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Minopoulou I, Kleyer A, Yalcin-Mutlu M, Fagni F, Kemenes S, Schmidkonz C, Atzinger A, Pachowsky M, Engel K, Folle L, Roemer F, Waldner M, D'Agostino MA, Schett G, Simon D. Imaging in inflammatory arthritis: progress towards precision medicine. Nat Rev Rheumatol 2023; 19:650-665. [PMID: 37684361 DOI: 10.1038/s41584-023-01016-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/10/2023]
Abstract
Imaging techniques such as ultrasonography and MRI have gained ground in the diagnosis and management of inflammatory arthritis, as these imaging modalities allow a sensitive assessment of musculoskeletal inflammation and damage. However, these techniques cannot discriminate between disease subsets and are currently unable to deliver an accurate prediction of disease progression and therapeutic response in individual patients. This major shortcoming of today's technology hinders a targeted and personalized patient management approach. Technological advances in the areas of high-resolution imaging (for example, high-resolution peripheral quantitative computed tomography and ultra-high field MRI), functional and molecular-based imaging (such as chemical exchange saturation transfer MRI, positron emission tomography, fluorescence optical imaging, optoacoustic imaging and contrast-enhanced ultrasonography) and artificial intelligence-based data analysis could help to tackle these challenges. These new imaging approaches offer detailed anatomical delineation and an in vivo and non-invasive evaluation of the immunometabolic status of inflammatory reactions, thereby facilitating an in-depth characterization of inflammation. By means of these developments, the aim of earlier diagnosis, enhanced monitoring and, ultimately, a personalized treatment strategy looms closer.
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Affiliation(s)
- Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Melek Yalcin-Mutlu
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Kemenes
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute for Medical Engineering, University of Applied Sciences Amberg-Weiden, Weiden, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Milena Pachowsky
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Lukas Folle
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank Roemer
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Maximilian Waldner
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Maria-Antonietta D'Agostino
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et Inflammation, Laboratory of Excellence Inflamex, Montigny-Le-Bretonneux, France
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.
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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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Exploring the Importance of Corticalization Occurring in Alveolar Bone Surrounding a Dental Implant. J Clin Med 2022; 11:jcm11237189. [PMID: 36498764 PMCID: PMC9738071 DOI: 10.3390/jcm11237189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Several measures describing the transformation of trabecular bone to cortical bone on the basis of analysis of intraoral radiographs are known (including bone index or corticalization index, CI). At the same time, it has been noted that after functional loading of dental implants such transformations occur in the bone directly adjacent to the fixture. Intuitively, it seems that this is a process conducive to the long-term maintenance of dental implants and certainly necessary when immediate loading is applied. The authors examined the relationship of implant design features to marginal bone loss (MBL) and the intensity of corticalization over a 10-year period of functional loading. This study is a general description of the phenomenon of peri-implant bone corticalization and an attempt to interpret this phenomenon to achieve success of implant treatment in the long term. Corticalization significantly increased over the first 5-year functional loading (CI from 200 ± 146 initially to 282 ± 182, p < 0.001) and maintained a high level (CI = 261 ± 168) in the 10-year study relative to the reference bone (149 ± 178). MBL significantly increased throughout the follow-up period—5 years: 0.83 ± 1.26 mm (p < 0.001), 10 years: 1.48 ± 2.01 mm (p < 0.001). MBL and radiographic bone structure (CI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. In the scope of the study, it can be concluded that the phenomenon of peri-implant jawbone corticalization seems an unfavorable condition for the future fate of bone-anchored implants, but it requires further research to fully explain the significance of this phenomenon.
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Gullberg J, Sundh D, Johansson L, Isberg PE, Lorentzon M, Lindh C. The outcome of an automated assessment of trabecular pattern in intraoral radiographs as a fracture risk predictor. Dentomaxillofac Radiol 2022; 51:20210483. [PMID: 35348365 PMCID: PMC10043615 DOI: 10.1259/dmfr.20210483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to investigate if automated analyses of the trabecular pattern in intraoral radiographs independently contribute to fracture risk assessment when other risk factors incorporated in the Fracture Risk Assessment Tool (FRAX) are taken into account. A secondary aim is to explore the correlation between the automated trabecular pattern assessment in intraoral radiographs and Trabecular Bone Score (TBS). METHODS A total of 567 intraoral radiographs from older females participating in a large population-based study (SUPERB) based in Gothenburg, Sweden, were selected to analyse trabecular pattern using semi-automated and fully automated software. Associations between trabecular pattern analysis and incident fractures were studied using Cox proportional hazard model, unadjusted and adjusted for FRAX risk factors (previous fracture, family history of hip fracture, smoking, corticosteroids, rheumatoid arthritis, without and with bone mineral density (BMD) of the femoral neck). In addition, the correlation between trabecular pattern analysis and TBS of the lumbar spine was investigated using Pearson correlation analysis. RESULTS Neither the unadjusted nor the adjusted trabecular pattern analysis in intraoral radiographs was significantly associated with any fracture or major osteoporotic fracture (MOF). A weak correlation was found between semi-automated trabecular pattern analysis and TBS. No correlation was found between the fully automated trabecular pattern analysis and TBS. CONCLUSIONS The present study shows that semi-automated and fully automated digital analyses of the trabecular pattern in intraoral radiographs do not contribute to fracture risk prediction. Furthermore, the study shows a weak correlation between semi-automated trabecular pattern analysis and TBS.
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Affiliation(s)
| | - Daniel Sundh
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lisa Johansson
- Department of Statistics, Lund University School of Economics and Management, Lunds University, Lund, Sweden
| | - Per-Erik Isberg
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | | | - Christina Lindh
- Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
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Soldati E, Pithioux M, Guenoun D, Bendahan D, Vicente J. Assessment of Bone Microarchitecture in Fresh Cadaveric Human Femurs: What Could Be the Clinical Relevance of Ultra-High Field MRI. Diagnostics (Basel) 2022; 12:diagnostics12020439. [PMID: 35204529 PMCID: PMC8870786 DOI: 10.3390/diagnostics12020439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
MRI could be applied for bone microarchitecture assessment; however, this technique is still suffering from low resolution compared to the trabecular dimension. A clear comparative analysis between MRI and X-ray microcomputed tomography (μCT) regarding microarchitecture metrics is still lacking. In this study, we performed a comparative analysis between μCT and 7T MRI with the aim of assessing the image resolution effect on the accuracy of microarchitecture metrics. We also addressed the issue of air bubble artifacts in cadaveric bones. Three fresh cadaveric femur heads were scanned using 7T MRI and µCT at high resolution (0.051 mm). Samples were submitted to a vacuum procedure combined with vibration to reduce the volume of air bubbles. Trabecular interconnectivity, a new metric, and conventional histomorphometric parameters were quantified using MR images and compared to those derived from µCT at full resolution and downsized resolutions (0.102 and 0.153 mm). Correlations between bone morphology and mineral density (BMD) were evaluated. Air bubbles were reduced by 99.8% in 30 min, leaving partial volume effects as the only source of bias. Morphological parameters quantified with 7T MRI were not statistically different (p > 0.01) to those computed from μCT images, with error up to 8% for both bone volume fraction and trabecular spacing. No linear correlation was found between BMD and all morphological parameters except trabecular interconnectivity (R2 = 0.69 for 7T MRI-BMD). These results strongly suggest that 7T MRI could be of interest for in vivo bone microarchitecture assessment, providing additional information about bone health and quality.
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Affiliation(s)
- Enrico Soldati
- Aix Marseille Univ, CNRS, IUSTI, 13453 Marseille, France;
- Aix Marseille Univ, CNRS, CRMBM, 13385 Marseille, France;
- Aix Marseille Univ, CNRS, ISM, 13288 Marseille, France; (M.P.); (D.G.)
- Correspondence:
| | - Martine Pithioux
- Aix Marseille Univ, CNRS, ISM, 13288 Marseille, France; (M.P.); (D.G.)
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13274 Marseille, France
| | - Daphne Guenoun
- Aix Marseille Univ, CNRS, ISM, 13288 Marseille, France; (M.P.); (D.G.)
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Radiology, 13274 Marseille, France
| | - David Bendahan
- Aix Marseille Univ, CNRS, CRMBM, 13385 Marseille, France;
| | - Jerome Vicente
- Aix Marseille Univ, CNRS, IUSTI, 13453 Marseille, France;
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Soldati E, Vicente J, Guenoun D, Bendahan D, Pithioux M. Validation and Optimization of Proximal Femurs Microstructure Analysis Using High Field and Ultra-High Field MRI. Diagnostics (Basel) 2021; 11:1603. [PMID: 34573945 PMCID: PMC8466948 DOI: 10.3390/diagnostics11091603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Trabecular bone could be assessed non-invasively using MRI. However, MRI does not yet provide resolutions lower than trabecular thickness and a comparative analysis between different MRI sequences at different field strengths and X-ray microtomography (μCT) is still missing. In this study, we compared bone microstructure parameters and bone mineral density (BMD) computed using various MRI approaches, i.e., turbo spin echo (TSE) and gradient recalled echo (GRE) images used at different magnetic fields, i.e., 7T and 3T. The corresponding parameters computed from μCT images and BMD derived from dual-energy X-ray absorptiometry (DXA) were used as the ground truth. The correlation between morphological parameters, BMD and fracture load assessed by mechanical compression tests was evaluated. Histomorphometric parameters showed a good agreement between 7T TSE and μCT, with 8% error for trabecular thickness with no significative statistical difference and a good intraclass correlation coefficient (ICC > 0.5) for all the extrapolated parameters. No correlation was found between DXA-BMD and all morphological parameters, except for trabecular interconnectivity (R2 > 0.69). Good correlation (p-value < 0.05) was found between failure load and trabecular interconnectivity (R2 > 0.79). These results suggest that MRI could be of interest for bone microstructure assessment. Moreover, the combination of morphological parameters and BMD could provide a more comprehensive view of bone quality.
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Affiliation(s)
- Enrico Soldati
- Aix Marseille Univ, CNRS, IUSTI, 13453 Marseille, France;
- Aix Marseille Univ, CNRS, CRMBM, 13385 Marseille, France;
- Aix Marseille Univ, CNRS, ISM, 13288 Marseille, France; (D.G.); (M.P.)
| | - Jerome Vicente
- Aix Marseille Univ, CNRS, IUSTI, 13453 Marseille, France;
| | - Daphne Guenoun
- Aix Marseille Univ, CNRS, ISM, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, 13274 Marseille, France
| | - David Bendahan
- Aix Marseille Univ, CNRS, CRMBM, 13385 Marseille, France;
| | - Martine Pithioux
- Aix Marseille Univ, CNRS, ISM, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Orthopaedics and Traumatology, Institute for Locomotion, Sainte-Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, 13274 Marseille, France
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Sala E, Malchiodi E, Carosi G, Verrua E, Cairoli E, Ferrante E, Filopanti M, Eller-Vainicher C, Ulivieri FM, Spada A, Arosio M, Chiodini I, Mantovani G. Spine Bone Texture Assessed by Trabecular Bone Score in Active and Controlled Acromegaly: A Prospective Study. J Endocr Soc 2021; 5:bvab090. [PMID: 34195527 PMCID: PMC8237850 DOI: 10.1210/jendso/bvab090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 11/19/2022] Open
Abstract
Context Acromegalic patients have an increased vertebral fracture (VFx) risk due to bone quality reduction, independently of bone mineral density (BMD). Objective The aim of the study is to describe bone quality in acromegaly, measured by trabecular bone score (TBS), a noninvasive index for assessing bone microarchitecture. Methods We collected data from 18 patients (13 female, age 56.2 ± 15 years) newly diagnosed with acromegaly. Thirty-six age- and sex-matched healthy controls were also recruited. Pituitary function, bone and calcium-phosphorous metabolism, and BMD at spine and femur and TBS (by dual-energy x-ray absorptiometry) were assessed in acromegalic patients at diagnosis and 12 months after the achievement of insulin-like growth factor 1 (IGF-1) normalization. Results At diagnosis, BMD and the VFx prevalence were comparable between patients and controls (28.3 ± 5.9 vs 27.6 ± 3.7 and 11% vs 8.3%), whereas TBS was significantly lower in acromegalic patients (1.20 ± 0.13 vs 1.30 ± 0.06; P < .001) and carboxyterminal telopeptide (CTX) and osteocalcin were significantly higher compared to controls (707 ± 365.7 vs 371 ± 104.1 pg/mL; P = .001 and 31.6 ± 15.4 vs 17.0 ± 5.7 ng/mL; P = .001, respectively). One year after IGF-1 normalization, a significant reduction of bone turnover indexes was observed in the group of acromegalic patients surgically cured (osteocalcin decrease of 61.2%, CTX decrease of 60.3%) compared to the ones controlled by medical therapy (osteocalcin decrease of 39%, CTX decrease of 40.7%; P = .01 and P = .001, respectively). Despite these findings, no TBS or BMD variations were observed. Conclusion Acromegalic patients have impaired bone quality despite normal density. Achieving normal growth hormone secretion rapidly leads to the normalization of bone turnover.
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Affiliation(s)
- E Sala
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - E Malchiodi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - G Carosi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - E Verrua
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - E Cairoli
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - E Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - M Filopanti
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - C Eller-Vainicher
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - F M Ulivieri
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - A Spada
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - M Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - I Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, 20149 Milan, Italy
| | - G Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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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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Abstract
Regulatory approval of ultrahigh field (UHF) MR imaging scanners for clinical use has opened new opportunities for musculoskeletal imaging applications. UHF MR imaging has unique advantages in terms of signal-to-noise ratio, contrast-to-noise ratio, spectral resolution, and multinuclear applications, thus providing unique information not available at lower field strengths. But UHF also comes with a set of technical challenges that are yet to be resolved and may not be suitable for all imaging applications. This review focuses on the latest research in musculoskeletal MR imaging applications at UHF including morphologic imaging, T2, T2∗, and T1ρ mapping, chemical exchange saturation transfer, sodium imaging, and phosphorus spectroscopy imaging applications.
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10
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Aringhieri G, Zampa V, Tosetti M. Musculoskeletal MRI at 7 T: do we need more or is it more than enough? Eur Radiol Exp 2020; 4:48. [PMID: 32761480 PMCID: PMC7410909 DOI: 10.1186/s41747-020-00174-1] [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: 03/20/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022] Open
Abstract
Ultra-high field magnetic resonance imaging (UHF-MRI) provides important diagnostic improvements in musculoskeletal imaging. The higher signal-to-noise ratio leads to higher spatial and temporal resolution which results in improved anatomic detail and higher diagnostic confidence. Several methods, such as T2, T2*, T1rho mapping, delayed gadolinium-enhanced, diffusion, chemical exchange saturation transfer, and magnetisation transfer techniques, permit a better tissue characterisation. Furthermore, UHF-MRI enables in vivo measurements by low-γ nuclei (23Na, 31P, 13C, and 39K) and the evaluation of different tissue metabolic pathways. European Union and Food and Drug Administration approvals for clinical imaging at UHF have been the first step towards a more routinely use of this technology, but some drawbacks are still present limiting its widespread clinical application. This review aims to provide a clinically oriented overview about the application of UHF-MRI in the different anatomical districts and tissues of musculoskeletal system and its pros and cons. Further studies are needed to consolidate the added value of the use of UHF-MRI in the routine clinical practice and promising efforts in technology development are already in progress.
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Affiliation(s)
- Giacomo Aringhieri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento, 36, Pisa, Italy.
| | - Virna Zampa
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Via paradisa, 2, Pisa, Italy
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11
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Next-generation imaging of the skeletal system and its blood supply. Nat Rev Rheumatol 2019; 15:533-549. [PMID: 31395974 DOI: 10.1038/s41584-019-0274-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 12/16/2022]
Abstract
Bone is organized in a hierarchical 3D architecture. Traditionally, analysis of the skeletal system was based on bone mass assessment by radiographic methods or on the examination of bone structure by 2D histological sections. Advanced imaging technologies and big data analysis now enable the unprecedented examination of bone and provide new insights into its 3D macrostructure and microstructure. These technologies comprise ex vivo and in vivo methods including high-resolution computed tomography (CT), synchrotron-based imaging, X-ray microscopy, ultra-high-field magnetic resonance imaging (MRI), light-sheet fluorescence microscopy, confocal and intravital two-photon imaging. In concert, these techniques have been used to detect and quantify a novel vascular system of trans-cortical vessels in bone. Furthermore, structures such as the lacunar network, which harbours and connects osteocytes, become accessible for 3D imaging and quantification using these methods. Next-generation imaging of the skeletal system and its blood supply are anticipated to contribute to an entirely new understanding of bone tissue composition and function, from macroscale to nanoscale, in health and disease. These insights could provide the basis for early detection and precision-type intervention of bone disorders in the future.
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12
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Menon RG, Chang G, Regatte RR. The Emerging Role of 7 Tesla MRI in Musculoskeletal Imaging. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0286-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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13
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Kroker A, Bhatla JL, Emery CA, Manske SL, Boyd SK. Subchondral bone microarchitecture in ACL reconstructed knees of young women: A comparison with contralateral and uninjured control knees. Bone 2018. [PMID: 29526780 DOI: 10.1016/j.bone.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Anterior cruciate ligament (ACL) tears are a common sports-related knee injury that increases the risk of developing post-traumatic osteoarthritis (OA). During OA progression bone microarchitecture changes in the affected knee, however, little is known about bone microarchitecture in knees with early stage OA. The purpose of this study is to investigate in a cohort of females predisposed to develop OA how bone microarchitecture in ACL reconstructed knees differs from uninjured contralateral knees as well as healthy control knees and how this relates to early changes in OA. Bone microarchitecture was directly assessed in ACL reconstructed knees of injured female participants (n=15) with a median age of 25.4years (age range: 22.5-28.5) and compared to their uninjured contralateral knees, as well as to a healthy age-matched female control sample (n=14) with a median age of 25.2years (age range: 22.2-27.1). ACL reconstructed knees had lower trabecular bone mineral density (compared to contralateral: -7.7% to -10.4%, p<0.05; control knees: -7.1% to -13.9%, p<0.05) and altered trabecular bone microarchitecture in the medial femur compared to contralateral and control knees. The subchondral bone plate in the lateral femur was thicker in ACL reconstructed knees compared to contralateral (29.6%, p=0.009) and control knees (47.9% to 53.7%, p<0.05). Contralateral knees did not differ from control knees. Loss of trabecular bone and increased subchondral bone plate thickness in the ACL-reconstructed knees are consistent with changes associated with OA progression. Most differences in bone microarchitecture were found in the femur, with few differences in the tibia. The bone microarchitecture of contralateral knees did not differ from control knees in our participants, suggesting the potential to use them as control references in future longitudinal studies.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Jennifer L Bhatla
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
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14
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Xue Y, Baker AL, Nader S, Orlander P, Sanchez AJ, Kellam J, Rianon NJ, Ambrose CG. Lumbar Spine Trabecular Bone Score (TBS) Reflects Diminished Bone Quality in Patients With Diabetes Mellitus and Oral Glucocorticoid Therapy. J Clin Densitom 2018; 21:185-192. [PMID: 29102474 DOI: 10.1016/j.jocd.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/14/2017] [Indexed: 12/31/2022]
Abstract
Trabecular bone score (TBS) is a texture parameter that measures the grayscale variation within dual-energy X-ray absorptiometry (DXA) images, and has been shown to significantly correlate with the 3-dimensional bone microarchitecture. The objective of this study was to determine whether TBS is a better clinical tool than traditionally used bone mineral density (BMD) to detect the skeletal deterioration seen in patients with diabetes (DM), patients undergoing oral glucocorticoid (GC) therapy, and patients who are both diabetic and taking steroids (GC + DM). We performed retrospective, cross-sectional study using DXA images of patients who visited UTHealth Department of Internal Medicine DXA clinic in Houston, TX, from May 30, 2014 to May 30, 2016. A total of 477 men and women, who were 55 years or older, were included in the study. Lumbar spine (LS) BMD and TBS were collected. Electronic medical records were reviewed to collect clinical information for each patient. When both men and women were analyzed as a single group, LS-BMD was significantly higher in the diabetic group than in the control group (1.14 vs 1.10, p = 0.038), whereas mean TBS of L1-L4 was significantly lower in the diabetic group (1.21 vs 1.26, p = 0.004). LS-TBS was also significantly lower in diabetic women than in nondiabetic women (1.20 vs 1.26, p = 0.002). Receiver operating characteristic curves and areas under the curve indicated that LS-TBS provided better ability than LS-BMD to discriminate between control subjects and those in the DM, GC, or GC + DM groups (areas under the curve between 0.645 and 0.697, p < 0.010 for all). LS-TBS is a BMD-independent parameter that is capable of capturing a larger portion of bone quality deterioration undetected by BMD alone in patients with DM and undergoing oral GC therapy.
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Affiliation(s)
- Yunfeng Xue
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Andrea L Baker
- Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Shahla Nader
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Philip Orlander
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Anthony J Sanchez
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - James Kellam
- Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Nahid J Rianon
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Catherine G Ambrose
- Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA.
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15
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Rajapakse CS, Kobe EA, Batzdorf AS, Hast MW, Wehrli FW. Accuracy of MRI-based finite element assessment of distal tibia compared to mechanical testing. Bone 2018; 108:71-78. [PMID: 29278746 PMCID: PMC5803422 DOI: 10.1016/j.bone.2017.12.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
High-resolution MRI-derived finite element analysis (FEA) has been used in translational research to estimate the mechanical competence of human bone. However, this method has yet to be validated adequately under in vivo imaging spatial resolution or signal-to-noise conditions. We therefore compared MRI-based metrics of bone strength to those obtained from direct, mechanical testing. The study was conducted on tibiae from 17 human donors (12 males and five females, aged 33 to 88years) with no medical history of conditions affecting bone mineral homeostasis. A 25mm segment from each distal tibia underwent MR imaging in a clinical 3-Tesla scanner using a fast large-angle spin-echo (FLASE) sequence at 0.137mm×0.137mm×0.410mm voxel size, in accordance with in vivo scanning protocol. The resulting high-resolution MR images were processed and used to generate bone volume fraction maps, which served as input for the micro-level FEA model. Simulated compression was applied to compute stiffness, yield strength, ultimate strength, modulus of resilience, and toughness, which were then compared to metrics obtained from mechanical testing. Moderate to strong positive correlations were found between computationally and experimentally derived values of stiffness (R2=0.77, p<0.0001), yield strength (R2=0.38, p=0.0082), ultimate strength (R2=0.40, p=0.0067), and resilience (R2=0.46, p=0.0026), but only a weak, albeit significant, correlation was found for toughness (R2=0.26, p=0.036). Furthermore, experimentally derived yield strength and ultimate strength were moderately correlated with MRI-derived stiffness (R2=0.48, p=0.0022 and R2=0.58, p=0.0004, respectively). These results suggest that high-resolution MRI-based finite element (FE) models are effective in assessing mechanical parameters of distal skeletal extremities.
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Affiliation(s)
- Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, United States; Department of Orthopaedic Surgery, University of Pennsylvania, United States.
| | - Elizabeth A Kobe
- Department of Radiology, University of Pennsylvania, United States
| | | | - Michael W Hast
- Department of Orthopaedic Surgery, University of Pennsylvania, United States
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, United States
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16
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Santini T, Kim J, Wood S, Krishnamurthy N, Farhat N, Maciel C, Raval SB, Zhao T, Ibrahim TS. A new RF transmit coil for foot and ankle imaging at 7T MRI. Magn Reson Imaging 2018; 45:1-6. [PMID: 28893660 PMCID: PMC5935253 DOI: 10.1016/j.mri.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022]
Abstract
A four-channel Tic-Tac-Toe (TTT) transmit RF coil was designed and constructed for foot and ankle imaging at 7T MRI. Numerical simulations using an in-house developed FDTD package and experimental analyses using a homogenous phantom show an excellent agreement in terms of B1+ field distribution and s-parameters. Simulations performed on an anatomically detailed human lower leg model demonstrated an B1+ field distribution with a coefficient of variation (CV) of 23.9%/15.6%/28.8% and average B1+ of 0.33μT/0.56μT/0.43μT for 1W input power (i.e., 0.25W per channel) in the ankle/calcaneus/mid foot respectively. In-vivo B1+ mapping shows an average B1+ of 0.29μT over the entire foot/ankle. This newly developed RF coil also presents acceptable levels of average SAR (0.07W/kg for 10g per 1W of input power) and peak SAR (0.34W/kg for 10g per 1W of input power) over the whole lower leg. Preliminary in-vivo images in the foot/ankle were acquired using the T2-DESS MRI sequence without the use of a dedicated receive-only array.
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Affiliation(s)
- Tales Santini
- University of Pittsburgh, Department of Bioengineering, United States
| | - Junghwan Kim
- University of Pittsburgh, Department of Bioengineering, United States
| | - Sossena Wood
- University of Pittsburgh, Department of Bioengineering, United States
| | | | - Nadim Farhat
- University of Pittsburgh, Department of Bioengineering, United States
| | - Carlos Maciel
- University of Sao Paulo, Department of Electrical and Computer Engineering, Brazil
| | | | | | - Tamer S Ibrahim
- University of Pittsburgh, Department of Bioengineering, United States; University of Pittsburgh, Department of Radiology, United States.
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17
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Ponti F, Guerri S, Sassi C, Battista G, Guglielmi G, Bazzocchi A. Imaging of diabetic bone. Endocrine 2017; 58:426-441. [PMID: 28293856 DOI: 10.1007/s12020-017-1278-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/24/2017] [Indexed: 01/02/2023]
Abstract
Diabetes is an important concern in terms of medical and socioeconomic costs; a high risk for low-trauma fractures has been reported in patients with both type 1 and type 2 diabetes. The mechanism involved in the increased fracture risk from diabetes is highly complex and still not entirely understood; obesity could play an important role: recent evidence suggests that the influence of fat on bone is mainly dependent on the pattern of regional fat deposition and that an increased amount of visceral adipose tissue negatively affects skeletal health.Correct and timely individuation of people with high fracture risk is critical for both prevention and treatment: Dual-energy X-ray Absorptiometry (currently the "gold standard" for diagnosis of osteoporosis) underestimates fracture risk in diabetic patients and therefore is not sufficient by itself to investigate bone status. This paper is focused on imaging, covering different modalities involved in the evaluation of skeletal deterioration in diabetes, discussing the limitations of conventional methods and exploring the potential of new tools and recent high-resolution techniques, with the intent to provide interesting insight into pathophysiology and fracture risk.
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Affiliation(s)
- Federico Ponti
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Division of Radiology S.Orsola-Malpighi Hospital, University of Bologna, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Sara Guerri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Division of Radiology S.Orsola-Malpighi Hospital, University of Bologna, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Claudia Sassi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Division of Radiology S.Orsola-Malpighi Hospital, University of Bologna, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Battista
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Division of Radiology S.Orsola-Malpighi Hospital, University of Bologna, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy
- Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy.
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18
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Kroker A, Zhu Y, Manske SL, Barber R, Mohtadi N, Boyd SK. Quantitative in vivo assessment of bone microarchitecture in the human knee using HR-pQCT. Bone 2017; 97:43-48. [PMID: 28039095 DOI: 10.1016/j.bone.2016.12.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/10/2016] [Accepted: 12/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE High-resolution peripheral quantitative computed tomography (HR-pQCT) is a novel imaging modality capable of visualizing bone microarchitecture in vivo at human peripheral sites such as the distal radius and distal tibia. This research has extended the technology to provide a non-invasive assessment of bone microarchitecture at the human knee by establishing new hardware, imaging protocols and data analysis. DESIGN A custom leg holder was developed to stabilize a human knee centrally within a second generation HR-pQCT field of view. Five participants with anterior cruciate ligament reconstructions had their knee joint imaged in a continuous scan of 6cm axially. The nominal isotropic voxel size was 60.7μm. Bone mineral density and microarchitecture were assessed within the weight-bearing regions of medial and lateral compartments of the knee at three depths from the weight-bearing articular bone surface, including both the cortical and trabecular bone regions. RESULTS Scan duration was approximately 18min per knee and produced 5GB of projection data and 10GB of reconstructed image data (2304×2304 image matrix, 1008 slices). Motion during the scan was minimized by the leg holder and was similar in magnitude as a scan of the distal tibia. Bone mineral density and microarchitectural parameters were assessed for 16 volumes of interest in the tibiofemoral joint. CONCLUSIONS This is a new non-invasive in vivo assessment tool for bone microarchitecture in the human knee that provides an opportunity to gain insight into normal, injured and surgically reconstructed human knee bone architecture in cross-sectional or longitudinal studies.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Ying Zhu
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Rhamona Barber
- University of Calgary Sport Medicine Centre, University of Calgary, Canada.
| | - Nicholas Mohtadi
- University of Calgary Sport Medicine Centre, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
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Lekadir K, Hoogendoorn C, Armitage P, Whitby E, King D, Dimitri P, Frangi AF. Estimation of trabecular bone parameters in children from multisequence MRI using texture-based regression. Med Phys 2017; 43:3071-3079. [PMID: 27277054 DOI: 10.1118/1.4950713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE This paper presents a statistical approach for the prediction of trabecular bone parameters from low-resolution multisequence magnetic resonance imaging (MRI) in children, thus addressing the limitations of high-resolution modalities such as HR-pQCT, including the significant exposure of young patients to radiation and the limited applicability of such modalities to peripheral bones in vivo. METHODS A statistical predictive model is constructed from a database of MRI and HR-pQCT datasets, to relate the low-resolution MRI appearance in the cancellous bone to the trabecular parameters extracted from the high-resolution images. The description of the MRI appearance is achieved between subjects by using a collection of feature descriptors, which describe the texture properties inside the cancellous bone, and which are invariant to the geometry and size of the trabecular areas. The predictive model is built by fitting to the training data a nonlinear partial least square regression between the input MRI features and the output trabecular parameters. RESULTS Detailed validation based on a sample of 96 datasets shows correlations >0.7 between the trabecular parameters predicted from low-resolution multisequence MRI based on the proposed statistical model and the values extracted from high-resolution HRp-QCT. CONCLUSIONS The obtained results indicate the promise of the proposed predictive technique for the estimation of trabecular parameters in children from multisequence MRI, thus reducing the need for high-resolution radiation-based scans for a fragile population that is under development and growth.
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Affiliation(s)
- Karim Lekadir
- Center for Computational Imaging and Simulation Technologies in Biomedicine, Universitat Pompeu Fabra, Barcelona 08018, Spain
| | - Corné Hoogendoorn
- The Academic Unit of Radiology, The University of Sheffield, Sheffield S10 2JF, United Kingdom
| | - Paul Armitage
- The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield S10 2SF, United Kingdom
| | - Elspeth Whitby
- The Academic Unit of Child Health, The University of Sheffield, Sheffield S10 2TH, United Kingdom
| | - David King
- The Mellanby Centre for Bone Research, The University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Paul Dimitri
- Center for Computational Imaging and Simulation Technologies in Biomedicine, The University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - Alejandro F Frangi
- The Academic Unit of Radiology, The University of Sheffield, Sheffield S10 2JF, United Kingdom
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20
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María RS, Marta PM, Sonia S, Natalia GG, Tamara M, Ignasi T, Maria MG, Jaime RM, Adolfo DP, Joan A, Xavier N. TBS and BMD at the end of AI-therapy: A prospective study of the B-ABLE cohort. Bone 2016; 92:1-8. [PMID: 27519968 DOI: 10.1016/j.bone.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Patients with breast cancer under aromatase inhibitor (AI) treatment often develop osteoporosis and their average bone loss rate is twice that of natural reduction during menopause, increasing fracture risk. As the current diagnostic technique based on bone mineral density (BMD) provides no information on bone quality, the Trabecular Bone Score (TBS) has been proposed to reflect bone microarchitecture status. The present study was designed to assess prospective changes in TBS and lumbar spine (LS) BMD in postmenopausal women with breast cancer at completion of AI treatment. METHODS B-ABLE is a prospective cohort of 735 women with breast cancer treated with AIs according to American Society of Clinical Oncology recommendations: 5years of AI starting within 6weeks post-surgery or 1month after the last cycle of chemotherapy (5y-AI group), or switching to an AI to complete 5-year therapy after 2-3years of tamoxifen (pTMX-AI group). Patients with osteoporosis were treated with oral bisphosphonates (BP). TBS and LS-BMD changes at completion of AI therapy were evaluated by Student t-test for paired samples. Pearson correlation coefficients were computed for correlations between LS-BMD and TBS. RESULTS AI treatment was completed by 277 women. Of these, 70 (25.3%) were allocated to BP therapy. The non-BP-treated patients (74.7%) showed significant decreases in TBS (-2.94% in pTMX-AI and -2.93% in 5y-AI groups) and in LS-BMD (-4.14% in pTMX-AI and -2.28% in 5y-AI groups) at the end of AI treatment. In BP-treated patients, TBS remained stable at the end of AI treatment, whereas LS-BMD showed significant increases (+2.30% in pTMX-AI and +5.33% in 5y-AI groups). Moderate associations between TBS and LS-BMD values at baseline and at the end of AI treatment (r=0.4; P<0.001) were observed. At the end of treatment, changes in spine BMD and TBS were weakly correlated (r=0.1, P<0.01). CONCLUSIONS AI therapy induces significant decreases in TBS, comparable to BMD loss. BP-treated patients maintained TBS values, whereas BMD increased. AI treatment leads to deterioration of bone microarchitecture, which seems to be attenuated by BP therapy.
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Affiliation(s)
- Rodríguez-Sanz María
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Pineda-Moncusí Marta
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Servitja Sonia
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Garcia-Giralt Natalia
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain.
| | - Martos Tamara
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tusquets Ignasi
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martínez-García Maria
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rodriguez-Morera Jaime
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diez-Perez Adolfo
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albanell Joan
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nogués Xavier
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Epstein S, Defeudis G, Manfrini S, Napoli N, Pozzilli P. Diabetes and disordered bone metabolism (diabetic osteodystrophy): time for recognition. Osteoporos Int 2016; 27:1931-51. [PMID: 26980458 DOI: 10.1007/s00198-015-3454-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/07/2015] [Indexed: 02/06/2023]
Abstract
Diabetes and osteoporosis are rapidly growing diseases. The link between the high fracture incidence in diabetes as compared with the non-diabetic state has recently been recognized. While this review cannot cover every aspect of diabetic osteodystrophy, it attempts to incorporate current information from the First International Symposium on Diabetes and Bone presentations in Rome in 2014. Diabetes and osteoporosis are fast-growing diseases in the western world and are becoming a major problem in the emerging economic nations. Aging of populations worldwide will be responsible for an increased risk in the incidence of osteoporosis and diabetes. Furthermore, the economic burden due to complications of these diseases is enormous and will continue to increase unless public awareness of these diseases, the curbing of obesity, and cost-effective measures are instituted. The link between diabetes and fractures being more common in diabetics than non-diabetics has been widely recognized. At the same time, many questions remain regarding the underlying mechanisms for greater bone fragility in diabetic patients and the best approach to risk assessment and treatment to prevent fractures. Although it cannot cover every aspect of diabetic osteodystrophy, this review will attempt to incorporate current information particularly from the First International Symposium on Diabetes and Bone presentations in Rome in November 2014.
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Affiliation(s)
- S Epstein
- Division of Endocrinology, Mount Sinai School of Medicine, New York, NY, USA
| | - G Defeudis
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - S Manfrini
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - P Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
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Experience with magnetic resonance imaging of human subjects with passive implants and tattoos at 7 T: a retrospective study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2015; 28:577-90. [DOI: 10.1007/s10334-015-0499-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/25/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
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Aloia JF, Mikhail M, Usera G, Dhaliwal R, Islam S. Trabecular bone score (TBS) in postmenopausal African American women. Osteoporos Int 2015; 26:1155-61. [PMID: 25304457 DOI: 10.1007/s00198-014-2928-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/02/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED Trabecular bone score (TBS) is a newly developed parameter that can be derived from DXA scans of the spine and may reflect bone quality. This study provides TBS values in healthy postmenopausal women of African descent. INTRODUCTION African American women have a lower risk for osteoporotic fractures as a result of higher bone density and better bone quality. We examined TBS in postmenopausal African American women since there are no previous reports in this population. METHODS This was a study of healthy African American volunteers using baseline values prior to their participation in two vitamin D intervention studies conducted at an ambulatory research center of an academic health center. RESULTS The study population consisted of 518 healthy postmenopausal African American women with a mean age of 66 years and a BMI of 30.1. Mean TBS (L1 to L4) was 1.300(.100 SD). Significant negative correlations were found between TBS and age and BMI. None of the biochemical variables were significantly correlated with TBS whereas the various bone density sites were correlated with TBS. CONCLUSION TBS values for African American women are higher than those reported in the literature for white women and are inversely related to age and BMI.
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Affiliation(s)
- J F Aloia
- Winthrop University Hospital, 222 Station Plaza North, Suite 510, Mineola, NY, 11501-3893, USA,
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Ulivieri FM, Silva BC, Sardanelli F, Hans D, Bilezikian JP, Caudarella R. Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine 2014; 47:435-48. [PMID: 24853880 DOI: 10.1007/s12020-014-0280-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/25/2014] [Indexed: 12/17/2022]
Abstract
Altered bone micro-architecture is an important factor in accounting for fragility fractures. Until recently, it has not been possible to gain information about skeletal microstructure in a way that is clinically feasible. Bone biopsy is essentially a research tool. High-resolution peripheral Quantitative Computed Tomography, while non-invasive, is available only sparsely throughout the world. The trabecular bone score (TBS) is an imaging technology adapted directly from the Dual Energy X-Ray Absorptiometry (DXA) image of the lumbar spine. Thus, it is potentially readily and widely available. In recent years, a large number of studies have demonstrated that TBS is significantly associated with direct measurements of bone micro-architecture, predicts current and future fragility fractures in primary osteoporosis, and may be a useful adjunct to BMD for fracture detection and prediction. In this review, we summarize its potential utility in secondary causes of osteoporosis. In some situations, like glucocorticoid-induced osteoporosis and in diabetes mellitus, the TBS appears to out-perform DXA. It also has apparent value in numerous other disorders associated with diminished bone health, including primary hyperparathyroidism, androgen-deficiency, hormone-receptor positive breast cancer treatment, chronic kidney disease, hemochromatosis, and autoimmune disorders like rheumatoid arthritis. Further research is both needed and warranted to more clearly establish the role of TBS in these and other disorders that adversely affect bone.
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Affiliation(s)
- Fabio M Ulivieri
- Bone Metabolic Unit, Division of Nuclear Medicine, Fondazione Irccs Ca' Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
A hallmark of menopause, which follows the decline in the ovarian production of estrogen, is the aggressive and persistent loss of bone mineral and structural elements leading to loss of bone strength and increased fracture risk. This review focuses on newer methods of diagnosing osteoporosis and assessing fracture risk, as well as on novel management strategies for prevention and treatment. Fracture-risk prediction has been significantly enhanced by the development of methods such as the trabecular bone score, which helps assess bone microarchitecture and adds value to standard bone densitometry, and the Fracture Risk Assessment Tool (FRAX) algorithm techniques. The treatment of osteoporosis, which has the goals of fracture prevention and risk reduction, is moving beyond traditional monotherapies with antiresorptives and anabolic agents into new combination regimens.
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Affiliation(s)
- Panagiota Andreopoulou
- Department of Medicine, Endocrine Service, Hospital for Special Surgery, New York, NY, 10021;
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Piodi LP, Poloni A, Ulivieri FM. Managing osteoporosis in ulcerative colitis: something new? World J Gastroenterol 2014; 20:14087-98. [PMID: 25339798 PMCID: PMC4202340 DOI: 10.3748/wjg.v20.i39.14087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/12/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX(®) tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.
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Donnelly E, Lane JM, Boskey AL. Research perspectives: The 2013 AAOS/ORS research symposium on Bone Quality and Fracture Prevention. J Orthop Res 2014; 32:855-64. [PMID: 24700449 PMCID: PMC4716655 DOI: 10.1002/jor.22626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/05/2014] [Indexed: 02/04/2023]
Abstract
Bone fracture resistance is determined by the amount of bone present ("bone quantity") and by a number of other geometric and material factors grouped under the term "bone quality." In May 2013, a workshop was convened among a group of clinicians and basic science investigators to review the current state of the art in Bone Quality and Fracture Prevention and to make recommendations for future directions for research. The AAOS/ORS/OREF workshop was attended by 64 participants, including two representatives of the National Institutes of Arthritis and Musculoskeletal and Skin Diseases and 13 new investigators whose posters stimulated additional interest. A key outcome of the workshop was a set of recommendations regarding clinically relevant aspects of both bone quality and quantity that clinicians can use to inform decisions about patient care and management. The common theme of these recommendations was the need for more education of clinicians in areas of bone quality and for basic science studies to address specific topics of pathophysiology, diagnosis, prevention, and treatment of altered bone quality. In this report, the organizers with the assistance of the speakers and other attendees highlight the major findings of the meeting that justify the recommendations and needs for this field.
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Affiliation(s)
- Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, New York,Hospital for Special Surgery, New York, New York
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Silva BC, Bilezikian JP. Trabecular bone score: perspectives of an imaging technology coming of age. ACTA ACUST UNITED AC 2014; 58:493-503. [DOI: 10.1590/0004-2730000003456] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
The trabecular bone score (TBS) is a new method to describe skeletal microarchitecture from the dual energy X-ray absorptiometry (DXA) image of the lumbar spine. While TBS is not a direct physical measurement of trabecular microarchitecture, it correlates with micro-computed tomography (µCT) measures of bone volume fraction, connectivity density, trabecular number, and trabecular separation, and with vertebral mechanical behavior in ex vivo studies. In human subjects, TBS has been shown to be associated with trabecular microarchitecture and bone strength by high resolution peripheral quantitative computed tomography (HRpQCT). Cross-sectional and prospective studies, involving a large number of subjects, have both shown that TBS is associated with vertebral, femoral neck, and other types of osteoporotic fractures in postmenopausal women. Data in men, while much less extensive, show similar findings. TBS is also associated with fragility fractures in subjects with secondary causes of osteoporosis, and preliminary data suggest that TBS might improve fracture prediction when incorporated in the fracture risk assessment system known as FRAX. In this article, we review recent advances that have helped to establish this new imaging technology.
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Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res 2014; 29:518-30. [PMID: 24443324 DOI: 10.1002/jbmr.2176] [Citation(s) in RCA: 532] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 12/16/2022]
Abstract
The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Based on experimental variograms of the projected DXA image, TBS has the potential to discern differences between DXA scans that show similar BMD measurements. An elevated TBS value correlates with better skeletal microstructure; a low TBS value correlates with weaker skeletal microstructure. Lumbar spine TBS has been evaluated in cross-sectional and longitudinal studies. The following conclusions are based upon publications reviewed in this article: 1) TBS gives lower values in postmenopausal women and in men with previous fragility fractures than their nonfractured counterparts; 2) TBS is complementary to data available by lumbar spine DXA measurements; 3) TBS results are lower in women who have sustained a fragility fracture but in whom DXA does not indicate osteoporosis or even osteopenia; 4) TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women; 5) efficacious therapies for osteoporosis differ in the extent to which they influence the TBS; 6) TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality. Based on these data, lumbar spine TBS holds promise as an emerging technology that could well become a valuable clinical tool in the diagnosis of osteoporosis and in fracture risk assessment.
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Affiliation(s)
- Barbara C Silva
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Chang G, Xia D, Sherman O, Strauss E, Jazrawi L, Recht MP, Regatte RR. High resolution morphologic imaging and T2 mapping of cartilage at 7 Tesla: comparison of cartilage repair patients and healthy controls. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 26:539-48. [PMID: 23657612 DOI: 10.1007/s10334-013-0379-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/20/2013] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECT Our objective was to use 7 T MRI to compare cartilage morphology (thickness) and collagen composition (T2 values) in cartilage repair patients and healthy controls. MATERIALS AND METHODS We scanned the knees of 11 cartilage repair patients and 11 controls on a 7 T MRI scanner using a high-resolution, gradient-echo sequence to measure cartilage thickness and a multi-echo spin-echo sequence to measure cartilage T2 values. We used two-tailed t tests to compare cartilage thickness and T2 values in: repair tissue (RT) versus adjacent cartilage (AC); RT versus healthy control cartilage (HC); AC versus HC. RESULTS Mean thickness in RT, AC, HC were: 2.2±1.4, 3.6±1.1, 3.3±0.7 mm. Differences in thickness between RT-AC (p=0.01) and RT-HC (p=0.02) were significant, but not AC-HC (p=0.45). Mean T2 values in RT, AC, HC were: 51.6±7.6, 40.0±4.7, 45.9±3.7 ms. Differences in T2 values between RT-AC (p=0.0005), RT-HC (p=0.04), and AC-HC (p=0.004) were significant. CONCLUSION 7 T MRI allows detection of differences in morphology and collagen architecture in: (1) cartilage repair tissue compared to adjacent cartilage and (2) cartilage repair tissue compared to cartilage from healthy controls. Although cartilage adjacent to repair tissue may be normal in thickness, it can demonstrate altered collagen composition.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, NYU Langone Medical Center, Center for Musculoskeletal Care, 333 East 38th Street, 6th Floor, Room 610, New York, NY, 10016, USA,
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Advanced MR methods at ultra-high field (7 Tesla) for clinical musculoskeletal applications. Eur Radiol 2012; 22:2338-46. [DOI: 10.1007/s00330-012-2508-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 12/16/2022]
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Moser E, Stahlberg F, Ladd ME, Trattnig S. 7-T MR--from research to clinical applications? NMR IN BIOMEDICINE 2012; 25:695-716. [PMID: 22102481 DOI: 10.1002/nbm.1794] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 05/31/2023]
Abstract
Over 20,000 MR systems are currently installed worldwide and, although the majority operate at magnetic fields of 1.5 T and below (i.e. about 70%), experience with 3-T (in high-field clinical diagnostic imaging and research) and 7-T (research only) human MR scanners points to a future in functional and metabolic MR diagnostics. Complementary to previous studies, this review attempts to provide an overview of ultrahigh-field MR research with special emphasis on emerging clinical applications at 7 T. We provide a short summary of the technical development and the current status of installed MR systems. The advantages and challenges of ultrahigh-field MRI and MRS are discussed with special emphasis on radiofrequency inhomogeneity, relaxation times, signal-to-noise improvements, susceptibility effects, chemical shifts, specific absorption rate and other safety issues. In terms of applications, we focus on the topics most likely to gain significantly from 7-T MR, i.e. brain imaging and spectroscopy and musculoskeletal imaging, but also body imaging, which is particularly challenging. Examples are given to demonstrate the advantages of susceptibility-weighted imaging, time-of-flight MR angiography, high-resolution functional MRI, (1)H and (31)P MRSI in the human brain, sodium and functional imaging of cartilage and the first results (and artefacts) using an eight-channel body array, suggesting future areas of research that should be intensified in order to fully explore the potential of 7-T MR systems for use in clinical diagnosis.
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Affiliation(s)
- Ewald Moser
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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Chang G, Rajapakse CS, Babb JS, Honig SP, Recht MP, Regatte RR. In vivo estimation of bone stiffness at the distal femur and proximal tibia using ultra-high-field 7-Tesla magnetic resonance imaging and micro-finite element analysis. J Bone Miner Metab 2012; 30:243-51. [PMID: 22124539 PMCID: PMC3723134 DOI: 10.1007/s00774-011-0333-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 10/26/2011] [Indexed: 01/13/2023]
Abstract
The goal of this study was to demonstrate the feasibility of using 7-Tesla (7T) magnetic resonance imaging (MRI) and micro-finite element analysis (µFEA) to evaluate mechanical and structural properties of whole, cortical, and trabecular bone at the distal femur and proximal tibia in vivo. 14 healthy subjects were recruited (age 40.7 ± 15.7 years). The right knee was scanned on a 7T MRI scanner using a 28 channel-receive knee coil and a three-dimensional fast low-angle shot sequence (TR/TE 20 ms/5.02 ms, 0.234 mm × 0.234 mm × 1 mm, 80 axial images, 7 min 9 s). Bone was analyzed at the distal femoral metaphysis, femoral condyles, and tibial plateau. Whole, cortical, and trabecular bone stiffness was computed using µFEA. Bone volume fraction (BVF), bone areas, and cortical thickness were measured. Trabecular bone stiffness (933.7 ± 433.3 MPa) was greater than cortical bone stiffness (216 ± 152 MPa) at all three locations (P < 0.05). Across locations, there were no differences in bone stiffness (whole, cortical, or trabecular). Whole, cortical, and trabecular bone stiffness correlated with BVF (R ≥ 0.69, P < 0.05) and inversely correlated with corresponding whole, cortical, and trabecular areas (R ≤ -0.54, P < 0.05), but not with cortical thickness (R < -0.11, P > 0.05). Whole, cortical, and trabecular stiffness correlated with body mass index (R ≥ 0.62, P < 0.05). In conclusion, at the distal femur and proximal tibia, trabecular bone contributes 66-74% of whole bone stiffness. 7T MRI and µFEA may be used as a method to provide insight into how structural properties of cortical or trabecular bone affect bone mechanical competence in vivo.
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Affiliation(s)
- Gregory Chang
- Quantitative Multinuclear Musculoskeletal Imaging Group, Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, 660 First Avenue, Room 231, New York, NY 10016, USA.
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Chang G, Wang L, Liang G, Babb JS, Wiggins GC, Saha PK, Regatte RR. Quantitative assessment of trabecular bone micro-architecture of the wrist via 7 Tesla MRI: preliminary results. MAGMA (NEW YORK, N.Y.) 2011; 24:191-9. [PMID: 21544680 PMCID: PMC3723135 DOI: 10.1007/s10334-011-0252-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 01/03/2023]
Abstract
OBJECT The goal of this study was to determine the feasibility of performing quantitative 7 T magnetic resonance imaging (MRI) assessment of trabecular bone micro-architecture of the wrist, a common fracture site. MATERIALS AND METHODS The wrists of 4 healthy subjects (1 woman, 3 men, 28 ± 8.9 years) were scanned on a 7 T whole body MR scanner using a 3D fast low-angle shot (FLASH) sequence (TR/TE = 20/4.5 m s, 0.169 × 0.169 × 0.5 mm). Trabecular bone was segmented and divided into 4 or 8 angular subregions. Total bone volume (TBV), bone volume fraction (BVF), surface-curve ratio (SC), and erosion index (EI) were computed. Subjects were scanned twice to assess measurement reproducibility. RESULTS Group mean subregional values for TBV, BVF, SC, and EI (8 subregion analysis) were as follows: 8489 ± 3686, 0.27 ± 0.045, 9.61 ± 6.52; and 1.43 ± 1.25. Within each individual, there was subregional variation in TBV, SC, and EI (>5%), but not BVF (<5%). Intersubject variation (≥12%) existed for all parameters. Within-subject coefficients of variation were ≤10%. CONCLUSION This is the first study to perform quantitative 7T MRI assessment of trabecular bone micro-architecture of the wrist. This method could be utilized to study perturbations in bone structure in subjects with osteoporosis or other bone disorders.
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Affiliation(s)
- Gregory Chang
- Quantitative Multinuclear Musculoskeletal Imaging Group, Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, 660 First Avenue, 4th Floor, New York, NY 10016, USA.
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Krug R, Larson PEZ, Wang C, Burghardt AJ, Kelley DAC, Link TM, Zhang X, Vigneron DB, Majumdar S. Ultrashort echo time MRI of cortical bone at 7 tesla field strength: a feasibility study. J Magn Reson Imaging 2011; 34:691-5. [PMID: 21769960 DOI: 10.1002/jmri.22648] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 04/11/2011] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To implement and examine the feasibility of a three-dimensional (3D) ultrashort TE (UTE) sequence on a 7 Tesla (T) clinical MR scanner in comparison with 3T MRI at high isotropic resolution. MATERIALS AND METHODS Using an in-house built saddle coil at both field strengths we have imaged mid-diaphysial sections of five fresh cadaveric specimens of the distal tibia. An additional in vivo scan was performed at 7 Tesla using a quadrature knee coil. RESULTS Using the same type of saddle coil at both field strengths, a significant increase in SNR at 7T compared with 3T (factor 1.7) was found. Significantly shorter T2* values were found at the higher field strength (T2* = 552.2 ± 126 μs at 7T versus T2* = 1163 ± 391 μs at 3T). CONCLUSION UHF MRI at 7T has great potential for imaging tissues with short T2.
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Affiliation(s)
- Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
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Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg MA. Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom 2011; 14:302-12. [PMID: 21724435 DOI: 10.1016/j.jocd.2011.05.005] [Citation(s) in RCA: 296] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 05/16/2011] [Accepted: 05/17/2011] [Indexed: 12/27/2022]
Abstract
Developing a novel technique for the efficient, noninvasive clinical evaluation of bone microarchitecture remains both crucial and challenging. The trabecular bone score (TBS) is a new gray-level texture measurement that is applicable to dual-energy X-ray absorptiometry (DXA) images. Significant correlations between TBS and standard 3-dimensional (3D) parameters of bone microarchitecture have been obtained using a numerical simulation approach. The main objective of this study was to empirically evaluate such correlations in anteroposterior spine DXA images. Thirty dried human cadaver vertebrae were evaluated. Micro-computed tomography acquisitions of the bone pieces were obtained at an isotropic resolution of 93μm. Standard parameters of bone microarchitecture were evaluated in a defined region within the vertebral body, excluding cortical bone. The bone pieces were measured on a Prodigy DXA system (GE Medical-Lunar, Madison, WI), using a custom-made positioning device and experimental setup. Significant correlations were detected between TBS and 3D parameters of bone microarchitecture, mostly independent of any correlation between TBS and bone mineral density (BMD). The greatest correlation was between TBS and connectivity density, with TBS explaining roughly 67.2% of the variance. Based on multivariate linear regression modeling, we have established a model to allow for the interpretation of the relationship between TBS and 3D bone microarchitecture parameters. This model indicates that TBS adds greater value and power of differentiation between samples with similar BMDs but different bone microarchitectures. It has been shown that it is possible to estimate bone microarchitecture status derived from DXA imaging using TBS.
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Affiliation(s)
- Didier Hans
- Department of Bone and Joint Diseases, Lausanne University Hospital, Lausanne, Switzerland
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Bhagat YA, Rajapakse CS, Magland JF, Love JH, Wright AC, Wald MJ, Song HK, Wehrli FW. Performance of μMRI-Based virtual bone biopsy for structural and mechanical analysis at the distal tibia at 7T field strength. J Magn Reson Imaging 2011; 33:372-81. [PMID: 21274979 DOI: 10.1002/jmri.22439] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the performance of a 3D fast spin echo (FSE) pulse sequence utilizing out-of-slab cancellation through phase alternation and micro-magnetic resonance imaging (μMRI)-based virtual bone biopsy processing methods to probe the serial reproducibility and sensitivity of structural and mechanical parameters of the distal tibia at 7.0T. MATERIALS AND METHODS The distal tibia of five healthy subjects was imaged at three timepoints with a 3D FSE sequence at 137 × 137 × 410 μm(3) voxel size. Follow-up images were retrospectively 3D registered to baseline images. Coefficients of variation (CV) and intraclass correlation coefficients (ICCs) for measures of scale and topology of the whole tibial trabecular bone (TB) cross-section as well as finite-element-derived Young's and shear moduli of central cuboidal TB subvolumes (8 × 8 × 5 mm(3) ) were evaluated as measures of reproducibility and reliability. Four additional cubic TB subregions (anterior, medial, lateral, and posterior) of similar dimensions were extracted and analyzed to determine associations between whole cross-section and subregional structural parameters. RESULTS The mean signal-to-noise ratio (SNR) over the 15 image acquisitions was 27.5 ± 2.1. Retrospective registration yielded an average common analysis volume of 67% across the three exams per subject. Reproducibility (mean CV = 3.6%; range, 1.5%-5%) and reliability (ICCs, 0.95-0.99) of all parameters permitted parameter-based discrimination of the five subjects in spite of the narrow age range (26-36 years) covered. Parameters characterizing topology were better able to distinguish two individuals who demonstrated similar values for scalar measurements (≈ 34% difference, P < 0.001). Whole-section axial stiffness encompassing the cortex was superior at distinguishing two individuals relative to its central subregional TB counterpart (≈ 8% difference; P < 0.05). Interregion comparisons showed that although all parameters were correlated (mean R(2) = 0.78; range 0.57-0.99), the strongest associations observed were those for the erosion index (mean R(2) = 0.95, P ≤ 0.01). CONCLUSION The reproducibility and structural and mechanical parameter-based discriminative ability achieved in five healthy subjects suggests that 7T-derived μMRI of TB can be applied towards serial patient studies of osteoporosis and may enable earlier detection of disease or treatment-based effects.
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Affiliation(s)
- Yusuf A Bhagat
- Laboratory for Structural NMR Imaging, Department of Radiology, University of Pennsylvania, MRI Education Center, Philadelphia, Pennsylvania 19104, USA
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Wright AC, Lemdiasov R, Connick TJ, Bhagat YA, Magland JF, Song HK, Toddes SP, Ludwig R, Wehrli FW. Helmholtz-pair transmit coil with integrated receive array for high-resolution MRI of trabecular bone in the distal tibia at 7T. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2011; 210:113-22. [PMID: 21402488 PMCID: PMC3085966 DOI: 10.1016/j.jmr.2011.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/31/2010] [Accepted: 02/18/2011] [Indexed: 05/17/2023]
Abstract
A Helmholtz-pair local transmit RF coil with an integrated four-element receive array RF coil and foot immobilization platform was designed and constructed for imaging the distal tibia in a whole-body 7T MRI scanner. Simulations and measurements of the B(1) field distribution of the transmit coil are described, along with SAR considerations for operation at 7T. Results of imaging the trabecular bone of three volunteers at 1.5T, 3T and 7T are presented, using identical 1.5T and 3T versions of the 7T four-element receive array. The spatially registered images reveal improved visibility for individual trabeculae and show average gains in SNR of 2.8× and 4.9× for imaging at 7T compared to 3T and 1.5T, respectively. The results thus display an approximately linear dependence of SNR with field strength and enable the practical utility of 7T scanners for micro-MRI of trabecular bone.
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Affiliation(s)
- Alexander C Wright
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
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Vossen M, Teeuwisse W, Reijnierse M, Collins C, Smith N, Webb A. A radiofrequency coil configuration for imaging the human vertebral column at 7 T. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2011; 208:291-7. [PMID: 21134773 PMCID: PMC3076136 DOI: 10.1016/j.jmr.2010.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 11/09/2010] [Accepted: 11/09/2010] [Indexed: 05/17/2023]
Abstract
We describe the design and testing of a quadrature transmit, eight-channel receive array RF coil configuration for the acquisition of images of the entire human spinal column at 7 T. Imaging parameters were selected to enable data acquisition in a clinically relevant scan time. Large field-of-view (FOV) scanning enabled sagittal imaging of the spine in two or three-stations, depending upon the height of the volunteer, with a total scan time of between 10 and 15 min. A total of 10 volunteers have been scanned, with results presented for the three subjects spanning the range of heights and weights, namely one female (1.6 m, 50 kg), one average male (1.8 m, 70 kg), and one large male (1.9 m, 100 kg).
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Affiliation(s)
- M. Vossen
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - W. Teeuwisse
- Department of Radiology, Leiden University Medical Center, The Netherlands
- C.J. Gorter Center for High Field Magnetic Resonance Imaging, Leiden, ZA 2333, The Netherlands
| | - M. Reijnierse
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - C.M. Collins
- Center for NMR Research, Hershey Medical School, Hershey, PA, USA
| | - N.B. Smith
- Department of Radiology, Leiden University Medical Center, The Netherlands
- C.J. Gorter Center for High Field Magnetic Resonance Imaging, Leiden, ZA 2333, The Netherlands
| | - A.G. Webb
- Department of Radiology, Leiden University Medical Center, The Netherlands
- C.J. Gorter Center for High Field Magnetic Resonance Imaging, Leiden, ZA 2333, The Netherlands
- Corresponding author. Address: C.J. Gorter Center for High Field MRI, Department of Radiology, C3-Q, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands. Fax: +31 71 524 8256. (A.G. Webb)
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Krug R, Burghardt AJ, Majumdar S, Link TM. High-resolution imaging techniques for the assessment of osteoporosis. Radiol Clin North Am 2010; 48:601-21. [PMID: 20609895 DOI: 10.1016/j.rcl.2010.02.015] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The importance of assessing the bone's microarchitectural make-up in addition to its mineral density in the context of osteoporosis has been emphasized in several publications. The high spatial resolution required to resolve the bone's microstructure in a clinically feasible scan time is challenging. At present, the best suited modalities meeting these requirements in vivo are high-resolution peripheral quantitative imaging (HR-pQCT) and magnetic resonance imaging (MRI). Whereas HR-pQCT is limited to peripheral skeleton regions like the wrist and ankle, MRI can also image other sites like the proximal femur but usually with lower spatial resolution. In addition, multidetector computed tomography has been used for high-resolution imaging of trabecular bone structure; however, the radiation dose is a limiting factor. This article provides an overview of the different modalities, technical requirements, and recent developments in this emerging field. Details regarding imaging protocols as well as image postprocessing methods for bone structure quantification are discussed.
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Affiliation(s)
- Roland Krug
- MQIR, Department of Radiology and Biomedical Imaging, University of California-San Francisco, UCSF China Basin Landing, 185 Berry Street, San Francisco, CA 94107, USA.
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Magland JF, Rajapakse CS, Wright AC, Acciavatti R, Wehrli FW. 3D fast spin echo with out-of-slab cancellation: a technique for high-resolution structural imaging of trabecular bone at 7 Tesla. Magn Reson Med 2010; 63:719-27. [PMID: 20187181 DOI: 10.1002/mrm.22213] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Spin-echo-based pulse sequences are desirable for the application of high-resolution imaging of trabecular bone but tend to involve high-power deposition. Increased availability of ultrahigh field scanners has opened new possibilities for imaging with increased signal-to-noise ratio (SNR) efficiency, but many pulse sequences that are standard at 1.5 and 3 T exceed specific absorption rate limits at 7 T. A modified, reduced specific absorption rate, three-dimensional, fast spin-echo pulse sequence optimized specifically for in vivo trabecular bone imaging at 7 T is introduced. The sequence involves a slab-selective excitation pulse, low-power nonselective refocusing pulses, and phase cycling to cancel undesired out-of-slab signal. In vivo images of the distal tibia were acquired using the technique at 1.5, 3, and 7 T field strengths, and SNR was found to increase at least linearly using receive coils of identical geometry. Signal dependence on the choice of refocusing flip angles in the echo train was analyzed experimentally and theoretically by combining the signal from hundreds of coherence pathways, and it is shown that a significant specific absorption rate reduction can be achieved with negligible SNR loss.
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Affiliation(s)
- Jeremy F Magland
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
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Moser E, Meyerspeer M, Fischmeister FPS, Grabner G, Bauer H, Trattnig S. Windows on the human body--in vivo high-field magnetic resonance research and applications in medicine and psychology. SENSORS (BASEL, SWITZERLAND) 2010; 10:5724-57. [PMID: 22219684 PMCID: PMC3247729 DOI: 10.3390/s100605724] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/02/2010] [Accepted: 05/17/2010] [Indexed: 12/30/2022]
Abstract
Analogous to the evolution of biological sensor-systems, the progress in "medical sensor-systems", i.e., diagnostic procedures, is paradigmatically described. Outstanding highlights of this progress are magnetic resonance imaging (MRI) and spectroscopy (MRS), which enable non-invasive, in vivo acquisition of morphological, functional, and metabolic information from the human body with unsurpassed quality. Recent achievements in high and ultra-high field MR (at 3 and 7 Tesla) are described, and representative research applications in Medicine and Psychology in Austria are discussed. Finally, an overview of current and prospective research in multi-modal imaging, potential clinical applications, as well as current limitations and challenges is given.
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Affiliation(s)
- Ewald Moser
- MR Center of Excellence, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; E-Mails: (M.M.); (F.Ph.S.F.); (G.G.); (S.T.)
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Department of Diagnostic Radiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Martin Meyerspeer
- MR Center of Excellence, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; E-Mails: (M.M.); (F.Ph.S.F.); (G.G.); (S.T.)
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Florian Ph. S. Fischmeister
- MR Center of Excellence, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; E-Mails: (M.M.); (F.Ph.S.F.); (G.G.); (S.T.)
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Brain Research Lab, Department of Clinical, Biological and Differential Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria; E-Mail:
| | - Günther Grabner
- MR Center of Excellence, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; E-Mails: (M.M.); (F.Ph.S.F.); (G.G.); (S.T.)
- Department of Diagnostic Radiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Herbert Bauer
- Brain Research Lab, Department of Clinical, Biological and Differential Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria; E-Mail:
| | - Siegfried Trattnig
- MR Center of Excellence, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; E-Mails: (M.M.); (F.Ph.S.F.); (G.G.); (S.T.)
- Department of Diagnostic Radiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Webb AG, Collins CM, Versluis MJ, Kan HE, Smith NB. MRI and localized proton spectroscopy in human leg muscle at 7 Tesla using longitudinal traveling waves. Magn Reson Med 2010; 63:297-302. [PMID: 20099323 PMCID: PMC2846515 DOI: 10.1002/mrm.22262] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 09/30/2009] [Indexed: 11/08/2022]
Abstract
Using a small resonant loop to produce a longitudinal traveling wave on a human 7-T system allows MR to be performed over the entire volume of the human leg. We have used this capability to perform localized proton MR spectroscopy of the lipid composition of muscle in volunteers with a coil placed approximately 30 cm away from the region of interest. Spectra with a reasonable signal-to-noise ratio can be acquired in a clinically relevant data acquisition time of less than 5 min using the loop in transmit/receive mode, maintaining the full flexibility to acquire spectra from any part of the calf and/or thigh. If a local receive coil is used in combination with the remote transmit coil, then the signal-to-noise improves significantly, as expected.
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Affiliation(s)
- Andrew G Webb
- C.J.Gorter Center for High Field Magnetic Resonance Imaging, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Trattnig S, Friedrich KM, Bogner W, Welsch GH. Advanced musculoskeletal MRI at ultra-high field (7 T). ACTA ACUST UNITED AC 2010. [DOI: 10.2217/iim.09.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Imaging of the musculoskeletal system in vivo using ultra-high field magnetic resonance at 7 T. Invest Radiol 2009; 44:613-8. [PMID: 19652609 DOI: 10.1097/rli.0b013e3181b4c055] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recently, great progress has been made in particularly in the imaging of cartilage and bone structure. Increased interest has focused on high-field (3 Tesla) imaging and more recently on ultra-high field (UHF) magnetic resonance imaging (MRI) at 7 T for in vivo imaging. Because the signal-to-noise ratio (SNR) scales linearly with field strength, a substantial increase in SNR is expected compared with lower field strengths. This gain in SNR can be used to increase spatial resolution or reduce imaging time. The goal of this review was to highlight recent developments and challenges in in vivo musculoskeletal (MSK) imaging using UHF-MRI at 7 T. One focus of this review is on the emerging methodology of quantitative MRI for the assessment of trabecular bone structure at the tibia, wrist, and knee. In particular for this application, susceptibility effects between the bone and bone marrow transitions that scale with field strength have to be considered. Another important MSK application is the characterization of knee cartilage morphology. The higher SNR provided by UHF-MRI is a potential advantage for visualizing, segmenting, and analyzing cartilage. Standard clinical MSK imaging relies heavily on T1, T2, and proton density weighted fast spin echo sequences. However, fast spin echo imaging has proven to be very challenging at higher fields because of very high specific absorption rates, using multiple pulses in a short time frame; thus the imaging protocols have to be adapted and gradient echo sequences may be more beneficial. Imaging of more central body parts such as the spine at 7 T is still in its infancy and dedicated coils have to be developed.
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Versluis MJ, Tsekos N, Smith NB, Webb AG. Simple RF design for human functional and morphological cardiac imaging at 7tesla. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2009; 200:161-6. [PMID: 19595618 DOI: 10.1016/j.jmr.2009.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/22/2009] [Accepted: 06/17/2009] [Indexed: 05/12/2023]
Abstract
Morphological and functional cardiac MRI can potentially benefit greatly from the recent advent of commercial high-field (7tesla and above) MRI systems. However, conventional hardware configurations at lower field using a body-coil for homogeneous transmission are not available at these field strengths. Sophisticated multiple-transmit-channel systems have been shown to be able to image the human heart at 7tesla but such systems are currently not widely available. In this paper, we empirically optimize the design of a simple quadrature coil for cardiac imaging at 7tesla. The size, geometry, and position have been chosen to produce a B(1) field with no tissue-induced signal voids within the heart. Standard navigator echoes for gating were adapted for operation at the heart/lung interface, directly along the head-foot direction. Using this setup, conventional and high-resolution cine functional imaging have been successfully performed, as has morphological imaging of the right coronary artery.
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Affiliation(s)
- M J Versluis
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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49
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Issever AS, Link TM, Kentenich M, Rogalla P, Burghardt AJ, Kazakia GJ, Majumdar S, Diederichs G. Assessment of trabecular bone structure using MDCT: comparison of 64- and 320-slice CT using HR-pQCT as the reference standard. Eur Radiol 2009; 20:458-68. [PMID: 19711081 PMCID: PMC2814042 DOI: 10.1007/s00330-009-1571-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 06/24/2009] [Accepted: 07/05/2009] [Indexed: 11/28/2022]
Abstract
Objectives The aim of our study was to perform trabecular bone structure analysis with images from 64- and 320-slice multidetector computed tomography (MDCT) and to compare these with high-resolution peripheral computed tomography (HR-pQCT). Materials and methods Twenty human cadaver distal forearm specimens were imaged on a 64- and 320-slice MDCT system at 120 kVp, 200 mA and 135 kVp, 400 mA (in-plane pixel size 234 µm; slice thickness 500 µm). HR-pQCT imaging was performed at an isotropic voxel size of 41 µm. Bone volume fraction (BV/TV), trabecular number (Tb.N), thickness (Tb.Th) and separation (Tb.Sp) were computed. Results MDCT-derived BV/TV and Tb.Sp were highly correlated (r = 0.92–0.96, p < 0.0001) with the corresponding HR-pQCT parameters. Tb.Th was the only structure measure that did not yield any significant correlation. Conclusion The 64- and 320-slice MDCT systems both perform equally well in depicting trabecular bone architecture. However, because of constrained resolutions accurate derivation of trabecular bone measures is limited to only a subset of microarchitectural parameters.
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Affiliation(s)
- Ahi S Issever
- Department of Radiology, Charité Campus Mitte, Universitaetsmedizin, Berlin, Germany.
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Diederichs G, Link T, Marie K, Huber M, Rogalla P, Burghardt A, Majumdar S, Issever A. Feasibility of measuring trabecular bone structure of the proximal femur using 64-slice multidetector computed tomography in a clinical setting. Calcif Tissue Int 2008; 83:332-41. [PMID: 18855036 DOI: 10.1007/s00223-008-9181-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 09/18/2008] [Indexed: 11/28/2022]
Abstract
We studied the feasibility of cancellous bone structure assessment of the proximal femur using multidetector computed tomography (MDCT) in an simulated in vivo experimental model. The proximal femur of 15 intact human cadavers was examined using 64-row MDCT using a thin-section protocol with an in-plane spatial resolution of 273 mum. High-resolution peripheral quantitative computed tomography (HR-pQCT) of the isolated specimens with a voxel size of 82 mum served as a standard of reference. Trabecular bone structure and optimized textural parameters were calculated in MDCT images and compared to measures obtained by HR-pQCT. Significant correlations between MDCT- and HR-pQCT-derived values for bone fraction (r = 0.87), trabecular separation (r = 0.66), and number (r = 0.53) were found. Parameters derived from textural analysis performed better in predicting trabecular separation (up to r = 0.86) and number (up to r = 0.83). Trabecular thickness could not be quantified correctly using MDCT, most likely due to its limited resolution. Individual parameters for assessement of trabecular microarchitecture can be measured using MDCT-derived imaging studies and a simulated in vivo setup. Thus, in vivo assessment of bone architecture in addition to BMD may be feasible in clinical practice.
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Affiliation(s)
- Gerd Diederichs
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
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