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Porrelli D, Abrami M, Pelizzo P, Formentin C, Ratti C, Turco G, Grassi M, Canton G, Grassi G, Murena L. Trabecular bone porosity and pore size distribution in osteoporotic patients - A low field nuclear magnetic resonance and microcomputed tomography investigation. J Mech Behav Biomed Mater 2021; 125:104933. [PMID: 34837800 DOI: 10.1016/j.jmbbm.2021.104933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 01/19/2023]
Abstract
The study of bone morphology is of great importance as bone morphology is influenced by factors such as age and underlying comorbidities and is associated with bone mechanical properties and fracture risk. Standard diagnostic techniques used in bone disease, such as Dual-Energy X-ray absorptiometry and ultrasonography do not provide qualitative and quantitative morphological information. In recent years, techniques such as High Resolution Computed Tomography (HR-CT), micro- CT, Magnetic Resonance Imaging (MRI), and Low Field Nuclear Magnetic Resonance (LF-NMR) have been developed for the study of bone structure and porosity. Data obtained from these techniques have been used to construct models to predict bone mechanical properties thanks to finite element analysis. Cortical porosity has been extensively studied and successfully correlated with disease progression and mechanical properties. Trabecular porosity and pore size distribution, however, have increasingly been taken into consideration to obtain a comprehensive analysis of bone pathology and mechanic. Therefore, we have decided to evaluate the ability of micro- CT (chosen for its high spatial resolving power) and LF-NMR (chosen to analyze the behavior of water molecules within trabecular bone pores) to characterize the morphology of trabecular bone in osteoporosis. Trabecular bone samples from human femoral heads collected during hip replacement surgery were from osteoporosis (test group) and osteoarthritis (control group) patients. Our data show that both micro- CT and LF-NMR can detect qualitative changes in trabecular bone (i.e., transition from plate-like to rod-like morphology). Micro- CT failed to detect significant differences in trabecular bone morphology parameters between osteoporotic and osteoarthritic specimens, with the exception of Trabecular Number and Connectivity Density, which are markers of osteoporosis progression. In contrast, LF-NMR was able to detect significant differences in porosity and pore size of trabecular bone from osteoporotic versus osteoarthritic (control) samples. However, only the combination of these two techniques allowed the detection of structural morphometric changes (increase in the larger pore fraction and enlargement of the larger pores) in the trabecular bone of osteoporotic specimens compared to osteoarthritic ones. In conclusion, the combined use of LF-NMR and micro- CT provides a valuable tool for characterizing the morphology of trabecular bone and may offer the possibility for a new approach to the study and modeling of bone mechanics in the context of aging and disease.
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Affiliation(s)
- Davide Porrelli
- Department of Medicine, Surgery and Health Sciences, Maggiore Ospital, Trieste University, Piazza dell'Ospitale 1, I-34125, Trieste, Italy
| | - Michela Abrami
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I 34127, Trieste, Italy
| | - Patrizia Pelizzo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Cristina Formentin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Chiara Ratti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Gianluca Turco
- Department of Medicine, Surgery and Health Sciences, Maggiore Ospital, Trieste University, Piazza dell'Ospitale 1, I-34125, Trieste, Italy
| | - Mario Grassi
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I 34127, Trieste, Italy.
| | - Gianluca Canton
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Gabriele Grassi
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Luigi Murena
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
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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: 34] [Impact Index Per Article: 6.8] [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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Guenoun D, Pithioux M, Souplet JC, Guis S, Le Corroller T, Fouré A, Pauly V, Mattei JP, Bernard M, Guye M, Chabrand P, Champsaur P, Bendahan D. Assessment of proximal femur microarchitecture using ultra-high field MRI at 7 Tesla. Diagn Interv Imaging 2019; 101:45-53. [PMID: 31331831 DOI: 10.1016/j.diii.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/07/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate bone microarchitecture of cadaveric proximal femurs using ultra-high field (UHF) 7-Tesla magnetic resonance imaging (MRI) and to compare the corresponding metrics with failure load assessed during mechanical compression test and areal bone mineral density (ABMD) measured using dual-energy X-ray absorptiometry. MATERIALS AND METHODS ABMD of ten proximal femurs from five cadavers (5 women; mean age=86.2±3.8 (SD) years; range: 82.5-90 years) were investigated using dual-energy X-ray absorptiometry and the bone volume fraction, trabecular thickness, trabecular spacing, fractal dimension, Euler characteristics, connectivity density and degree of anisotropy of each femur was quantified using UHF MRI. The whole set of specimens underwent mechanical compression tests to failure. The inter-rater reliability of microarchitecture characterization was assessed with the intraclass correlation coefficient (ICC). Associations were searched using correlation tests and multiple regression analysis. RESULTS The inter-rater reliability for bone microarchitecture parameters measurement was good with ICC ranging from 0.80 and 0.91. ABMD and the whole set of microarchitecture metrics but connectivity density significantly correlated with failure load. Microarchitecture metrics correlated to each other but did not correlate with ABMD. Multiple regression analysis disclosed that the combination of microarchitecture metrics and ABMD improved the association with failure load. CONCLUSION Femur bone microarchitecture metrics quantified using UHF MRI significantly correlated with biomechanical parameters. The multimodal assessment of ABMD and trabecular bone microarchitecture using UHF MRI provides more information about fracture risk of femoral bone and might be of interest for future investigations of patients with undetected osteoporosis.
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Affiliation(s)
- D Guenoun
- Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, APHM, 13009 Marseille, France; CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France.
| | - M Pithioux
- CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - J-C Souplet
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - S Guis
- CNRS, CRMBM UMR 7339, Department of Rheumatology, Aix-Marseille Université, AP-HM, 13000 Marseille, France
| | - T Le Corroller
- Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, APHM, 13009 Marseille, France; CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - A Fouré
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - V Pauly
- Unité de recherche EA3279, santé publique et maladies chroniques: qualité de vie concepts, usages et limites, déterminants, Aix-Marseille Université, 13005 Marseille, France; Service de santé publique et d'information médicale, Hôpital de la Conception, APHM, 13000 Marseille, France
| | - J-P Mattei
- CNRS, CRMBM UMR 7339, Department of Rheumatology, Aix-Marseille Université, AP-HM, 13000 Marseille, France
| | - M Bernard
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - M Guye
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
| | - P Chabrand
- CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - P Champsaur
- Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, APHM, 13009 Marseille, France; CNRS, ISM, Institute Movement Sci, Aix-Marseille Université, 13000 Marseille, France
| | - D Bendahan
- CNRS, CRMBM UMR 7339, Aix-Marseille Université, 13385 Marseille, France
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Rajapakse CS, Chang G. Micro-Finite Element Analysis of the Proximal Femur on the Basis of High-Resolution Magnetic Resonance Images. Curr Osteoporos Rep 2018; 16:657-664. [PMID: 30232586 PMCID: PMC6234089 DOI: 10.1007/s11914-018-0481-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Hip fractures have catastrophic consequences. The purpose of this article is to review recent developments in high-resolution magnetic resonance imaging (MRI)-guided finite element analysis (FEA) of the hip as a means to determine subject-specific bone strength. RECENT FINDINGS Despite the ability of DXA to predict hip fracture, the majority of fractures occur in patients who do not have BMD T scores less than - 2.5. Therefore, without other detection methods, these individuals go undetected and untreated. Of methods available to image the hip, MRI is currently the only one capable of depicting bone microstructure in vivo. Availability of microstructural MRI allows generation of patient-specific micro-finite element models that can be used to simulate real-life loading conditions and determine bone strength. MRI-based FEA enables radiation-free approach to assess hip fracture strength. With further validation, this technique could become a potential clinical tool in managing hip fracture risk.
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Affiliation(s)
- Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, 1 Founders Building, Philadelphia, PA, 19104, USA.
| | - Gregory Chang
- Department of Radiology, New York University, 426 1st Avenue, New York, NY, 10010, USA
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Rajapakse CS, Leonard MB, Kobe EA, Slinger MA, Borges KA, Billig E, Rubin CT, Wehrli FW. The Efficacy of Low-intensity Vibration to Improve Bone Health in Patients with End-stage Renal Disease Is Highly Dependent on Compliance and Muscle Response. Acad Radiol 2017; 24:1332-1342. [PMID: 28652048 DOI: 10.1016/j.acra.2017.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/23/2017] [Indexed: 12/28/2022]
Abstract
RATIONAL AND OBJECTIVES Low intensity vibration (LIV) may represent a nondrug strategy to mitigate bone deficits in patients with end-stage renal disease. MATERIALS AND METHODS Thirty end-stage renal patients on maintenance hemodialysis were randomized to stand for 20 minutes each day on either an active or placebo LIV device. Analysis at baseline and completion of 6-month intervention included magnetic resonance imaging (tibia and fibula stiffness; trabecular thickness, number, separation, bone volume fraction, plate-to-rod ratio; and cortical bone porosity), dual-energy X-ray absorptiometry (hip and spine bone mineral density [BMD]), and peripheral quantitative computed tomography (tibia trabecular and cortical BMD; calf muscle cross-sectional area). RESULTS Intention-to-treat analysis did not show any significant changes in outcomes associated with LIV. Subjects using the active device and with greater than the median adherence (70%) demonstrated an increase in distal tibia stiffness (5.3%), trabecular number (1.7%), BMD (2.3%), and plate-to-rod ratio (6.5%), and a decrease in trabecular separation (-1.8%). Changes in calf muscle cross-sectional area were associated with changes in distal tibia stiffness (R = 0.85), trabecular bone volume/total volume (R = 0.91), number (R = 0.92), and separation (R = -0.94) in the active group but not in the placebo group. Baseline parathyroid hormone levels were positively associated with increased cortical bone porosity over the 6-month study period in the placebo group (R = 0.55) but not in the active group (R = 0.01). No changes were observed in the nondistal tibia locations for either group except a decrease in hip BMD in the placebo group (-1.7%). CONCLUSION Outcomes and adherence thresholds identified from this pilot study could guide future longitudinal studies involving vibration therapy.
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Chang G, Boone S, Martel D, Rajapakse CS, Hallyburton RS, Valko M, Honig S, Regatte RR. MRI assessment of bone structure and microarchitecture. J Magn Reson Imaging 2017; 46:323-337. [PMID: 28165650 PMCID: PMC5690546 DOI: 10.1002/jmri.25647] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis is a disease of weak bone and increased fracture risk caused by low bone mass and microarchitectural deterioration of bone tissue. The standard-of-care test used to diagnose osteoporosis, dual-energy x-ray absorptiometry (DXA) estimation of areal bone mineral density (BMD), has limitations as a tool to identify patients at risk for fracture and as a tool to monitor therapy response. Magnetic resonance imaging (MRI) assessment of bone structure and microarchitecture has been proposed as another method to assess bone quality and fracture risk in vivo. MRI is advantageous because it is noninvasive, does not require ionizing radiation, and can evaluate both cortical and trabecular bone. In this review article, we summarize and discuss research progress on MRI of bone structure and microarchitecture over the last decade, focusing on in vivo translational studies. Single-center, in vivo studies have provided some evidence for the added value of MRI as a biomarker of fracture risk or treatment response. Larger, prospective, multicenter studies are needed in the future to validate the results of these initial translational studies. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:323-337.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Sean Boone
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Dimitri Martel
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert S Hallyburton
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Mitch Valko
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Stephen Honig
- Osteoporosis Center, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York, USA
| | - Ravinder R Regatte
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
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Fractures in chronic kidney disease: pursuing the best screening and management. Curr Opin Nephrol Hypertens 2016; 24:317-23. [PMID: 26050117 DOI: 10.1097/mnh.0000000000000131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Osteoporotic fractures are common and cause increased sickness and death. Men and women with chronic kidney disease (CKD) are at particularly high risk of osteoporotic fractures. Currently, however, there are no guidelines concerning noninvasive methods to assess fracture risk in CKD. Further, approved treatments to prevent fractures in otherwise healthy men and women are only recommended for use with caution in those with CKD. This review focuses on the recent data that support the use of noninvasive methods to assess fracture risk in CKD and highlights new therapies that could be used in fracture prevention in CKD. RECENT FINDINGS Data from prospective studies demonstrate that low bone mineral density predicts fracture in CKD patients. Post-hoc analyses demonstrate that agents approved for the treatment of postmenopausal osteoporosis (bisphosphonates, denosumab and teriparatide) when given to those with CKD are well tolerated and potentially efficacious with respect to fracture risk reduction. SUMMARY To date, patients, and nephrologists taking care of them, have largely ignored fracture risk assessment and treatment in CKD. This should change given recent data. Further studies are needed, specifically bone histomorphometric studies, which will increase our understanding of CKD-mineral bone disease (MBD) pathophysiology, and randomized clinical trials of therapy in patients with CKD.
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Chang G, Hotca-Cho A, Rusinek H, Honig S, Mikheev A, Egol K, Regatte RR, Rajapakse CS. Measurement reproducibility of magnetic resonance imaging-based finite element analysis of proximal femur microarchitecture for in vivo assessment of bone strength. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2014; 28:407-12. [PMID: 25487834 DOI: 10.1007/s10334-014-0475-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Osteoporosis is a disease of weak bone. Our goal was to determine the measurement reproducibility of magnetic resonance assessment of proximal femur strength. METHODS This study had institutional review board approval, and written informed consent was obtained from all subjects. We obtained images of proximal femur microarchitecture by scanning 12 subjects three times within 1 week at 3T using a high-resolution 3-D FLASH sequence. We applied finite element analysis to compute proximal femur stiffness and femoral neck elastic modulus. RESULTS Within-day and between-day root-mean-square coefficients of variation and intraclass correlation coefficients ranged from 3.5 to 6.6 % and 0.96 to 0.98, respectively. CONCLUSION The measurement reproducibility of magnetic resonance assessment of proximal femur strength is suitable for clinical studies of disease progression or treatment response related to osteoporosis bone-strengthening interventions.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, 660 First Avenue, Room 334, 3rd Floor, New York, NY, 10016, USA,
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Plantinga BR, Temel Y, Roebroeck A, Uludağ K, Ivanov D, Kuijf ML, Ter Haar Romenij BM. Ultra-high field magnetic resonance imaging of the basal ganglia and related structures. Front Hum Neurosci 2014; 8:876. [PMID: 25414656 PMCID: PMC4220687 DOI: 10.3389/fnhum.2014.00876] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation is a treatment for Parkinson's disease and other related disorders, involving the surgical placement of electrodes in the deeply situated basal ganglia or thalamic structures. Good clinical outcome requires accurate targeting. However, due to limited visibility of the target structures on routine clinical MR images, direct targeting of structures can be challenging. Non-clinical MR scanners with ultra-high magnetic field (7T or higher) have the potential to improve the quality of these images. This technology report provides an overview of the current possibilities of visualizing deep brain stimulation targets and their related structures with the aid of ultra-high field MRI. Reviewed studies showed improved resolution, contrast- and signal-to-noise ratios at ultra-high field. Sequences sensitive to magnetic susceptibility such as T2* and susceptibility weighted imaging and their maps in general showed the best visualization of target structures, including a separation between the subthalamic nucleus and the substantia nigra, the lamina pallidi medialis and lamina pallidi incompleta within the globus pallidus and substructures of the thalamus, including the ventral intermediate nucleus (Vim). This shows that the visibility, identification, and even subdivision of the small deep brain stimulation targets benefit from increased field strength. Although ultra-high field MR imaging is associated with increased risk of geometrical distortions, it has been shown that these distortions can be avoided or corrected to the extent where the effects are limited. The availability of ultra-high field MR scanners for humans seems to provide opportunities for a more accurate targeting for deep brain stimulation in patients with Parkinson's disease and related disorders.
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Affiliation(s)
- Birgit R Plantinga
- Biomedical Image Analysis, Eindhoven University of Technology Eindhoven, Netherlands ; Department of Neuroscience, Maastricht University Maastricht, Netherlands
| | - Yasin Temel
- Department of Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Alard Roebroeck
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Kâmil Uludağ
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Dimo Ivanov
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Mark L Kuijf
- Department of Cognitive Neuroscience, Maastricht University Maastricht, Netherlands
| | - Bart M Ter Haar Romenij
- Biomedical Image Analysis, Eindhoven University of Technology Eindhoven, Netherlands ; Department of Biomedical and Information Engineering, Northeastern University Shenyang, China
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Zhang N, Magland JF, Rajapakse CS, Lam SB, Wehrli FW. Assessment of trabecular bone yield and post-yield behavior from high-resolution MRI-based nonlinear finite element analysis at the distal radius of premenopausal and postmenopausal women susceptible to osteoporosis. Acad Radiol 2013; 20:1584-91. [PMID: 24200486 DOI: 10.1016/j.acra.2013.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 08/12/2013] [Accepted: 09/04/2013] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the performance of a nonlinear microfinite element model on predicting trabecular bone yield and post-yield behavior based on high-resolution in vivo magnetic resonance images via the serial reproducibility. MATERIALS AND METHODS The nonlinear model captures material nonlinearity by iteratively adjusting tissue-level modulus based on tissue-level effective strain. It enables simulations of trabecular bone yield and post-yield behavior from micro magnetic resonance images at in vivo resolution by solving a series of nonlinear systems via an iterative algorithm on a desktop computer. Measures of mechanical competence (yield strain/strength, ultimate strain/strength, modulus of resilience, and toughness) were estimated at the distal radius of premenopausal and postmenopausal women (N = 20, age range 50-75) in whom osteoporotic fractures typically occur. Each subject underwent three scans (20.2 ± 14.5 days). Serial reproducibility was evaluated via coefficient of variation (CV) and intraclass correlation coefficient (ICC). RESULTS Nonlinear simulations were completed in an average of 14 minutes per three-dimensional image data set involving analysis of 61 strain levels. The predicted yield strain/strength, ultimate strain/strength, modulus of resilience, and toughness had a mean value of 0.78%, 3.09 MPa, 1.35%, 3.48 MPa, 14.30 kPa, and 32.66 kPa, respectively, covering a substantial range by a factor of up to 4. Intraclass correlation coefficient ranged from 0.986 to 0.994 (average 0.991); CV ranged from 1.01% to 5.62% (average 3.6%), with yield strain and toughness having the lowest and highest CV values, respectively. CONCLUSIONS The data suggest that the yield and post-yield parameters have adequate reproducibility to evaluate treatment effects in interventional studies within short follow-up periods.
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Affiliation(s)
- Ning Zhang
- Laboratory for Structural NMR Imaging, Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104
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Abstract
Bone of normal quality and quantity can successfully endure physiologically imposed mechanical loads. Chronic kidney disease-mineral and bone disorder (CKD-MBD) adversely affects bone quality through alterations in bone turnover and mineralization, whereas bone quantity is affected through changes in bone volume. Changes in bone quality can be associated with altered bone material, structure, or microdamage, which can result in an elevated rate of fracture in patients with CKD-MBD. Fractures cannot always be explained by reduced bone quantity and, therefore, bone quality should be assessed with a variety of techniques from the macro-organ level to the nanoscale level. In this Review, we demonstrate the importance of evaluating bone from multiple perspectives and hierarchical levels to understand CKD-MBD-related abnormalities in bone quality. Understanding the relationships between variations in material, structure, microdamage, and mechanical properties of bone in patients with CKD-MBD should aid in the development of new modalities to prevent, or treat, these abnormalities.
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Chang G, Rajapakse CS, Diamond M, Honig S, Recht MP, Weiss DS, Regatte RR. Micro-finite element analysis applied to high-resolution MRI reveals improved bone mechanical competence in the distal femur of female pre-professional dancers. Osteoporos Int 2013; 24:1407-17. [PMID: 22893356 PMCID: PMC3719856 DOI: 10.1007/s00198-012-2105-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/10/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED Micro-finite element analysis applied to high-resolution (0.234-mm length scale) MRI reveals greater whole and cancellous bone stiffness, but not greater cortical bone stiffness, in the distal femur of female dancers compared to controls. Greater whole bone stiffness appears to be mediated by cancellous, rather than cortical bone adaptation. INTRODUCTION The purpose of this study was to compare bone mechanical competence (stiffness) in the distal femur of female dancers compared to healthy, relatively inactive female controls. METHODS This study had institutional review board approval. We recruited nine female modern dancers (25.7±5.8 years, 1.63±0.06 m, 57.1±4.6 kg) and ten relatively inactive, healthy female controls matched for age, height, and weight (32.1±4.8 years, 1.6±0.04 m, 55.8±5.9 kg). We scanned the distal femur using a 7-T MRI scanner and a three-dimensional fast low-angle shot sequence (TR/TE=31 ms/5.1 ms, 0.234 mm×0.234 mm×1 mm, 80 slices). We applied micro-finite element analysis to 10-mm-thick volumes of interest at the distal femoral diaphysis, metaphysis, and epiphysis to compute stiffness and cross-sectional area of whole, cortical, and cancellous bone, as well as cortical thickness. We applied two-tailed t-tests and ANCOVA to compare groups. RESULTS Dancers demonstrated greater whole and cancellous bone stiffness and cross-sectional area at all locations (p<0.05). Cortical bone stiffness, cross-sectional area, and thickness did not differ between groups (>0.08). At all locations, the percent of intact whole bone stiffness for cortical bone alone was lower in dancers (p<0.05). Adjustment for cancellous bone cross-sectional area eliminated significant differences in whole bone stiffness between groups (p>0.07), but adjustment for cortical bone cross-sectional area did not (p<0.03). CONCLUSIONS Modern dancers have greater whole and cancellous bone stiffness in the distal femur compared to controls. Elevated whole bone stiffness in dancers may be mediated via cancellous, rather than cortical bone adaptation.
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Affiliation(s)
- G Chang
- Quantitative Multinuclear Musculoskeletal Imaging Group, Center for Biomedical Imaging, NYU Langone Medical Center, 660 First Avenue, 2nd Floor, New York, NY 10016, USA.
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Malluche HH, Porter DS, Monier-Faugere MC, Mawad H, Pienkowski D. Differences in bone quality in low- and high-turnover renal osteodystrophy. J Am Soc Nephrol 2012; 23:525-32. [PMID: 22193385 PMCID: PMC3294305 DOI: 10.1681/asn.2010121253] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 10/27/2011] [Indexed: 11/03/2022] Open
Abstract
Abnormal bone turnover is common in CKD, but its effects on bone quality remain unclear. We qualitatively screened iliac crest bone specimens from patients on dialysis to identify those patients with low (n=18) or high (n=17) bone turnover. In addition, we obtained control bone specimens from 12 healthy volunteers with normal kidney function. In the patient and control specimens, Fourier transform infrared spectroscopy and nanoindentation quantified the material and mechanical properties of the specimens, and we used bone histomorphometry to assess parameters of bone microstructure and bone formation and resorption. Compared with high or normal turnover, bone with low turnover had microstructural abnormalities such as lower cancellous bone volume and reduced trabecular thickness. Compared with normal or low turnover, bone with high turnover had material and nanomechanical abnormalities such as reduced mineral to matrix ratio and lower stiffness. These data suggest that turnover-related alterations in bone quality may contribute to the diminished mechanical competence of bone in CKD, albeit through different mechanisms. Therapies tailored specifically to low- or high-turnover bone may treat renal osteodystrophy more effectively.
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Affiliation(s)
- Hartmut H Malluche
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Albert B. Chandler Medical Center, Lexington, KY 40536-0298, USA.
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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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Vesuna S, Torres R, Levene MJ. Multiphoton fluorescence, second harmonic generation, and fluorescence lifetime imaging of whole cleared mouse organs. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:106009. [PMID: 22029356 DOI: 10.1117/1.3641992] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Multiphoton microscopy of cleared tissue has previously been demonstrated to generate large three-dimensional (3D) volumetric image data on entire intact mouse organs using intrinsic tissue fluorescence. This technique holds great promise for performing 3D virtual biopsies, providing unique information on tissue morphology, and guidance for subsequent traditional slicing and staining. Here, we demonstrate the use of fluorescence lifetime imaging in cleared organs for achieving molecular contrast that can reveal morphologically distinct structures, even in the absence of knowledge of the underlying molecular source. In addition, we demonstrate the power of multimodal imaging, combining multiphoton fluorescence, second harmonic generation, and lifetime imaging to reveal exceptional morphological detail in an optically cleared mouse knee.
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Affiliation(s)
- Sam Vesuna
- Yale University, Department of Biomedical Engineering, 55 Prospect St., New Haven, Connecticut 06511, USA
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Lam SCB, Wald MJ, Rajapakse CS, Liu Y, Saha PK, Wehrli FW. Performance of the MRI-based virtual bone biopsy in the distal radius: serial reproducibility and reliability of structural and mechanical parameters in women representative of osteoporosis study populations. Bone 2011; 49:895-903. [PMID: 21784189 PMCID: PMC3167016 DOI: 10.1016/j.bone.2011.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 06/14/2011] [Accepted: 07/08/2011] [Indexed: 11/25/2022]
Abstract
Serial reproducibility and reliability critically determine sensitivity to detect changes in response to intervention and provide a basis for sample size estimates. Here, we evaluated the performance of the MRI-based virtual bone biopsy in terms of 26 structural and mechanical parameters in the distal radius of 20 women in the age range of 50 to 75 years (mean=62.0 years, S.D.=8.1 years), representative of typical study populations in drug intervention trials and fracture studies. Subjects were examined three times at average intervals of 20.2 days (S.D.=14.5 days) by MRI at 1.5 T field strength at a voxel size of 137×137×410 μm(3). Methods involved prospective and retrospective 3D image registration and auto-focus motion correction. Analyses were performed from a central 5×5×5 mm(3) cuboid subvolume and trabecular volume consisting of a 13 mm axial slab encompassing the entire medullary cavity. Whole-volume axial stiffness and sub-regional Young's and shear moduli were computed by finite-element analysis. Whole-volume-derived aggregate mean coefficient of variation of all structural parameters was 4.4% (range 1.8% to 7.7%) and 4.0% for axial stiffness; corresponding data in the subvolume were 6.5% (range 1.6% to 13.0%) for structural, and 5.5% (range 4.6% to 6.5%) for mechanical parameters. Aggregate ICC was 0.976 (range 0.947 to 0.986) and 0.992 for whole-volume-derived structural parameters and axial stiffness, and 0.946 (range 0.752 to 0.991) and 0.974 (range 0.965 to 0.978) for subvolume-derived structural and mechanical parameters, respectively. The strongest predictors of whole-volume axial stiffness were BV/TV, junction density, skeleton density and Tb.N (R(2) 0.79-0.87). The same parameters were also highly predictive of sub-regional axial modulus (R(2) 0.88-0.91). The data suggest that the method is suited for longitudinal assessment of the response to therapy. The underlying technology is portable and should be compatible with all general-purpose MRI scanners, which is appealing considering the very large installed base of this modality.
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Affiliation(s)
- Shing Chun Benny Lam
- Laboratory for Structural NMR Imaging, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, 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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