI. Int J Comput Assist Radiol Surg 2014; 10:35-43. [PMID: 24799271 DOI: 10.1007/s11548-014-1009-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/15/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the precision of measures of bone volume and bone volume fraction derived from high-resolution 3T MRI of proximal femur bone microarchitecture using non-uniformity correction. METHODS This HIPAA compliant, institutional review board approved study was conducted on six volunteers (mean age 56 ± 13 years), and written informed consent was obtained. All volunteers underwent a 3T FLASH MRI hip scan at three time points: baseline, second scan same day (intra-scans), and third scan one week later (inter-scans). Segmentation of femur images and values for total proximal femur volume (T), bone volume (B), and bone volume fraction (BVF) were calculated using in-house developed software, FireVoxel. Two types of non-uniformity corrections were applied to images (N3 and BiCal). Precision values were calculated using absolute percent error (APE). Statistical analysis was carried out using one-sample one-sided t test to observe the consistency of the precision and paired t test to compare between the various methods and scans. RESULTS No significant differences in bone volume measurements were observed for intra- and inter-scans. When using non-uniformity correction and assessing all subjects uniformly at the level of the lesser trochanter, precision values overall improved, especially significantly (p < 0.05) when measuring bone volume, B . B values using the combination of N3 or BiCal with CLT had a significant consistent APE values of less than 2.5 %, while BVF values were all consistently and significantly lower than 2.5 % APE. CONCLUSION Our results demonstrate the precision of high-resolution 3D MRI measures were comparable to that of dual-energy X-ray absorptiometry. Additional corrections to the analysis technique by cropping at the lesser trochanter or using non-uniformity corrections helped to improve precision. The high precision values from these MRI scans provide evidence for MRI of the proximal femur as a promising tool for osteoporosis diagnosis and treatment.
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Affiliation(s)
- Alexandra Hotca
- Department of Radiology, NYU Langone Medical Center, Center for Biomedical Imaging, New York University, 660 First Ave. 4th Floor, New York, NY, 10016, USA,
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Chang G, Honig S, Brown R, Deniz CM, Egol KA, Babb JS, Regatte RR, Rajapakse CS. Finite element analysis applied to 3-T MR imaging of proximal femur microarchitecture: lower bone strength in patients with fragility fractures compared with control subjects. Radiology 2014; 272:464-74. [PMID: 24689884 DOI: 10.1148/radiol.14131926] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine the feasibility of using finite element analysis applied to 3-T magnetic resonance (MR) images of proximal femur microarchitecture for detection of lower bone strength in subjects with fragility fractures compared with control subjects without fractures. MATERIALS AND METHODS This prospective study was institutional review board approved and HIPAA compliant. Written informed consent was obtained. Postmenopausal women with (n = 22) and without (n = 22) fragility fractures were matched for age and body mass index. All subjects underwent standard dual-energy x-ray absorptiometry. Images of proximal femur microarchitecture were obtained by using a high-spatial-resolution three-dimensional fast low-angle shot sequence at 3 T. Finite element analysis was applied to compute elastic modulus as a measure of strength in the femoral head and neck, Ward triangle, greater trochanter, and intertrochanteric region. The Mann-Whitney test was used to compare bone mineral density T scores and elastic moduli between the groups. The relationship (R(2)) between elastic moduli and bone mineral density T scores was assessed. RESULTS Patients with fractures showed lower elastic modulus than did control subjects in all proximal femur regions (femoral head, 8.51-8.73 GPa vs 9.32-9.67 GPa; P = .04; femoral neck, 3.11-3.72 GPa vs 4.39-4.82 GPa; P = .04; Ward triangle, 1.85-2.21 GPa vs 3.98-4.13 GPa; P = .04; intertrochanteric region, 1.62-2.18 GPa vs 3.86-4.47 GPa; P = .006-.007; greater trochanter, 0.65-1.21 GPa vs 1.96-2.62 GPa; P = .01-.02), but no differences in bone mineral density T scores. There were weak relationships between elastic moduli and bone mineral density T scores in patients with fractures (R(2) = 0.25-0.31, P = .02-.04), but not in control subjects. CONCLUSION Finite element analysis applied to high-spatial-resolution 3-T MR images of proximal femur microarchitecture can allow detection of lower elastic modulus, a marker of bone strength, in subjects with fragility fractures compared with control subjects. MR assessment of proximal femur strength may provide information about bone quality that is not provided by dual-energy x-ray absorptiometry.
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Affiliation(s)
- Gregory Chang
- From the Department of Radiology, Center for Musculoskeletal Care (G.C.), Osteoporosis Center, Hospital for Joint Diseases (S.H.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.A.E.), and Department of Radiology, Center for Biomedical Imaging (G.C., R.B., C.M.D., J.S.B., R.R.R.), NYU Langone Medical Center, 550 First Avenue, New York, NY 10016; and Department of Radiology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA (C.S.R.)
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Modlesky CM, Whitney DG, Carter PT, Allerton BM, Kirby JT, Miller F. The pattern of trabecular bone microarchitecture in the distal femur of typically developing children and its effect on processing of magnetic resonance images. Bone 2014; 60:1-7. [PMID: 24269277 PMCID: PMC4485561 DOI: 10.1016/j.bone.2013.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is used to assess trabecular bone microarchitecture in humans; however, image processing can be labor intensive and time consuming. One aim of this study was to determine the pattern of trabecular bone microarchitecture in the distal femur of typically developing children. A second aim was to determine the proportion and location of magnetic resonance images that need to be processed to yield representative estimates of trabecular bone microarchitecture. MATERIALS AND METHODS Twenty-six high resolution magnetic resonance images were collected immediately above the growth plate in the distal femur of 6-12year-old typically developing children (n=40). Measures of trabecular bone microarchitecture [i.e., apparent trabecular bone volume to total volume (appBV/TV), trabecular number (appTb.N), trabecular thickness (appTb.Th) and trabecular separation (appTb.Sp)] in the lateral aspect of the distal femur were determined using the twenty most central images (20IM). The average values for appBV/TV, appTb.N, appTb.Th and appTb.Sp from 20IM were compared to the average values from 10 images (10IM), 5 images (5IM) and 3 images (3IM) equally dispersed throughout the total image set and one image (1IM) from the center of the total image set using linear regression analysis. The resulting mathematical models were cross-validated using the leave-one-out technique. RESULTS Distance from the growth plate was strongly and inversely related to appBV/TV (r(2)=0.68, p<0.001) and appTb.N (r(2)=0.92, p<0.001) and was strongly and positively related to appTb.Sp (r(2)=0.86, p<0.001). The relationship between distance from the growth plate and appTb.Th was not linear (r(2)=0.06, p=0.28), but instead it was quadratic and statistically significant (r(2)=0.54, p<0.001). Trabecular bone microarchitecture estimates from 10IM, 5IM, 3IM and 1IM were not different from estimates from 20IM (p>0.05). However, there was a progressive decrease in the strength of the relationships as a smaller proportion of images were used to predict estimates from 20IM (r(2)=0.98 to 0.99 using 10IM, 0.94 to 0.96 using 5IM, 0.87 to 0.90 using 3IM and 0.66 to 0.72 using 1IM; all p<0.001). Using the resulting mathematical models and the leave-one-out cross-validation analysis, measures of trabecular bone microarchitecture estimated from the 10IM and 5IM partial image sets agreed extremely well with estimates from 20IM. CONCLUSIONS The findings indicate that partial magnetic resonance image sets can be used to provide reasonable estimates of trabecular bone microarchitecture status in the distal femur of typically developing children. However, because the relative amount of trabecular bone in the distal femur decreases with distance from the growth plate due to a decrease in trabecular number, careful positioning of the region of interest and sampling from throughout the region of interest is necessary.
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Affiliation(s)
- Christopher M Modlesky
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA.
| | - Daniel G Whitney
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA.
| | - Patrick T Carter
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA.
| | - Brianne M Allerton
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA.
| | - Joshua T Kirby
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA.
| | - Freeman Miller
- Department of Orthopedics, Nemours AI duPont Hospital for Children, Wilmington, DE, USA.
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Wang G, Wang J, Fu Y, Bai L, He M, Li B, Fu Q. Systemic treatment with vanadium absorbed by Coprinus comatus promotes femoral fracture healing in streptozotocin-diabetic rats. Biol Trace Elem Res 2013; 151:424-33. [PMID: 23271683 DOI: 10.1007/s12011-012-9584-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to analyze the impact of vanadium absorbed by Coprinus comatus (VACC) on fracture healing in streptozotocin-diabetic rats. Forty-five male Wistar rats used were divided into three groups: normal rats (control), diabetic rats, and diabetic rats treated with VACC. A standardized fracture-healing model with a stable plate fixation was established for the rat femoral fracture. After a 4-week stable fixation, callus quality was assessed by microcomputerized tomography and histological and biomechanical examinations. In addition, bone samples were obtained to evaluate the content of mineral substances in bones. Compared with the diabetic group, vanadium treatment significantly increased bone mineral content and biomechanical strength and improved microstructural properties of the callus. The ultimate load was increased by 29.1 % (P<0.05), and the total bone volume of callus enhanced by 11.2 % (P<0.05) at 4 weeks post fracture. Vanadium also promoted callus bone formation, which caused a 35.5 % increase in the total area of callus. However, VACC did not accelerate the fracture repair process in histological analysis. In conclusion, the current study suggests that systemic treatment with vanadium could promote fracture healing in streptozotocin-diabetic rats.
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Affiliation(s)
- Guangbin Wang
- Department of Orthopaedics, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, 110004, People's Republic of China
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Chuah TK, Van Reeth E, Sheah K, Poh CL. Texture analysis of bone marrow in knee MRI for classification of subjects with bone marrow lesion - data from the Osteoarthritis Initiative. Magn Reson Imaging 2013; 31:930-8. [PMID: 23434436 DOI: 10.1016/j.mri.2013.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/11/2012] [Accepted: 01/14/2013] [Indexed: 11/25/2022]
Abstract
Visualization of bone marrow lesion (BML) can improve the diagnosis of many bone disorders that are associated with it. A quantitative approach in detecting BML could increase the accuracy and efficiency of diagnosing those bone disorders. In this paper, we investigated the feasibility of using magnetic resonance imaging (MRI)-based texture to (a) identify slices and (b) classify subjects with and without BML. A total of 58 subjects were studied; 29 of them were affected by BML. The ages of subjects ranged from 45 to 74years with a mean age of 59. Texture parameters were calculated for the weight-bearing region of distal femur. The parameters were then analyzed using Mann-Whitney U test and individual feature selection methods to identify potentially discriminantive parameters. Forward feature selection was applied to select features subset for classification. Classification results from eight classifiers were studied. Results show that 98 of the 147 parameters studied are statistically significantly different between the normal and affected marrows: parameters based on co-occurrence matrix are ranked highest in their separability. The classification of subjects achieved an area under the receiver operating characteristic curve (AUC) of 0.914, and the classification of slices achieved an AUC of 0.780. The results show that MRI-texture-based classification can effectively classify subjects/slices with and without BML.
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Affiliation(s)
- Tong Kuan Chuah
- School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore
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Poelert S, Valstar E, Weinans H, Zadpoor AA. Patient-specific finite element modeling of bones. Proc Inst Mech Eng H 2012; 227:464-78. [PMID: 23637222 DOI: 10.1177/0954411912467884] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Finite element modeling is an engineering tool for structural analysis that has been used for many years to assess the relationship between load transfer and bone morphology and to optimize the design and fixation of orthopedic implants. Due to recent developments in finite element model generation, for example, improved computed tomography imaging quality, improved segmentation algorithms, and faster computers, the accuracy of finite element modeling has increased vastly and finite element models simulating the anatomy and properties of an individual patient can be constructed. Such so-called patient-specific finite element models are potentially valuable tools for orthopedic surgeons in fracture risk assessment or pre- and intraoperative planning of implant placement. The aim of this article is to provide a critical overview of current themes in patient-specific finite element modeling of bones. In addition, the state-of-the-art in patient-specific modeling of bones is compared with the requirements for a clinically applicable patient-specific finite element method, and judgment is passed on the feasibility of application of patient-specific finite element modeling as a part of clinical orthopedic routine. It is concluded that further development in certain aspects of patient-specific finite element modeling are needed before finite element modeling can be used as a routine clinical tool.
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Affiliation(s)
- Sander Poelert
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands
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Wang G, He M, Yi P, Wang J, Li B, Li J, Fu Y, Bai L, Fu Q. Comparison of effects of vanadium absorbed by Coprinus comatus with those of inorganic vanadium on bone in streptozotocin-diabetic rats. Biol Trace Elem Res 2012; 149:391-8. [PMID: 22549703 DOI: 10.1007/s12011-012-9437-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/19/2012] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to compare the effect of vanadium absorbed by Coprinus comatus (VACC) with inorganic vanadium (vanadium nitrate, IV) in preventing diabetes-related osteopenia in streptozotocin-diabetic rats. Sixty Wistar female rats used were divided into four groups: (1) normal rats (control), (2) diabetic rats, (3) diabetic rats treated with VACC, and (4) diabetic rats treated with vanadium nitrate. A standardized type 1-like diabetes model was induced by injection of streptozotocin. After the rats were treated orally with VACC and IV respectively, plasma glucose, body weights, micro-CT, biomechanical testing, and histomorphometry were examined. In addition, bone samples were obtained to evaluate the content of mineral substances in bones. Treatments were performed over a 12-week period. Both VACC and IV have a positive effect on plasma glucose and body weights of STZ-induced diabetic rats. However, treatment with IV only caused a 39.6 % decrease in glucose levels and a 14.6 % increase in body weights, whereas VACC decreased plasma glucose and increased body weights by up to 52.2 and 24.5 %, respectively. At the same time, VACC significantly improved trabecular microstructure and mechanical strength, while IV did not exhibit desirable such effects. Also, bone Ca and bone P were not significantly increased by IV. These results indicated that both VACC and IV have hypoglycemic activity on diabetic rats, while IV did not improve bone properties. In conclusion, this study suggests that VACC improves diabetes-related bone dysfunction, primarily by improving the diabetic states.
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Affiliation(s)
- Guangbin Wang
- Department of Orthopaedics, ShengJing Hospital, China Medical University, Shenyang, People's Republic of China
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Kijowski R, Tuite M, Kruger D, Munoz Del Rio A, Kleerekoper M, Binkley N. Evaluation of trabecular microarchitecture in nonosteoporotic postmenopausal women with and without fracture. J Bone Miner Res 2012; 27:1494-500. [PMID: 22407970 PMCID: PMC3377771 DOI: 10.1002/jbmr.1595] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study compared microscopic magnetic resonance imaging (µMRI) parameters of trabecular microarchitecture between postmenopausal women with and without fracture who have normal or osteopenic bone mineral density (BMD) on dual-energy X-ray absorptiometry (DXA). It included 36 postmenopausal white women 50 years of age and older with normal or osteopenic BMD (T-scores better than -2.5 at the lumbar spine, proximal femur, and one-third radius on DXA). Eighteen women had a history of low-energy fracture, whereas 18 women had no history of fracture and served as an age, race, and ultradistal radius BMD-matched control group. A three-dimensional fast large-angle spin-echo (FLASE) sequence with 137 µm × 137 µm × 400 µm resolution was performed through the nondominant wrist of all 36 women using the same 1.5T scanner. The high-resolution images were used to measure trabecular bone volume fraction, trabecular thickness, surface-to-curve ratio, and erosion index. Wilcoxon signed-rank tests were used to compare differences in BMD and µMRI parameters between postmenopausal women with and without fracture. Post-menopausal women with fracture had significantly lower (p < 0.05) trabecular bone volume fraction and surface-to-curve ratio and significantly higher (p < 0.05) erosion index than postmenopausal women without fracture. There was no significant difference between postmenopausal women with and without fracture in trabecular thickness (p = 0.80) and BMD of the spine (p = 0.21), proximal femur (p = 0.19), one-third radius (p = 0.47), and ultradistal radius (p = 0.90). Postmenopausal women with normal or osteopenic BMD who had a history of low-energy fracture had significantly different (p < 0.05) µMRI parameters than an age, race, and ultradistal radius BMD-matched control group of postmenopausal women with no history of fracture. Our study suggests that µMRI can be used to identify individuals without a DXA-based diagnosis of osteoporosis who have impaired trabecular microarchitecture and thus a heretofore-unappreciated elevated fracture risk.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792-3252, USA.
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Abstract
Osteoporosis is becoming an increasingly important public health issue, and effective treatments to prevent fragility fractures are available. Osteoporosis imaging is of critical importance in identifying individuals at risk for fractures who would require pharmacotherapy to reduce fracture risk and also in monitoring response to treatment. Dual x-ray absorptiometry is currently the state-of-the-art technique to measure bone mineral density and to diagnose osteoporosis according to the World Health Organization guidelines. Motivated by a 2000 National Institutes of Health consensus conference, substantial research efforts have focused on assessing bone quality by using advanced imaging techniques. Among these techniques aimed at better characterizing fracture risk and treatment effects, high-resolution peripheral quantitative computed tomography (CT) currently plays a central role, and a large number of recent studies have used this technique to study trabecular and cortical bone architecture. Other techniques to analyze bone quality include multidetector CT, magnetic resonance imaging, and quantitative ultrasonography. In addition to quantitative imaging techniques measuring bone density and quality, imaging needs to be used to diagnose prevalent osteoporotic fractures, such as spine fractures on chest radiographs and sagittal multidetector CT reconstructions. Radiologists need to be sensitized to the fact that the presence of fragility fractures will alter patient care, and these fractures need to be described in the report. This review article covers state-of-the-art imaging techniques to measure bone mineral density, describes novel techniques to study bone quality, and focuses on how standard imaging techniques should be used to diagnose prevalent osteoporotic fractures.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA 94143, USA.
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