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Praveen AD, Sollmann N, Baum T, Ferguson SJ, Benedikt H. CT image-based biomarkers for opportunistic screening of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 2024; 35:971-996. [PMID: 38353706 PMCID: PMC11136833 DOI: 10.1007/s00198-024-07029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/19/2024] [Indexed: 05/30/2024]
Abstract
The use of opportunistic computed tomography (CT) image-based biomarkers may be a low-cost strategy for screening older individuals at high risk for osteoporotic fractures and populations that are not sufficiently targeted. This review aimed to assess the discriminative ability of image-based biomarkers derived from existing clinical routine CT scans for hip, vertebral, and major osteoporotic fracture prediction. A systematic search in PubMed MEDLINE, Embase, Cochrane, and Web of Science was conducted from the earliest indexing date until July 2023. The evaluation of study quality was carried out using a modified Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. The primary outcome of interest was the area under the curve (AUC) and its corresponding 95% confidence intervals (CIs) obtained for four main categories of biomarkers: areal bone mineral density (BMD), image attenuation, volumetric BMD, and finite element (FE)-derived biomarkers. The meta-analyses were performed using random effects models. Sixty-one studies were included in this review, among which 35 were synthesized in a meta-analysis and the remaining articles were qualitatively synthesized. In comparison to the pooled AUC of areal BMD (0.73 [95% CI 0.71-0.75]), the pooled AUC values for predicting osteoporotic fractures for FE-derived parameters (0.77 [95% CI 0.72-0.81]; p < 0.01) and volumetric BMD (0.76 [95% CI 0.71-0.81]; p < 0.01) were significantly higher, but there was no significant difference with the pooled AUC for image attenuation (0.73 [95% CI 0.66-0.79]; p = 0.93). Compared to areal BMD, volumetric BMD and FE-derived parameters may provide a significant improvement in the discrimination of osteoporotic fractures using opportunistic CT assessments.
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Affiliation(s)
- Anitha D Praveen
- Early Detection of Health Risks and Prevention, Future Health Technologies, Singapore-ETH Centre (SEC), Campus for Research Excellence and Technological Enterprise (CREATE), 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore.
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephen J Ferguson
- Early Detection of Health Risks and Prevention, Future Health Technologies, Singapore-ETH Centre (SEC), Campus for Research Excellence and Technological Enterprise (CREATE), 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland
| | - Helgason Benedikt
- Early Detection of Health Risks and Prevention, Future Health Technologies, Singapore-ETH Centre (SEC), Campus for Research Excellence and Technological Enterprise (CREATE), 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland
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2
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Cheneymann A, Therkildsen J, Winther S, Nissen L, Thygesen J, Langdahl BL, Hauge EM, Bøttcher M. Bone Mineral Density Derived from Cardiac CT Scans: Using Contrast Enhanced Scans for Opportunistic Screening. J Clin Densitom 2024; 27:101441. [PMID: 38006641 DOI: 10.1016/j.jocd.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE Osteoporosis is under-diagnosed and often co-exists with other diseases. Very low bone mineral density (BMD) indicates risk of osteoporosis and opportunistic screening for low BMD in CT-scans has been suggested. In a non-contrast enhanced thoracic CT scan, the scan-field-of-view includes vertebrae enabling BMD estimation. However, many CT scans are obtained by administration of contrast material. If the impact of contrast enhancement on BMD measurements could be quantified, considerably more patients are eligible for screening. METHODS This study investigated the impact of intravenous contrast on thoracic BMD measurements in cardiac CT scans pre- and post-contrast, including different contrast trigger levels of 130 and 180 Hounsfield units (HU). BMD was measured using quantitative CT with asynchronous calibration. RESULTS In 195 participants undergoing cardiac CT (mean age 57±9 years, 37 % females) contrast increased mean thoracic BMD from 116±33 mg/cm3 (non-enhanced CT) to 130±38 mg/cm3 (contrast-enhanced CT) (p<0.001). Using clinical cut-off values for very low (<80 mg/cm3) and low BMD (<120 mg/cm3) showed that 24 % (47/195 participants) were misclassified when BMD was measured on contrast-enhanced CT-scans. Of the misclassified patients, 6 % (12/195 participants) were categorized as having low BMD despite having very low BMD on the non-enhanced images. Contrast-CT using a higher contrast trigger level showed a significant increase in BMD compared to the lower trigger level (119±32 vs. 135±40 mg/cm3, p<0.01). CONCLUSION For patients undergoing cardiac CT, using contrast-enhanced images to assess BMD entails substantial overestimation. Contrast protocol trigger levels also affect BMD measurements. Adjusting for these factors is needed before contrast-enhanced images can be used clinically. MINI ABSTRACT Osteoporosis is under-diagnosed. Contrast-enhanced CT made to examine other diseases might be utilized simultaneously for bone mineral density (BMD) screening. These scans, however, likely entails overestimation of BMD due to the effect of contrast. Adjusting for this effect is needed before contrast-enhanced images can be implemented clinically for BMD screening.
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Affiliation(s)
| | - Josephine Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Louise Nissen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Bente L Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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3
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Goller SS, Rischewski JF, Liebig T, Ricke J, Siller S, Schmidt VF, Stahl R, Kulozik J, Baum T, Kirschke JS, Foreman SC, Gersing AS. Automated Opportunistic Trabecular Volumetric Bone Mineral Density Extraction Outperforms Manual Measurements for the Prediction of Vertebral Fractures in Routine CT. Diagnostics (Basel) 2023; 13:2119. [PMID: 37371014 DOI: 10.3390/diagnostics13122119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Opportunistic osteoporosis screening using multidetector CT-scans (MDCT) and convolutional neural network (CNN)-derived segmentations of the spine to generate volumetric bone mineral density (vBMD) bears the potential to improve incidental osteoporotic vertebral fracture (VF) prediction. However, the performance compared to the established manual opportunistic vBMD measures remains unclear. Hence, we investigated patients with a routine MDCT of the spine who had developed a new osteoporotic incidental VF and frequency matched to patients without incidental VFs as assessed on follow-up MDCT images after 1.5 years. Automated vBMD was generated using CNN-generated segmentation masks and asynchronous calibration. Additionally, manual vBMD was sampled by two radiologists. Automated vBMD measurements in patients with incidental VFs at 1.5-years follow-up (n = 53) were significantly lower compared to patients without incidental VFs (n = 104) (83.6 ± 29.4 mg/cm3 vs. 102.1 ± 27.7 mg/cm3, p < 0.001). This comparison was not significant for manually assessed vBMD (99.2 ± 37.6 mg/cm3 vs. 107.9 ± 33.9 mg/cm3, p = 0.30). When adjusting for age and sex, both automated and manual vBMD measurements were significantly associated with incidental VFs at 1.5-year follow-up, however, the associations were stronger for automated measurements (β = -0.32; 95% confidence interval (CI): -20.10, 4.35; p < 0.001) compared to manual measurements (β = -0.15; 95% CI: -11.16, 5.16; p < 0.03). In conclusion, automated opportunistic measurements are feasible and can be useful for bone mineral density assessment in clinical routine.
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Affiliation(s)
- Sophia S Goller
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jon F Rischewski
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Sebastian Siller
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Julian Kulozik
- Institute of Micro Technology and Medical Device Technology (MIMED), Technical University of Munich, Boltzmannstr. 15, 85748 Garching, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sarah C Foreman
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexandra S Gersing
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Hou X, Cheng X, You Y, Li J, Ma D, Yang Z, Ma Q. Effect of intravenous iodinated contrast administration on diagnostic ability for osteoporosis using CT attenuation measurement in patients with liver cirrhosis. Br J Radiol 2022; 95:20201251. [PMID: 36043473 PMCID: PMC9793469 DOI: 10.1259/bjr.20201251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/01/2022] [Accepted: 07/29/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To evaluate the influence of intravenous contrast agent on the diagnostic ability for osteoporosis using CT attenuation measurement in patients with liver cirrhosis. METHODS This retrospective study was approved by our institutional review board and informed consent was waived. 208 patients with liver cirrhosis (mean age, 61.25 years ± 9.43 [standard deviation]; range, 30-82 years) who underwent both unenhanced and two contrast-enhanced (arterial and venous phase) abdominal dual-energy CT examinations from January 1 to September 1, 2020, were recruited. CT attenuation values were measured in the medullary compartment of vertebral body (L1-L3) and bone mass was determined by the hydroxyapatite concentration obtained in dual-energy spectral CT and used as the reference standard. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic ability of using CT attenuation number in unenhanced, arterial, and venous phases. RESULTS Area under ROC curve using unenhanced CT attenuation was different from using arterial CT attenuation (p= 0.038) and venous CT attenuation (p = 0.048) to diagnosing osteoporosis. However, there was no significant difference between unenhanced CT attenuation and arterial CT attenuation (p = 0.773) and between unenhanced CT attenuation and venous CT attenuation (p = 0.746) to distinguish low bone mass (osteoporosis or osteopenia). CONCLUSIONS The diagnostic ability for osteoporosis using CT attenuation measurement in contrast-enhanced scans is decreased due to intravenous contrast contamination, however, which had no influence on the diagnostic ability of CT attenuation for low bone mass (osteoporosis or osteopenia). ADVANCES IN KNOWLEDGE The diagnostic ability of using enhanced CT attenuation values for osteoporosis decreased compared to unenhanced CT attenuation values.
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Affiliation(s)
- Xinmeng Hou
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Xiaoyue Cheng
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Yuangang You
- Beijing Tropical Medicine Research Institute, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases Beijing, Beijing, China
| | | | - Daqing Ma
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Zhenghan Yang
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Qiang Ma
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
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Patient-Specific Finite Element Modeling of the Whole Lumbar Spine Using Clinical Routine Multi-Detector Computed Tomography (MDCT) Data-A Pilot Study. Biomedicines 2022; 10:biomedicines10071567. [PMID: 35884872 PMCID: PMC9312902 DOI: 10.3390/biomedicines10071567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
(1) Background: To study the feasibility of developing finite element (FE) models of the whole lumbar spine using clinical routine multi-detector computed tomography (MDCT) scans to predict failure load (FL) and range of motion (ROM) parameters. (2) Methods: MDCT scans of 12 subjects (6 healthy controls (HC), mean age ± standard deviation (SD): 62.16 ± 10.24 years, and 6 osteoporotic patients (OP), mean age ± SD: 65.83 ± 11.19 years) were included in the current study. Comprehensive FE models of the lumbar spine (5 vertebrae + 4 intervertebral discs (IVDs) + ligaments) were generated (L1−L5) and simulated. The coefficients of correlation (ρ) were calculated to investigate the relationship between FE-based FL and ROM parameters and bone mineral density (BMD) values of L1−L3 derived from MDCT (BMDQCT-L1-3). Finally, Mann−Whitney U tests were performed to analyze differences in FL and ROM parameters between HC and OP cohorts. (3) Results: Mean FE-based FL value of the HC cohort was significantly higher than that of the OP cohort (1471.50 ± 275.69 N (HC) vs. 763.33 ± 166.70 N (OP), p < 0.01). A strong correlation of 0.8 (p < 0.01) was observed between FE-based FL and BMDQCT-L1-L3 values. However, no significant differences were observed between ROM parameters of HC and OP cohorts (p = 0.69 for flexion; p = 0.69 for extension; p = 0.47 for lateral bending; p = 0.13 for twisting). In addition, no statistically significant correlations were observed between ROM parameters and BMDQCT- L1-3. (4) Conclusions: Clinical routine MDCT data can be used for patient-specific FE modeling of the whole lumbar spine. ROM parameters do not seem to be significantly altered between HC and OP. In contrast, FE-derived FL may help identify patients with increased osteoporotic fracture risk in the future.
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Sollmann N, Kirschke JS, Kronthaler S, Boehm C, Dieckmeyer M, Vogele D, Kloth C, Lisson CG, Carballido-Gamio J, Link TM, Karampinos DC, Karupppasamy S, Beer M, Krug R, Baum T. Imaging of the Osteoporotic Spine - Quantitative Approaches in Diagnostics and for the Prediction of the Individual Fracture Risk. ROFO-FORTSCHR RONTG 2022; 194:1088-1099. [PMID: 35545103 DOI: 10.1055/a-1770-4626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Osteoporosis is a highly prevalent systemic skeletal disease that is characterized by low bone mass and microarchitectural bone deterioration. It predisposes to fragility fractures that can occur at various sites of the skeleton, but vertebral fractures (VFs) have been shown to be particularly common. Prevention strategies and timely intervention depend on reliable diagnosis and prediction of the individual fracture risk, and dual-energy X-ray absorptiometry (DXA) has been the reference standard for decades. Yet, DXA has its inherent limitations, and other techniques have shown potential as viable add-on or even stand-alone options. Specifically, three-dimensional (3 D) imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), are playing an increasing role. For CT, recent advances in medical image analysis now allow automatic vertebral segmentation and value extraction from single vertebral bodies using a deep-learning-based architecture that can be implemented in clinical practice. Regarding MRI, a variety of methods have been developed over recent years, including magnetic resonance spectroscopy (MRS) and chemical shift encoding-based water-fat MRI (CSE-MRI) that enable the extraction of a vertebral body's proton density fat fraction (PDFF) as a promising surrogate biomarker of bone health. Yet, imaging data from CT or MRI may be more efficiently used when combined with advanced analysis techniques such as texture analysis (TA; to provide spatially resolved assessments of vertebral body composition) or finite element analysis (FEA; to provide estimates of bone strength) to further improve fracture prediction. However, distinct and experimentally validated diagnostic criteria for osteoporosis based on CT- and MRI-derived measures have not yet been achieved, limiting broad transfer to clinical practice for these novel approaches. KEY POINTS:: · DXA is the reference standard for diagnosis and fracture prediction in osteoporosis, but it has important limitations.. · CT- and MRI-based methods are increasingly used as (opportunistic) approaches.. · For CT, particularly deep-learning-based automatic vertebral segmentation and value extraction seem promising.. · For MRI, multiple techniques including spectroscopy and chemical shift imaging are available to extract fat fractions.. · Texture and finite element analyses can provide additional measures for vertebral body composition and bone strength.. CITATION FORMAT: · Sollmann N, Kirschke JS, Kronthaler S et al. Imaging of the Osteoporotic Spine - Quantitative Approaches in Diagnostics and for the Prediction of the Individual Fracture Risk. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1770-4626.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States.,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Stefan Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sophia Kronthaler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christof Boehm
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | | | - Julio Carballido-Gamio
- Department of Radiology, University of Colorado - Anschutz Medical Campus, Aurora, CO, United States
| | - Thomas Marc Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Dimitrios Charalampos Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Subburaj Karupppasamy
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design, Singapore.,Sobey School of Business, Saint Mary's University, Halifax, NS, Canada
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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7
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Woisetschläger M, Klintström E, Spångeus A. The impact of imaging time and contrast agent dose on screening for osteoporosis with contrast-enhanced CT. Eur Radiol Exp 2022; 6:8. [PMID: 35141833 PMCID: PMC8828831 DOI: 10.1186/s41747-021-00259-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Screening for osteoporosis with contrast-enhanced computed tomography (CT) is promising for identifying high-risk osteoporotic patients. Our aims were (1) to investigate the estimated volume bone mineral density (vBMD) change over time after contrast injection (CT perfusion imaging, CTPI); and (2) to examine the influence of contrast dose on vBMD. METHODS Fifteen patients, aged 71 ± 9 years (mean ± standard deviation, range 55-86) underwent a CTPI examination (28 scans within 63 s) of the upper body followed (after a waiting time of 10 min) by a full 4-phase CT examination (4 scans within 4 min). The contrast dose for CTPI was 0.38-0.83 mL/kg, and for 4-phase CT was 0.87-1.29 mL/kg. Vertebrae L1-L3 were analysed totalling 43 vertebrae, using Mindways qCT Pro. RESULTS After contrast injection, vBMD showed a near-horizontal line until 17.5 s (non-contrast phase), followed by a steep increase 17.5-41.5 s after contrast injection, i.e., in the arterial phase, which plateaued 41.5 s after, i.e., in the early venous phase. A higher contrast dose per kg yielded significantly higher vBMD increase in both the arterial and venous phase (p < 0.003). CONCLUSIONS Both time from contrast administration and contrast dose per kg affected vBMD results. In arterial phase, the steepness of the curve makes vBMD estimation unsure. However, as values plateaued in the venous phase it might be possible to predict the correct vBMD values. Furthermore, contrast dose is a factor that needs to be adjusted for when using such a formula.
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Affiliation(s)
- Mischa Woisetschläger
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Eva Klintström
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Anna Spångeus
- Department of Acute Internal Medicine and Geriatrics, Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Dieckmeyer M, Löffler MT, El Husseini M, Sekuboyina A, Menze B, Sollmann N, Wostrack M, Zimmer C, Baum T, Kirschke JS. Level-Specific Volumetric BMD Threshold Values for the Prediction of Incident Vertebral Fractures Using Opportunistic QCT: A Case-Control Study. Front Endocrinol (Lausanne) 2022; 13:882163. [PMID: 35669688 PMCID: PMC9165054 DOI: 10.3389/fendo.2022.882163] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To establish and evaluate the diagnostic accuracy of volumetric bone mineral density (vBMD) threshold values at different spinal levels, derived from opportunistic quantitative computed tomography (QCT), for the prediction of incident vertebral fractures (VF). MATERIALS AND METHODS In this case-control study, 35 incident VF cases (23 women, 12 men; mean age: 67 years) and 70 sex- and age-matched controls were included, based on routine multi detector CT (MDCT) scans of the thoracolumbar spine. Trabecular vBMD was measured from routine baseline CT scans of the thoracolumbar spine using an automated pipeline including vertebral segmentation, asynchronous calibration for HU-to-vBMD conversion, and correction of intravenous contrast medium (https://anduin.bonescreen.de). Threshold values at T1-L5 were calculated for the optimal operating point according to the Youden index and for fixed sensitivities (60 - 85%) in receiver operating characteristic (ROC) curves. RESULTS vBMD at each single level of the thoracolumbar spine was significantly associated with incident VFs (odds ratio per SD decrease [OR], 95% confidence interval [CI] at T1-T4: 3.28, 1.66-6.49; at T5-T8: 3.28, 1.72-6.26; at T9-T12: 3.37, 1.78-6.36; and at L1-L4: 3.98, 1.97-8.06), independent of adjustment for age, sex, and prevalent VF. AUC showed no significant difference between vertebral levels and was highest at the thoracolumbar junction (AUC = 0.75, 95%-CI = 0.63 - 0.85 for T11-L2). Optimal threshold values increased from lumbar (L1-L4: 52.0 mg/cm³) to upper thoracic spine (T1-T4: 69.3 mg/cm³). At T11-L2, T12-L3 and L1-L4, a threshold of 80.0 mg/cm³ showed sensitivities of 85 - 88%, and specificities of 41 - 49%. To achieve comparable sensitivity (85%) at more superior spinal levels, resulting thresholds were higher: 114.1 mg/cm³ (T1-T4), 92.0 mg/cm³ (T5-T8), 88.2 mg/cm³ (T9-T12). CONCLUSIONS At all levels of the thoracolumbar spine, lower vBMD was associated with incident VFs in an elderly, predominantly oncologic patient population. Automated opportunistic osteoporosis screening of vBMD along the entire thoracolumbar spine allows for risk assessment of imminent VFs. We propose level-specific vBMD threshold at the thoracolumbar spine to identify individuals at high fracture risk.
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Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Michael Dieckmeyer,
| | - Maximilian Thomas Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Malek El Husseini
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bjoern Menze
- Image-Based Biomedical Modeling, Department of Computer Science, Technical University of Munich, Munich, Germany
- Department of Quantitative Biomedicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Maria Wostrack
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Stefan Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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9
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Proposed diagnostic volumetric bone mineral density thresholds for osteoporosis and osteopenia at the cervicothoracic spine in correlation to the lumbar spine. Eur Radiol 2022; 32:6207-6214. [PMID: 35384459 PMCID: PMC9381469 DOI: 10.1007/s00330-022-08721-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the correlation between cervicothoracic and lumbar volumetric bone mineral density (vBMD) in an average cohort of adults and to identify specific diagnostic thresholds for the cervicothoracic spine on the individual subject level. METHODS In this HIPPA-compliant study, we retrospectively included 260 patients (59.7 ± 18.3 years, 105 women), who received a contrast-enhanced or non-contrast-enhanced CT scan. vBMD was extracted using an automated pipeline ( https://anduin.bonescreen.de ). The association of vBMD between each vertebra spanning C2-T12 and the averaged values at the lumbar spine (L1-L3) was analyzed before and after semiquantitative assessment of fracture status and degeneration, and respective vertebra-specific cut-off values for osteoporosis were calculated using linear regression. RESULTS In both women and men, trabecular vBMD decreased with age in the cervical, thoracic, and lumbar regions. vBMD values of cervicothoracic vertebrae showed strong correlations with lumbar vertebrae (L1-L3), with a median Pearson value of r = 0.87 (range: rC2 = 0.76 to rT12 = 0.96). The correlation coefficients were significantly lower (p < 0.0001) without excluding fractured and degenerated vertebrae, median r = 0.82 (range: rC2 = 0.69 to rT12 = 0.93). Respective cut-off values for osteoporosis peaked at C4 (209.2 mg/ml) and decreased to 83.8 mg/ml at T12. CONCLUSION Our data show a high correlation between clinically used mean L1-L3 values and vBMD values elsewhere in the spine, independent of age. The proposed cut-off values for the cervicothoracic spine therefore may allow the determination of low bone mass even in clinical cases where only parts of the spine are imaged. KEY POINTS vBMD of all cervicothoracic vertebrae showed strong correlation with lumbar vertebrae (L1-L3), with a median Pearson's correlation coefficient of r = 0.87 (range: rC2 = 0.76 to rT12 = 0.96). The correlation coefficients were significantly lower (p < 0.0001) without excluding fractured and moderate to severely degenerated vertebrae, median r = 0.82 (range: rC2 = 0.69 to rT12 = 0.93). We postulate that trabecular vBMD < 200 mg/ml for the cervical spine and < 100 mg/ml for the thoracic spine are strong indicators of osteoporosis, similar to < 80 mg/ml at the lumbar spine.
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10
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Leonhardt Y, Ketschau J, Ruschke S, Gassert FT, Glanz L, Feuerriegel GC, Gassert FG, Baum T, Kirschke JS, Braren RF, Schwaiger BJ, Makowski MR, Karampinos DC, Gersing AS. Associations of incidental vertebral fractures and longitudinal changes of MR-based proton density fat fraction and T2* measurements of vertebral bone marrow. Front Endocrinol (Lausanne) 2022; 13:1046547. [PMID: 36465625 PMCID: PMC9713243 DOI: 10.3389/fendo.2022.1046547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Quantitative magnetic resonance imaging (MRI) techniques such as chemical shift encoding-based water-fat separation techniques (CSE-MRI) are increasingly applied as noninvasive biomarkers to assess the biochemical composition of vertebrae. This study aims to investigate the longitudinal change of proton density fat fraction (PDFF) and T2* derived from CSE-MRI of the thoracolumbar vertebral bone marrow in patients that develop incidental vertebral compression fractures (VCFs), and whether PDFF and T2* enable the prediction of an incidental VCF. METHODS In this study we included 48 patients with CT-derived bone mineral density (BMD) measurements at baseline. Patients that presented an incidental VCF at follow up (N=12, mean age 70.5 ± 7.4 years, 5 female) were compared to controls without incidental VCF at follow up (N=36, mean age 71.1 ± 8.6 years, 15 females). All patients underwent 3T MRI, containing a significant part of the thoracolumbar spine (Th11-L4), at baseline, 6-month and 12 month follow up, including a gradient echo sequence for chemical shift encoding-based water-fat separation, from which PDFF and T2* maps were obtained. Associations between changes in PDFF, T2* and BMD measurements over 12 months and the group (incidental VCF vs. no VCF) were assessed using multivariable regression models. Mixed-effect regression models were used to test if there is a difference in the rate of change in PDFF, T2* and BMD between patients with and without incidental VCF. RESULTS Prior to the occurrence of an incidental VCF, PDFF in vertebrae increased in the VCF group (ΔPDFF=6.3 ± 3.1%) and was significantly higher than the change of PDFF in the group without VCF (ΔPDFF=2.1 ± 2.5%, P=0.03). There was no significant change in T2* (ΔT2*=1.7 ± 1.1ms vs. ΔT2*=1.1 ± 1.3ms, P=0.31) and BMD (ΔBMD=-1.2 ± 11.3mg/cm3 vs. ΔBMD=-11.4 ± 24.1mg/cm3, P= 0.37) between the two groups over 12 months. At baseline, no significant differences were detected in the average PDFF, T2* and BMD of all measured vertebrae (Th11-L4) between the VCF group and the group without VCF (P=0.66, P=0.35 and P= 0.21, respectively). When assessing the differences in rates of change, there was a significant change in slope for PDFF (2.32 per 6 months, 95% confidence interval (CI) 0.31-4.32; P=0.03) but not for T2* (0.02 per 6 months, CI -0.98-0.95; P=0.90) or BMD (-4.84 per 6 months, CI -23.4-13.7; P=0.60). CONCLUSIONS In our study population, the average change of PDFF over 12 months is significantly higher in patients that develop incidental fractures at 12-month follow up compared to patients without incidental VCF, while T2* and BMD show no significant changes prior to the occurrence of the incidental vertebral fractures. Therefore, a longitudinal increase in bone marrow PDFF may be predictive for vertebral compression fractures.
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Affiliation(s)
- Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- *Correspondence: Yannik Leonhardt,
| | - Jannik Ketschau
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T. Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Leander Glanz
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg C. Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix G. Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department on Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department on Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rickmer F. Braren
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J. Schwaiger
- Department on Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S. Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich (LMU), Munich, Germany
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Palanca M, Liebsch C, Hübner S, Marras D, Ruspi ML, Marconi F, Cristofolini L, Wilke HJ. Global and local characterization explains the different mechanisms of failure of the human ribs. J Mech Behav Biomed Mater 2021; 125:104931. [PMID: 34736031 DOI: 10.1016/j.jmbbm.2021.104931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/03/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
Knowledge of the mechanics and mechanistic reasons inducing rib fracture is fundamental for forensic investigations and for the design of implants and cardiopulmonary resuscitation devices. A mechanical rationale to explain the different rib mechanisms of failure is still a challenge. The aim of this work was to experimentally characterize human ribs to test the hypothesis that a correlation exists between the ribs properties and the mechanism of failure. 89 ribs were tested in antero-posterior compression. The full-field strain distribution was measured through Digital Image Correlation. The fracture load ranged 7-132 N. Two main different mechanisms of failure were observed: brittle and buckling. The strain analysis showed that the direction of principal strains was either aligned with the ribs, or oblique, around 45°, with a rather uniform direction in the most strained area. The maximum principal strains were in the range between 1000 and 30000 microstrain and the minimum principal strain between -30000 and -800 microstrain. The ribs undergoing brittle fracture had significantly thicker cortical bone than those undergoing buckling. Also, larger tensile strains were observed in the specimens with brittle fracture than in the buckling ones. These findings support the focus of cortical thickness modelling which could help in sharpening computational models for the aforesaid purposes.
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Affiliation(s)
- Marco Palanca
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; INSIGNEO Institute for in Silico Medicine, University of Sheffield, Sheffield, UK; Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm ZTF, University Hospital Ulm, Ulm, Germany
| | - Shamila Hübner
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm ZTF, University Hospital Ulm, Ulm, Germany
| | - Daniele Marras
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Maria Luisa Ruspi
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesco Marconi
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm ZTF, University Hospital Ulm, Ulm, Germany
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Brunnquell CL, Winsor C, Aaltonen HL, Telfer S. Sources of error in bone mineral density estimates from quantitative CT. Eur J Radiol 2021; 144:110001. [PMID: 34700093 DOI: 10.1016/j.ejrad.2021.110001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Abstract
Bone mineral density (BMD) estimates from quantitative computed tomography (QCT) have proven useful for opportunistic screening of osteoporosis, treatment monitoring, and bone strength measurement. These estimates are subject to bias and variance from a variety of sources related to the imaging equipment, methods applied in the estimation procedure, and the patients themselves. In this article, we review the literature to describe the sources and sizes of error in spine and hip BMD estimates from single-energy QCT that can result from factors related to the scanner, imaging techniques, imaging subject, calibration phantom, and calibration approach. We also describe the baseline variance that can be expected based on repeatability and reproducibility studies. Though reproducible BMD estimates may be achievable with QCT, a thorough understanding of the potential sources of error and their size relative to the diagnostic task is essential to their appropriate and meaningful interpretation.
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Affiliation(s)
| | - Carla Winsor
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, United States
| | - H Laura Aaltonen
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Scott Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington. Seattle, WA, United States
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13
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Automated detection of the contrast phase in MDCT by an artificial neural network improves the accuracy of opportunistic bone mineral density measurements. Eur Radiol 2021; 32:1465-1474. [PMID: 34687347 PMCID: PMC8831336 DOI: 10.1007/s00330-021-08284-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
Objectives To determine the accuracy of an artificial neural network (ANN) for fully automated detection of the presence and phase of iodinated contrast agent in routine abdominal multidetector computed tomography (MDCT) scans and evaluate the effect of contrast correction for osteoporosis screening. Methods This HIPPA-compliant study retrospectively included 579 MDCT scans in 193 patients (62.4 ± 14.6 years, 48 women). Three different ANN models (2D DenseNet with random slice selection, 2D DenseNet with anatomy-guided slice selection, 3D DenseNet) were trained in 462 MDCT scans of 154 patients (threefold cross-validation), who underwent triphasic CT. All ANN models were tested in 117 unseen triphasic scans of 39 patients, as well as in a public MDCT dataset containing 311 patients. In the triphasic test scans, trabecular volumetric bone mineral density (BMD) was calculated using a fully automated pipeline. Root-mean-square errors (RMSE) of BMD measurements with and without correction for contrast application were calculated in comparison to nonenhanced (NE) scans. Results The 2D DenseNet with anatomy-guided slice selection outperformed the competing models and achieved an F1 score of 0.98 and an accuracy of 98.3% in the test set (public dataset: F1 score 0.93; accuracy 94.2%). Application of contrast agent resulted in significant BMD biases (all p < .001; portal-venous (PV): RMSE 18.7 mg/ml, mean difference 17.5 mg/ml; arterial (AR): RMSE 6.92 mg/ml, mean difference 5.68 mg/ml). After the fully automated correction, this bias was no longer significant (p > .05; PV: RMSE 9.45 mg/ml, mean difference 1.28 mg/ml; AR: RMSE 3.98 mg/ml, mean difference 0.94 mg/ml). Conclusion Automatic detection of the contrast phase in multicenter CT data was achieved with high accuracy, minimizing the contrast-induced error in BMD measurements. Key Points • A 2D DenseNet with anatomy-guided slice selection achieved an F1 score of 0.98 and an accuracy of 98.3% in the test set. In a public dataset, an F1 score of 0.93 and an accuracy of 94.2% were obtained. • Automated adjustment for contrast injection improved the accuracy of lumbar bone mineral density measurements (RMSE 18.7 mg/ml vs. 9.45 mg/ml respectively, in the portal-venous phase). • An artificial neural network can reliably reveal the presence and phase of iodinated contrast agent in multidetector CT scans (https://github.com/ferchonavarro/anatomy_guided_contrast_c). This allows minimizing the contrast-induced error in opportunistic bone mineral density measurements.
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14
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Leonhardt Y, Gassert FT, Feuerriegel G, Gassert FG, Kronthaler S, Boehm C, Kufner A, Ruschke S, Baum T, Schwaiger BJ, Makowski MR, Karampinos DC, Gersing AS. Vertebral bone marrow T2* mapping using chemical shift encoding-based water-fat separation in the quantitative analysis of lumbar osteoporosis and osteoporotic fractures. Quant Imaging Med Surg 2021; 11:3715-3725. [PMID: 34341744 PMCID: PMC8245952 DOI: 10.21037/qims-20-1373] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chemical shift encoding-based water-fat separation techniques have been used for fat quantification [proton density fat fraction (PDFF)], but they also enable the assessment of bone marrow T2*, which has previously been reported to be a potential biomarker for osteoporosis and may give insight into the cause of vertebral fractures (i.e., osteoporotic vs. traumatic) and the microstructure of the bone when applied to vertebral bone marrow. METHODS The 32 patients (78.1% with low-energy osteopenic/osteoporotic fractures, mean age 72.3±9.8 years, 76% women; 21.9% with high-energy traumatic fractures, 47.3±12.8 years, no women) were frequency-matched for age and sex to subjects without vertebral fractures (n=20). All study patients underwent 3T-MRI of the lumbar spine including sagittally acquired spoiled gradient echo sequences for chemical shift encoding-based water-fat separation, from which T2* values were obtained. Volumetric trabecular bone mineral density (BMD) and trabecular bone parameters describing the three-dimensional structural integrity of trabecular bone were derived from quantitative CT. Associations between T2* measurements, fracture status and trabecular bone parameters were assessed using multivariable linear regression models. RESULTS Mean T2* values of non fractured vertebrae in all patients showed a significant correlation with BMD (r=-0.65, P<0.001), trabecular number (TbN) (r=-0.56, P<0.001) and trabecular spacing (TbSp) (r=0.61, P<0.001); patients with low-energy osteoporotic vertebral fractures showed significantly higher mean T2* values than those with traumatic fractures (13.6±4.3 vs. 8.4±2.2 ms, P=0.01) as well as a significantly lower TbN (0.69±0.08 vs. 0.93±0.03 mm-1, P<0.01) and a significantly larger trabecular spacing (1.06±0.16 vs. 0.56±0.08 mm, P<0.01). Mean T2* values of osteoporotic patients with and without vertebral fracture showed no significant difference (13.5±3.4 vs. 15.6±3.5 ms, P=0.40). When comparing the mean T2* of the fractured vertebrae, no significant difference could be detected between low-energy osteoporotic fractures and high-energy traumatic fractures (12.6±5.4 vs. 8.1±2.4 ms, P=0.10). CONCLUSIONS T2* mapping of vertebral bone marrow using using chemical shift encoding-based water-fat separation allows for assessing osteoporosis as well as the trabecular microstructure and enables a radiation-free differentiation between patients with low-energy osteoporotic and high-energy traumatic vertebral fractures, suggesting its potential as a biomarker for bone fragility.
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Affiliation(s)
- Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T. Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix G. Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christof Boehm
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Kufner
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J. Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S. Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich (LMU), Munich, Germany
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15
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The Effect of Abdominal Anatomy on the Measurement of Bone Mineral Density With Dual-Energy X-Ray Absorptiometry. J Comput Assist Tomogr 2021; 45:458-462. [PMID: 34297515 DOI: 10.1097/rct.0000000000001158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to assess the effects of abdominal fat content and anatomical changes on the measurement of bone mineral density using dual-energy X-ray absorptiometry (DXA). MATERIALS AND METHODS The bone mineral density measurements were performed with quantitative computed tomography for patients who underwent DXA and abdominal CT on the same day. The effects of abdominal fat content and anatomic changes on the results of DXA were assessed. RESULTS Of the 43 patients, 88.3% were women, 11.7% were men, and the mean age was 55.6 years (range, 32-72). There was a significant relationship between the error in the measurement of T-scores with DXA and osteophytic new bone formation (P = 0.011). There were significant relationships between the error in detecting osteoporosis with DXA and osteophytic new bone formation, facet joint degeneration, and aortic calcification (P < 0.05). CONCLUSIONS Abdominal fat content does not significantly affect T-scores. However, DXA can give false-negative results in detecting osteoporosis, especially in patients with osteophyte new bone formation, facet joint degeneration, and aortic calcifications, all conditions primarily in elderly patients. In these cases, it is more appropriate to use quantitative computed tomography instead of DXA.
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Dieckmeyer M, Rayudu NM, Yeung LY, Löffler M, Sekuboyina A, Burian E, Sollmann N, Kirschke JS, Baum T, Subburaj K. Prediction of incident vertebral fractures in routine MDCT: Comparison of global texture features, 3D finite element parameters and volumetric BMD. Eur J Radiol 2021; 141:109827. [PMID: 34225250 DOI: 10.1016/j.ejrad.2021.109827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In this case-control study, we evaluated different quantitative parameters derived from routine multi-detector computed tomography (MDCT) scans with respect to their ability to predict incident osteoporotic vertebral fractures of the thoracolumbar spine. METHODS 16 patients who received baseline and follow-up contrast-enhanced MDCT and were diagnosed with an incident osteoporotic vertebral fracture at follow-up, and 16 age-, sex-, and follow-up-time-matched controls were included in the study. Vertebrae were labelled and segmented using a fully automated pipeline. Volumetric bone mineral density (vBMD), finite element analysis (FEA)-based failure load (FL) and failure displacement (FD), as well as 24 texture features were extracted from L1 - L3 and averaged. Odds ratios (OR) with 95% confidence intervals (CI), expressed per standard deviation decrease, receiver operating characteristic (ROC) area under the curve (AUC), as well as logistic regression models, including all analyzed parameters as independent variables, were used to assess the prediction of incident vertebral fractures. RESULTS The texture feature Correlation (AUC = 0.754, p = 0.014; OR = 2.76, CI = 1.16-6.58) and vBMD (AUC = 0.750, p = 0.016; OR = 2.67, CI = 1.12-6.37) classified incident vertebral fractures best, while the best FEA-based parameter FL showed an AUC = 0.719 (p = 0.035). Correlation was the only significant predictor of incident fractures in the logistic regression analysis of all parameters (p = 0.022). CONCLUSION MDCT-derived FEA parameters and texture features, averaged from L1 - L3, showed only a moderate, but no statistically significant improvement of incident vertebral fracture prediction beyond BMD, supporting the hypothesis that vertebral-specific parameters may be superior for fracture risk assessment.
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Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Nithin Manohar Rayudu
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore.
| | - Long Yu Yeung
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore.
| | - Maximilian Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; Department of Radiology, University Medical Center, Albert-Ludwigs-University Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Karupppasamy Subburaj
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore; Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore.
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Sollmann N, Rayudu NM, Yeung LY, Sekuboyina A, Burian E, Dieckmeyer M, Löffler MT, Schwaiger BJ, Gersing AS, Kirschke JS, Baum T, Subburaj K. MDCT-Based Finite Element Analyses: Are Measurements at the Lumbar Spine Associated with the Biomechanical Strength of Functional Spinal Units of Incidental Osteoporotic Fractures along the Thoracolumbar Spine? Diagnostics (Basel) 2021; 11:455. [PMID: 33800876 PMCID: PMC7998199 DOI: 10.3390/diagnostics11030455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/16/2022] Open
Abstract
Assessment of osteoporosis-associated fracture risk during clinical routine is based on the evaluation of clinical risk factors and T-scores, as derived from measurements of areal bone mineral density (aBMD). However, these parameters are limited in their ability to identify patients at high fracture risk. Finite element models (FEMs) have shown to improve bone strength prediction beyond aBMD. This study aims to investigate whether FEM measurements at the lumbar spine can predict the biomechanical strength of functional spinal units (FSUs) with incidental osteoporotic vertebral fractures (VFs) along the thoracolumbar spine. Multi-detector computed tomography (MDCT) data of 11 patients (5 females and 6 males, median age: 67 years) who underwent MDCT twice (median interval between baseline and follow-up MDCT: 18 months) and sustained an incidental osteoporotic VF between baseline and follow-up scanning were used. Based on baseline MDCT data, two FSUs consisting of vertebral bodies and intervertebral discs (IVDs) were modeled: one standardly capturing L1-IVD-L2-IVD-L3 (FSU_L1-L3) and one modeling the incidentally fractured vertebral body at the center of the FSU (FSU_F). Furthermore, volumetric BMD (vBMD) derived from MDCT, FEM-based displacement, and FEM-based load of the single vertebrae L1 to L3 were determined. Statistically significant correlations (adjusted for a BMD ratio of fracture/L1-L3 segments) were revealed between the FSU_F and mean load of L1 to L3 (r = 0.814, p = 0.004) and the mean vBMD of L1 to L3 (r = 0.745, p = 0.013), whereas there was no statistically significant association between the FSU_F and FSU_L1-L3 or between FSU_F and the mean displacement of L1 to L3 (p > 0.05). In conclusion, FEM measurements of single vertebrae at the lumbar spine may be able to predict the biomechanical strength of incidentally fractured vertebral segments along the thoracolumbar spine, while FSUs seem to predict only segment-specific fracture risk.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Nithin Manohar Rayudu
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore 487372, Singapore; (N.M.R.); (L.Y.Y.)
| | - Long Yu Yeung
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore 487372, Singapore; (N.M.R.); (L.Y.Y.)
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany
| | - Benedikt J. Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
| | - Alexandra S. Gersing
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany;
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (A.S.); (E.B.); (M.D.); (M.T.L.); (B.J.S.); (J.S.K.); (T.B.)
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore 487372, Singapore; (N.M.R.); (L.Y.Y.)
- Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
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18
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Burian E, Grundl L, Greve T, Junker D, Sollmann N, Löffler M, Makowski MR, Zimmer C, Kirschke JS, Baum T. Local Bone Mineral Density, Subcutaneous and Visceral Adipose Tissue Measurements in Routine Multi Detector Computed Tomography-Which Parameter Predicts Incident Vertebral Fractures Best? Diagnostics (Basel) 2021; 11:diagnostics11020240. [PMID: 33557092 PMCID: PMC7913817 DOI: 10.3390/diagnostics11020240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
In this case-control study the value of bone mineral density (BMD) at different vertebral levels, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) to identify patients with incident osteoporotic vertebral fractures in routine multi-detector computed tomography (MDCT) exams was assessed. MATERIAL AND METHODS Seventeen patients who underwent baseline and follow-up routine contrast-enhanced MDCT and had an incident osteoporotic vertebral fracture at follow-up were included. Seventeen age-, sex- and follow-up duration-matched controls were identified. Trabecular BMD (from Th5 to L5) as well as cross-sectional area of SAT and VAT were extracted. RESULTS BMD performed best to differentiate patients with an incident fracture from controls at the levels of Th5 (area under the curve [AUC] = 0.781, p = 0.014), Th7 (AUC = 0.877, p = 0.001), and Th9 (AUC = 0.818, p = 0.005). Applying multivariate logistic regression BMD at Th7 level remained the only significant predictor of incident vertebral fractures (Th5-L5) with an odds ratio of 1.07 per BMD SD decrease. VAT and SAT did not show significant differences between the fracture and control group (p > 0.05). CONCLUSION The local BMD measurement appears to be more suitable than standard mean BMD from L1-L3 for fracture risk assessment.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (D.J.); (M.R.M.)
- Correspondence: ; Tel.: +49-89-4140-8791
| | - Lioba Grundl
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
| | - Tobias Greve
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
- Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistraße 15, 81377 Munich, Germany
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (D.J.); (M.R.M.)
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
| | - Maximilian Löffler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
| | - Marcus R. Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (D.J.); (M.R.M.)
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (L.G.); (T.G.); (N.S.); (M.L.); (C.Z.); (J.S.K.); (T.B.)
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Yeung LY, Rayudu NM, Löffler M, Sekuboyina A, Burian E, Sollmann N, Dieckmeyer M, Greve T, Kirschke JS, Subburaj K, Baum T. Prediction of Incidental Osteoporotic Fractures at Vertebral-Specific Level Using 3D Non-Linear Finite Element Parameters Derived from Routine Abdominal MDCT. Diagnostics (Basel) 2021; 11:208. [PMID: 33573295 PMCID: PMC7911185 DOI: 10.3390/diagnostics11020208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
To investigate whether finite element (FE) analysis of the spine in routine thoracic/abdominal multi-detector computed tomography (MDCT) can predict incidental osteoporotic fractures at vertebral-specific level; Baseline routine thoracic/abdominal MDCT scans of 16 subjects (8(m), mean age: 66.1 ± 8.2 years and 8(f), mean age: 64.3 ± 9.5 years) who sustained incidental osteoporotic vertebral fractures as confirmed in follow-up MDCTs were included in the current study. Thoracic and lumbar vertebrae (T5-L5) were automatically segmented, and bone mineral density (BMD), finite element (FE)-based failure-load, and failure-displacement were determined. These values of individual vertebrae were normalized globally (g), by dividing the absolute value with the average of L1-3 and locally by dividing the absolute value with the average of T5-12 and L1-5 for thoracic and lumbar vertebrae, respectively. Mean-BMD of L1-3 was determined as reference. Receiver operating characteristics (ROC) and area under the curve (AUC) were calculated for different normalized FE (Kload, Kdisplacement,K(load)g, and K(displacement)g) and BMD (KBMD, and K(BMD)g) ratio parameter combinations for identifying incidental fractures. Kload, K(load)g, KBMD, and K(BMD)g showed significantly higher discriminative power compared to standard mean BMD of L1-3 (BMDStandard) (AUC = 0.67 for Kload; 0.64 for K(load)g; 0.64 for KBMD; 0.61 for K(BMD)g vs. 0.54 for BMDStandard). The combination of Kload, Kdisplacement, and KBMD increased the AUC further up to 0.77 (p < 0.001). The combination of FE with BMD measurements derived from routine thoracic/abdominal MDCT allowed an improved prediction of incidental fractures at vertebral-specific level.
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Affiliation(s)
- Long Yu Yeung
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore 487372, Singapore; (L.Y.Y.); (N.M.R.)
| | - Nithin Manohar Rayudu
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore 487372, Singapore; (L.Y.Y.); (N.M.R.)
| | - Maximilian Löffler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
| | - Tobias Greve
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
- Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistraße 15, 81377 Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore 487372, Singapore; (L.Y.Y.); (N.M.R.)
- Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany; (M.L.); (A.S.); (E.B.); (N.S.); (M.D.); (T.G.); (J.S.K.); (T.B.)
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20
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Rayudu NM, Dieckmeyer M, Löffler MT, Noël PB, Kirschke JS, Baum T, Subburaj K. Predicting Vertebral Bone Strength Using Finite Element Analysis for Opportunistic Osteoporosis Screening in Routine Multidetector Computed Tomography Scans-A Feasibility Study. Front Endocrinol (Lausanne) 2021; 11:526332. [PMID: 33542701 PMCID: PMC7851077 DOI: 10.3389/fendo.2020.526332] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To investigate the feasibility of using routine clinical multidetector computed tomography (MDCT) scans for conducting finite element (FE) analysis to predict vertebral bone strength for opportunistic osteoporosis screening. Methods Routine abdominal MDCT with and without intravenous contrast medium (IVCM) of seven subjects (five male; two female; mean age: 71.86 ± 7.40 years) without any bone disease were used. FE analysis was performed on individual vertebrae (T11, T12, L1, and L2) including the posterior elements to investigate the effect of IVCM and slice thickness (1 and 3 mm) on vertebral bone strength. Another subset of data from subjects with vs. without osteoporotic vertebral fractures (n = 9 age and gender-matched pairs) was analyzed for investigating the ability of FE-analysis to differentiate the two cohorts. Bland-Altman plots, box plots, and coefficient of correlation (R2) were calculated to determine the variations in FE-predicted failure loads for different conditions. Results The FE-predicted failure loads obtained from routine MDCT scans were strongly correlated with those from without IVCM (R2 = 0.91 for 1mm; R2 = 0.92 for 3mm slice thickness, respectively) and different slice thicknesses (R2 = 0.93 for 1mm vs. 3mm with IVCM). Furthermore, a good correlation was observed for 3mm slice thickness with IVCM vs. 1mm without IVCM (R2 = 0.87). Significant difference between FE-predicted failure loads of healthy and fractured patients was observed (4,705 ± 1,238 vs. 4,010 ± 1,297 N; p=0.026). Conclusion Routine clinical MDCT scans could be reliably used for assessment of fracture risk based on FE analysis and may be beneficial for patients who are at increased risk for osteoporotic fractures.
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Affiliation(s)
- Nithin Manohar Rayudu
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore, Singapore
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Peter B. Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore, Singapore
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21
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Sollmann N, Becherucci EA, Boehm C, Husseini ME, Ruschke S, Burian E, Kirschke JS, Link TM, Subburaj K, Karampinos DC, Krug R, Baum T, Dieckmeyer M. Texture Analysis Using CT and Chemical Shift Encoding-Based Water-Fat MRI Can Improve Differentiation Between Patients With and Without Osteoporotic Vertebral Fractures. Front Endocrinol (Lausanne) 2021; 12:778537. [PMID: 35058878 PMCID: PMC8763669 DOI: 10.3389/fendo.2021.778537] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Osteoporosis is a highly prevalent skeletal disease that frequently entails vertebral fractures. Areal bone mineral density (BMD) derived from dual-energy X-ray absorptiometry (DXA) is the reference standard, but has well-known limitations. Texture analysis can provide surrogate markers of tissue microstructure based on computed tomography (CT) or magnetic resonance imaging (MRI) data of the spine, thus potentially improving fracture risk estimation beyond areal BMD. However, it is largely unknown whether MRI-derived texture analysis can predict volumetric BMD (vBMD), or whether a model incorporating texture analysis based on CT and MRI may be capable of differentiating between patients with and without osteoporotic vertebral fractures. MATERIALS AND METHODS Twenty-six patients (15 females, median age: 73 years, 11 patients showing at least one osteoporotic vertebral fracture) who had CT and 3-Tesla chemical shift encoding-based water-fat MRI (CSE-MRI) available were analyzed. In total, 171 vertebral bodies of the thoracolumbar spine were segmented using an automatic convolutional neural network (CNN)-based framework, followed by extraction of integral and trabecular vBMD using CT data. For CSE-MRI, manual segmentation of vertebral bodies and consecutive extraction of the mean proton density fat fraction (PDFF) and T2* was performed. First-order, second-order, and higher-order texture features were derived from texture analysis using CT and CSE-MRI data. Stepwise multivariate linear regression models were computed using integral vBMD and fracture status as dependent variables. RESULTS Patients with osteoporotic vertebral fractures showed significantly lower integral and trabecular vBMD when compared to patients without fractures (p<0.001). For the model with integral vBMD as the dependent variable, T2* combined with three PDFF-based texture features explained 40% of the variance (adjusted R2[Ra2] = 0.40; p<0.001). Furthermore, regarding the differentiation between patients with and without osteoporotic vertebral fractures, a model including texture features from CT and CSE-MRI data showed better performance than a model based on integral vBMD and PDFF only ( Ra2 = 0.47 vs. Ra2 = 0.81; included texture features in the final model: integral vBMD, CT_Short-run_emphasis, CT_Varianceglobal, and PDFF_Variance). CONCLUSION Using texture analysis for spine CT and CSE-MRI can facilitate the differentiation between patients with and without osteoporotic vertebral fractures, implicating that future fracture prediction in osteoporosis may be improved.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Nico Sollmann,
| | - Edoardo A. Becherucci
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christof Boehm
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Malek El Husseini
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore, Singapore
- Changi General Hospital, Singapore, Singapore
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Roski F, Hammel J, Mei K, Haller B, Baum T, Kirschke JS, Pfeiffer D, Woertler K, Pfeiffer F, Noël PB, Gersing AS, Schwaiger BJ. Opportunistic osteoporosis screening: contrast-enhanced dual-layer spectral CT provides accurate measurements of vertebral bone mineral density. Eur Radiol 2020; 31:3147-3155. [PMID: 33052464 PMCID: PMC8043862 DOI: 10.1007/s00330-020-07319-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/04/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
Objectives Osteoporosis remains under-diagnosed, which may be improved by opportunistic bone mineral density (BMD) measurements on CT. However, correcting for the influence of intravenous iodine-based contrast agent is challenging. The purpose of this study was to assess the diagnostic accuracy of iodine-corrected vertebral BMD measurements derived from non-dedicated contrast-enhanced phantomless dual-layer spectral CT (DLCT) examinations. Methods Vertebral volumetric DLCT-BMD was measured in native, arterial, and portal-venous scans of 132 patients (63 ± 16 years; 32% women) using virtual monoenergetic images (50 and 200 keV). For comparison, conventional BMD was determined using an asynchronous QCT calibration. Additionally, iodine densities were measured in the abdominal aorta (AA), inferior vena cava, and vena portae (VP) on each CT phase to adjust for iodine-related measurement errors in multivariable linear regressions and a generalized estimated equation, and conversion equations were calculated. Results BMD values derived from contrast-enhanced phases using conversion equations adjusted for individual vessel iodine concentrations of VP and/or AA showed a high agreement with those from non-enhanced scans in Bland-Altman plots. Mean absolute errors (MAE) of DLCT-BMD were 3.57 mg/ml for the arterial (R2 = 0.989) and 3.69 mg/ml for the portal-venous phase (R2 = 0.987) (conventional BMD: 4.70 [R2 = 0.983] and 5.15 mg/ml [R2 = 0.981]). In the phase-independent analysis, MAE was 4.49 mg/ml for DLCT (R2 = 0.989) (conventional BMD: 4.82 mg/ml [R2 = 0.981]). Conclusions Converted BMD derived from contrast-enhanced DLCT examinations and adjusted for individual vessel iodine concentrations showed a high agreement with non-enhanced DLCT-BMD, suggesting that opportunistic BMD measurements are feasible even in non-dedicated contrast-enhanced DLCT examinations. Key Points • Accurate BMD values can be converted from contrast-enhanced DLCT scans, independent from the used scan phase. • DLCT-BMD measurements from contrast-enhanced scans should be adjusted with iodine concentrations of portal vein and/or abdominal aorta, which significantly improves the goodness-of-fit of conversion models.
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Affiliation(s)
- Ferdinand Roski
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Johannes Hammel
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Kai Mei
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Franz Pfeiffer
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Alexandra S Gersing
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
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Pumberger M, Issever AS, Diekhoff T, Schwemmer C, Berg S, Palmowski Y, Putzier M. Bone structure determined by HR-MDCT does not correlate with micro-CT of lumbar vertebral biopsies: a prospective cross-sectional human in vivo study. J Orthop Surg Res 2020; 15:398. [PMID: 32912263 PMCID: PMC7488144 DOI: 10.1186/s13018-020-01895-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/16/2020] [Indexed: 01/22/2023] Open
Abstract
Background Osteoporosis is characterized by a deterioration of bone structure and quantity that leads to an increased risk of fractures. The primary diagnostic tool for the assessment of the bone quality is currently the dual-energy X-ray absorptiometry (DXA), which however only measures bone quantity. High-resolution multidetector computed tomography (HR-MDCT) offers an alternative approach to assess bone structure, but still lacks evidence for its validity in vivo. The objective of this study was to assess the validity of HR-MDCT for the evaluation of bone architecture in the lumbar spine. Methods We conducted a prospective cross-sectional study to compare the results of preoperative lumbar HR-MDCT scans with those from microcomputed tomography (μCT) analysis of transpedicular vertebral body biopsies. For this purpose, we included patients undergoing spinal surgery in our orthopedic department. Each patient underwent preoperative HR-MDCT scanning (L1-L4). Intraoperatively, transpedicular biopsies were obtained from intact vertebrae. Micro-CT analysis of these biopsies was used as a reference method to assess the actual bone architecture. HR-MDCT results were statistically analyzed regarding the correlation with results from μCT. Results Thirty-four patients with a mean age of 69.09 years (± 10.07) were included in the study. There was no significant correlation for any of the parameters (bone volume/total volume, trabecular separation, trabecular thickness) between μCT and HR-MDCT (bone volume/total volume: r = − 0.026 and p = 0.872; trabecular thickness: r = 0.074 and r = 6.42; and trabecular separation: r = − 0.18 and p = 0.254). Conclusion To our knowledge, this is the first study comparing in vivo HR-MDCT with μCT analysis of vertebral biopsies in human patients. Our findings suggest that lumbar HR-MDCT is not valid for the in vivo evaluation of bone architecture in the lumbar spine. New diagnostic tools for the evaluation of osteoporosis and preoperative orthopedic planning are urgently needed.
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Affiliation(s)
- Matthias Pumberger
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Ahi Sema Issever
- Department of Radiology, Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Christin Schwemmer
- Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Susanne Berg
- Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Yannick Palmowski
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany.
| | - Michael Putzier
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany
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Güngör Ö, Gezer NS, Özdamarlar U, Balcı A. The effect of bone mineral density on development of Schmorl's nodes in young patients. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:287-292. [PMID: 32544064 DOI: 10.5152/j.aott.2020.03.577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to detect the relationship between the development of Schmorl's nodes (SNs) and bone mineral density (BMD) in young patients. METHODS Computerized tomography (CT) images of the thoracolumbar vertebral column were retrospectively examined by two experienced radiologists for SNs. The diagnostic criterion for SN was defined as a node size larger than one-third but not more than two-thirds of the relevant vertebral endplate. Considering the eligibility criteria, a total of 74 individuals (60 males and 14 females; mean age: 24.3 years; age range: 18-40 years) with SN at the thoracolumbar vertebrae were included in the patient group, and a total of 38 age- and gender-matched individuals (30 males and 8 females; mean age: 25 years) with no evidence of SN were included in the control group. All these individuals were younger than 40 years. In the patient group, SNs were assessed in terms of the distribution of the thoracolumbar vertebrae, the location of the upper and lower endplates, and the total number of lesions. In all individuals included in the study, BMD was measured from the axial CT sections by quantitative CT and then compared between the two groups. RESULTS The distribution of age and gender was comparable between the two groups (p=0.438). A total of 208 SNs were identified in the patient group. Of these, 92 (44%) were located at the thoracic vertebrae and 116 (56%) at the lumbar vertebrae. The mean BMD was 131.6 g/cm3 in the patient group and 140.7 g/cm3 in the control group (p=0.03). There was no significant relationship between the total number of SNs per patient and the mean BMD (p=0.156). CONCLUSION Evidence from this study revealed that low BMD may be a predisposing factor for the development of SNs in patients younger than 40 years. LEVEL OF EVIDENCE Level III, Diagnostic Study.
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Affiliation(s)
- Özlem Güngör
- Clinic of Radiology, Hakkari State Hospital, Hakkari, Turkey
| | - Naciye Sinem Gezer
- Department of Radiology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Umut Özdamarlar
- Department of Radiology Bahçeşehir University, School of Medicine, Medical Park Göztepe Hospital, İstanbul, Turkey
| | - Ali Balcı
- Department of Radiology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
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Assessment of paraspinal muscle characteristics, lumbar BMD, and their associations in routine multi-detector CT of patients with and without osteoporotic vertebral fractures. Eur J Radiol 2020; 125:108867. [PMID: 32065929 DOI: 10.1016/j.ejrad.2020.108867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/17/2020] [Accepted: 01/29/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate paraspinal muscle characteristics and lumbar bone mineral density (BMD) and their associations in routine abdominal multi-detector computed tomography (MDCT) as well as the impact of osteoporotic vertebral fractures on such associations. METHOD 116 patients (69.7 ± 8.1 years, 72 males) who underwent routine abdominal MDCT (oncological staging and/or follow-up for tumor recurrence) were retrospectively included and assigned to a fracture and control group (age- and gender-matched), depending on the presence or absence of lumbar osteoporotic vertebral fractures. BMD was derived from lumbar vertebrae using a conversion equation, and the cross-sectional area (CSA), CSA ratio (CSA psoas muscles divided by CSA erector spinae muscles), and muscle attenuation were measured for the psoas and erector spinae muscles at the levels L2 and L4/5 without dedicated software. RESULTS Males showed significantly higher BMD, CSA, and CSA ratios at the levels L2 and L4/5, while females had decreased erector spinae muscle attenuation at L4/5 (p < 0.05). No significant differences between patients with versus without fractures were observed except for BMD (68.5 ± 37.2 mg/ml vs. 91.4 ± 26.8 mg/ml; p < 0.01). Age-adjusted partial correlation testing revealed significant correlations of BMD and the CSA ratio at level L4/5 (r = 0.20; p = 0.03), but not with muscle attenuation (p > 0.05). CONCLUSIONS Paraspinal muscle characteristics and lumbar BMD can be assessed seamlessly in routine abdominal MDCT without dedicated software. There are level-dependent interactions between paraspinal muscle characteristics as well as lumbar BMD. Vertebral fracture status was independent of paraspinal muscle characteristics.
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Löffler MT, Sollmann N, Mei K, Valentinitsch A, Noël PB, Kirschke JS, Baum T. X-ray-based quantitative osteoporosis imaging at the spine. Osteoporos Int 2020; 31:233-250. [PMID: 31728606 DOI: 10.1007/s00198-019-05212-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022]
Abstract
Osteoporosis is a metabolic bone disease with a high prevalence that affects the population worldwide, particularly the elderly. It is often due to fractures associated with bone fragility that the diagnosis of osteoporosis becomes clinically evident. However, early diagnosis would be necessary to initiate therapy and to prevent occurrence of further fractures, thus reducing morbidity and mortality. X-ray-based imaging plays a key role for fracture risk assessment and monitoring of osteoporosis. Whereas over decades dual-energy X-ray absorptiometry (DXA) has been the main method used and still reflects the reference standard, another modality reemerges with quantitative computed tomography (QCT) because of its three-dimensional advantages and the opportunistic exploitation of routine CT scans. Against this background, this article intends to review and evaluate recent advances in the field of X-ray-based quantitative imaging of osteoporosis at the spine. First, standard DXA with the recent addition of trabecular bone score (TBS) is presented. Secondly, standard QCT, dual-energy BMD quantification, and opportunistic BMD screening in non-dedicated CT exams are discussed. Lastly, finite element analysis and microstructural parameter analysis are reviewed.
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Affiliation(s)
- M T Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - N Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - K Mei
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Valentinitsch
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - P B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - T Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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27
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Leonhardt Y, May P, Gordijenko O, Koeppen-Ursic VA, Brandhorst H, Zimmer C, Makowski MR, Baum T, Kirschke JS, Gersing AS, Seifert-Klauss V, Schwaiger BJ. Opportunistic QCT Bone Mineral Density Measurements Predicting Osteoporotic Fractures: A Use Case in a Prospective Clinical Cohort. Front Endocrinol (Lausanne) 2020; 11:586352. [PMID: 33240220 PMCID: PMC7680958 DOI: 10.3389/fendo.2020.586352] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/14/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess whether volumetric vertebral bone mineral density (BMD) measured with opportunistic quantitative computed tomography (QCT) (i.e., CT acquired for other reasons) can predict osteoporotic fracture occurrence in a prospective clinical cohort and how this performs in comparison to dual-energy X-ray absorptiometry (DXA) measurements. METHODS In the database of our fracture liaison service, 58 patients (73 ± 11 years, 72% women) were identified that had at least one prevalent low-energy fracture and had undergone CT of the spine. BMD was determined by converting HU using scanner-specific conversion equations. Baseline DXA was available for 31 patients. During a 3-year follow-up, new fractures were diagnosed either by (i) recent in-house imaging or (ii) clinical follow-up with validated external reports. Associations were assessed using logistic regression models, and cut-off values were determined with ROC/Youden analyses. RESULTS Within 3 years, 20 of 58 patients presented new low-energy fractures (34%). Mean QCT BMD of patients with fractures was significantly lower (56 ± 20 vs. 91 ± 38 mg/cm3; p = 0.003) and age was higher (77 ± 10 vs. 71 ± 11 years; p = 0.037). QCT BMD was significantly associated with the occurrence of new fractures, and the OR for developing a new fracture during follow-up was 1.034 (95% CI, 1.010-1.058, p = 0.005), suggesting 3% higher odds for every unit of BMD decrease (1 mg/cm3). Age and sex showed no association. For the differentiation between patients with and without new fractures, ROC showed an AUC of 0.76 and a Youden's Index of J = 0.48, suggesting an optimal cut-off value of 82 mg/cm3. DXA T-scores showed no significant association with fracture occurrence in analogous regression models. CONCLUSION In this use case, opportunistic BMD measurements attained through QCT predicted fractures during a 3-year follow-up. This suggests that opportunistic measurements are useful to reduce the diagnostic gap and evaluate the fracture risk in osteoporotic patients.
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Affiliation(s)
- Yannik Leonhardt
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
- *Correspondence: Yannik Leonhardt,
| | - Pauline May
- Interdisciplinary Osteoporosis Center, Department of Gynaecology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Olga Gordijenko
- Department of Trauma Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Veronika A. Koeppen-Ursic
- Department of Orthopedics and Trauma Surgery, Klinikum Freising, Technical University of Munich, Freising, Germany
| | - Henrike Brandhorst
- Interdisciplinary Osteoporosis Center, Department of Gynaecology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S. Gersing
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Vanadin Seifert-Klauss
- Interdisciplinary Osteoporosis Center, Department of Gynaecology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J. Schwaiger
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
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Association between true non-contrast and virtual non-contrast vertebral bone CT attenuation values determined using dual-layer spectral detector CT. Eur J Radiol 2019; 121:108740. [DOI: 10.1016/j.ejrad.2019.108740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/23/2019] [Accepted: 11/04/2019] [Indexed: 01/07/2023]
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Löffler MT, Jacob A, Valentinitsch A, Rienmüller A, Zimmer C, Ryang YM, Baum T, Kirschke JS. Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA. Eur Radiol 2019; 29:4980-4989. [PMID: 30790025 PMCID: PMC6682570 DOI: 10.1007/s00330-019-06018-w] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/18/2018] [Accepted: 01/17/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare opportunistic quantitative CT (QCT) with dual energy X-ray absorptiometry (DXA) in their ability to predict incident vertebral fractures. METHODS We included 84 patients aged 50 years and older, who had routine CT including the lumbar spine and DXA within a 12-month period (baseline) as well as follow-up imaging after at least 12 months or who sustained an incident vertebral fracture documented earlier. Patients with bone disorders aside from osteoporosis were excluded. Fracture status and trabecular bone mineral density (BMD) were retrospectively evaluated in baseline CT and fracture status was reassessed at follow-up. BMDQCT was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners. RESULTS Sixteen patients had incident vertebral fractures showing lower mean BMDQCT than patients without fracture (p = 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMDQCT (4.07; 95% CI, 1.98-8.38), as well as after adjusting for age, sex, and prevalent fractures (2.54; 95% CI, 1.09-5.90). For DXA, a statistically significant increase in relative hazard per SD decrease in T-score was only observed after age and sex adjustment (1.57; 95% CI, 1.04-2.38). The predictability of incident vertebral fractures was good by BMDQCT (AUC = 0.76; 95% CI, 0.64-0.89) and non-significant by T-scores. Asynchronously calibrated CT scanners showed good long-term stability (linear drift ranging from - 0.55 to - 2.29 HU per year). CONCLUSIONS Opportunistic screening of mainly neurosurgical and oncologic patients in CT performed for indications other than densitometry allows for better risk assessment of imminent vertebral fractures than dedicated DXA. KEY POINTS • Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients. • More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA. • Standard ACR QCT-cutoff values for osteoporosis (< 80 mg/cm 3 ) and osteopenia (≤ 120 mg/cm 3 ) can also be applied scanner independently in calibrated opportunistic QCT.
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Affiliation(s)
- Maximilian T Löffler
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Alina Jacob
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Alexander Valentinitsch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Anna Rienmüller
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Orthopedic and Trauma Surgery, Medical University Vienna, Vienna, Austria
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Evaluation of vertebral bone mineral density in scoliosis by using quantitative computed tomography. Pol J Radiol 2019; 84:e131-e135. [PMID: 31019606 PMCID: PMC6479145 DOI: 10.5114/pjr.2019.84060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/14/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Scoliosis is described as a lateral curvature of the spine. We aimed to evaluate bone mineral density (BMD) in patients with scoliosis by using quantitative computed tomography (QCT) and compare the BMD of idiopathic and congenital scoliosis patients. Material and methods Forty-three patients aged 1 to 40 years with idiopathic, congenital, or neuromuscular scoliosis and 41 matched controls of the same sex and approximate age were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5, and mean BMD was calculated for each case. Results Twenty-two of the patients with scoliosis were idiopathic, 15 were congenital, four were neuromuscular, and two were neurofibromatosis. The mean BMD values of patients with scoliosis were significantly lower compared with the control group (106.8 ± 33.4 mg/cm3 vs. 124.9 ± 29.1 mg/cm3, p = 0.009). No significant difference in BMD values was found between idiopathic and congenital scoliosis patients (p > 0.05). Conclusions This study illustrated that the vertebral body BMD values of the patients with scoliosis were significantly lower than those seen in the control group.
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Patient-Specific Phantomless Estimation of Bone Mineral Density and Its Effects on Finite Element Analysis Results: A Feasibility Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:4102410. [PMID: 30719069 PMCID: PMC6335860 DOI: 10.1155/2019/4102410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/06/2018] [Accepted: 12/06/2018] [Indexed: 01/22/2023]
Abstract
Objectives This study proposes a regression model for the phantomless Hounsfield units (HU) to bone mineral density (BMD) conversion including patient physical factors and analyzes the accuracy of the estimated BMD values. Methods The HU values, BMDs, circumferences of the body, and cross-sectional areas of bone were measured from 39 quantitative computed tomography images of L2 vertebrae and hips. Then, the phantomless HU-to-BMD conversion was derived using a multiple linear regression model. For the statistical analysis, the correlation between the estimated BMD values and the reference BMD values was evaluated using Pearson's correlation test. Voxelwise BMD and finite element analysis (FEA) results were analyzed in terms of root-mean-square error (RMSE) and strain energy density, respectively. Results The HU values and circumferences were statistically significant (p < 0.05) for the lumbar spine, whereas only the HU values were statistically significant (p < 0.05) for the proximal femur. The BMD values estimated using the proposed HU-to-BMD conversion were significantly correlated with those measured using the reference phantom: Pearson's correlation coefficients of 0.998 and 0.984 for the lumbar spine and proximal femur, respectively. The RMSEs of the estimated BMD values for the lumbar spine and hip were 4.26 ± 0.60 (mg/cc) and 8.35 ± 0.57 (mg/cc), respectively. The errors of total strain energy were 1.06% and 0.91%, respectively. Conclusions The proposed phantomless HU-to-BMD conversion demonstrates the potential of precisely estimating BMD values from CT images without the reference phantom and being utilized as a viable tool for FEA-based quantitative assessment using routine CT images.
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Sollmann N, Mei K, Schwaiger B, Gersing A, Kopp F, Bippus R, Maegerlein C, Zimmer C, Rummeny E, Kirschke J, Noël P, Baum T. Effects of virtual tube current reduction and sparse sampling on MDCT-based femoral BMD measurements. Osteoporos Int 2018; 29:2685-2692. [PMID: 30143850 PMCID: PMC6267136 DOI: 10.1007/s00198-018-4675-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/14/2018] [Indexed: 01/14/2023]
Abstract
UNLABELLED This study investigates the impact of tube current reduction and sparse sampling on femoral bone mineral density (BMD) measurements derived from multi-detector computed tomography (MDCT). The application of sparse sampling led to robust and clinically acceptable BMD measurements. In contrast, BMD measurements derived from MDCT with virtually reduced tube currents showed a considerable increase when compared to original data. INTRODUCTION The study aims to evaluate the effects of radiation dose reduction by using virtual reduction of tube current or sparse sampling combined with standard filtered back projection (FBP) and statistical iterative reconstruction (SIR) on femoral bone mineral density (BMD) measurements derived from multi-detector computed tomography (MDCT). METHODS In routine MDCT scans of 41 subjects (65.9% men; age 69.3 ± 10.1 years), reduced radiation doses were simulated by lowering tube currents and applying sparse sampling (50, 25, and 10% of the original tube current and projections, respectively). Images were reconstructed using FBP and SIR. BMD values were assessed in the femoral neck and compared between the different dose levels, numbers of projections, and image reconstruction approaches. RESULTS Compared to full-dose MDCT, virtual lowering of the tube current by applying our simulation algorithm resulted in increases in BMD values for both FBP (up to a relative change of 32.5%) and SIR (up to a relative change of 32.3%). In contrast, the application of sparse sampling with a reduction down to 10% of projections showed robust BMD values, with clinically acceptable relative changes of up to 0.5% (FBP) and 0.7% (SIR). CONCLUSIONS Our simulations, which still require clinical validation, indicate that reductions down to ultra-low tube currents have a significant impact on MDCT-based femoral BMD measurements. In contrast, the application of sparse-sampled MDCT seems a promising future clinical option that may enable a significant reduction of the radiation dose without considerable changes of BMD values.
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Affiliation(s)
- N. Sollmann
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
- 0000000123222966grid.6936.aTUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - K. Mei
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - B.J. Schwaiger
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - A.S. Gersing
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - F.K. Kopp
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - R. Bippus
- 0000 0004 0373 4886grid.418621.8Philips GmbH Innovative Technologies, Research Laboratories, Röntgenstr. 24-26, 22335 Hamburg, Germany
| | - C. Maegerlein
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - C. Zimmer
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - E.J. Rummeny
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - J.S. Kirschke
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - P.B. Noël
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - T. Baum
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
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Abstract
BACKGROUND Effects of high-dose radiation using protons and photons on bone are relatively unexplored, but high rates of insufficiency fractures are reported, and the causes of this are incompletely understood. Imaging studies with pre- and postradiation scans can help one understand the effect of radiation on bone. QUESTIONS/PURPOSES The purpose of this study was to assess the effects of high-dose radiation on the trabecular density of bone in the sacrum using CT-derived Hounsfield units (HU). METHODS Between 2009 and 2015, we treated 57 patients (older then 18 years) with sacral chordoma. Fourteen (25%) of them were treated with radiation only. The general indication for this approach is inoperability resulting from tumor size. Forty-two (74%) patients were treated with transverse sacral resections and high-dose radiotherapy (using either protons or photons or a combination) before surgery and after surgery. During this time period, our indication for this approach generally was symptomatic sacral chordoma in which resection would prevent further growth and reasonable sacrifice of nerve roots was possible. Of those patients, 21 (50%) had CT scans both before and after radiation treatment. We used HU as a surrogate for bone density. CT uses HU to derive information on tissue and bone quantity. A recent study presented reference HU values for normal (mean 133 ± 38 HU), osteoporotic (101 ± 25 HU), and osteopenic bone (79 ± 32 HU). To adjust for scanning protocol-induced changes in HU, we calculated the ratio between bone inside and outside the radiation field rather than using absolute values. To assess the effect of radiation, we tested whether there was a difference in ratio (sacrum/L1) before and after radiation. A control measurement was performed (L2/L1) and also tested for a difference before and after radiation. Statistical analyses were performed using the paired t-test. RESULTS The effects of radiation appeared confined to the intended field, because the bone density outside the treated field was not observed to decrease. The ratio of HU (a surrogate for bone density) in L2 relative to L1 did not change after radiotherapy (preradiation mean: 0.979 ± 0.009, postradiation mean: 0.980 ± 0.009, mean difference outside the radiation field: -0.001, 95% confidence interval [CI], -0.009 to 0.007, p = 0.799). The ratio of HU within the radiation field relative to L1 decreased after radiotherapy (preradiation mean: 0.895 ± 0.050, postradiation mean: 0.658 ± 0.050, mean difference inside the radiation field: 0.237, 95% CI, 0.187-0.287, p < 0.001), suggesting the bone density stayed the same outside the radiation field but decreased inside the radiation field. CONCLUSIONS Trabecular bone density decreased after high-dose radiation therapy in a small group of patients with sacral chordoma. High-dose radiation is increasingly gaining acceptance for treating sacral malignancies; further long-term prospective studies using calibrated CT scanners and preferably bone biopsies are needed. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Gerety EL, Bearcroft PW. L1 vertebral density on CT is too variable with different scanning protocols to be a useful screening tool for osteoporosis in everyday practice. Br J Radiol 2018; 91:20170395. [PMID: 29308913 DOI: 10.1259/bjr.20170395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To determine whether a single L1 density threshold can be used to screen all patients undergoing CT at a busy tertiary referral centre for those at risk of osteoporosis. METHODS 200 patients, who had been randomly selected for an audit of CT reporting of incidental vertebral fractures, had their L1 density measured on 864 routine CT examinations. These had been performed with a variety of kVp and intravenous (i.v.) contrast protocols, reflecting the wide range of imaging indications. RESULTS L1 density measured on thick axial, thin axial or sagittal images had an excellent intraclass correlation coefficient (0.996). For the same patients imaged twice within 6 months, there was mean intraexamination L1 density difference of 27.5 HU. Variability due to i.v. contrast medium administration resulted in a mean difference of 24.5 HU. Mean difference due to acquisition kVp was 24.1 HU. Once matched for sex, age, kVp and i.v. contrast, there was a significant difference between the L1 density in patients with vertebral fractures compared to those without fractures (mean 30.19 HU). CONCLUSION There is significant variability in the L1 vertebral body CT density due to differences in acquisition variables such as kVp and timing post-i.v. contrast medium. Advances in knowledge: Previous studies suggested that L1 CT density could be used to screen for osteoporosis. The current study cautions that it is not possible to define a single L1 density threshold for screening, due to the number of variables within a wide range of scanning protocols for different imaging indications in everyday practice.
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Affiliation(s)
- Emma-Louise Gerety
- 1 Department of Radiology, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Philip Wp Bearcroft
- 1 Department of Radiology, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
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Schwaiger BJ, Kopperdahl DL, Nardo L, Facchetti L, Gersing AS, Neumann J, Lee KJ, Keaveny TM, Link TM. Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations. Bone 2017; 101:62-69. [PMID: 28442297 PMCID: PMC5506071 DOI: 10.1016/j.bone.2017.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 03/23/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans-as validated in previous studies-as a reference standard. MATERIALS AND METHODS Men with prostate cancer (n=82, 71.6±8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤80mg/cm3, femoral neck or total hip T-score ≤-2.5, vertebral strength ≤6500N and femoral strength ≤3500N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. RESULTS All measurements from PET/CT versus MDCT were strongly correlated (R2=0.93-0.97; P<0.0001 for all). Mean differences for total hip areal BMD (0.001g/cm2, 1.1%), femoral strength (-60N, 1.3%), vertebral trabecular BMD (2mg/cm3, 2.6%) and vertebral strength (150N; 1.7%) measurements were not statistically significant (P>0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (-0.018g/cm2; -2.5%; P=0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). CONCLUSION Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.
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Affiliation(s)
- Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
| | | | - Lorenzo Nardo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
| | - Kwang J Lee
- O.N. Diagnostics, LLC, Berkeley, CA, United States
| | - Tony M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, United States.
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
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Ma Q, Yang Z, Han X, Liu F, Su D, Xing H. Influence of Parathyroidectomy on Bone Calcium Concentration: Evaluation with Spectral CT in Patients with Secondary Hyperparathyroidism Undergoing Hemodialysis—A Prospective Feasibility Study. Radiology 2017; 284:143-152. [PMID: 28170301 DOI: 10.1148/radiol.2016161797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Qiang Ma
- From the Departments of Radiology (Q.M., Z.Y.) and Nephrology (X.H.), Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing, 100050, P.R. China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China (F.L.); Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R
| | - Zhenghan Yang
- From the Departments of Radiology (Q.M., Z.Y.) and Nephrology (X.H.), Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing, 100050, P.R. China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China (F.L.); Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R
| | - Xue Han
- From the Departments of Radiology (Q.M., Z.Y.) and Nephrology (X.H.), Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing, 100050, P.R. China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China (F.L.); Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R
| | - Fen Liu
- From the Departments of Radiology (Q.M., Z.Y.) and Nephrology (X.H.), Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing, 100050, P.R. China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China (F.L.); Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R
| | - Dechun Su
- From the Departments of Radiology (Q.M., Z.Y.) and Nephrology (X.H.), Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing, 100050, P.R. China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China (F.L.); Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R
| | - Haidong Xing
- From the Departments of Radiology (Q.M., Z.Y.) and Nephrology (X.H.), Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing, 100050, P.R. China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China (F.L.); Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R
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Is multidetector CT-based bone mineral density and quantitative bone microstructure assessment at the spine still feasible using ultra-low tube current and sparse sampling? Eur Radiol 2017. [PMID: 28639046 PMCID: PMC5674130 DOI: 10.1007/s00330-017-4904-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective Osteoporosis diagnosis using multidetector CT (MDCT) is limited to relatively high radiation exposure. We investigated the effect of simulated ultra-low-dose protocols on in-vivo bone mineral density (BMD) and quantitative trabecular bone assessment. Materials and methods Institutional review board approval was obtained. Twelve subjects with osteoporotic vertebral fractures and 12 age- and gender-matched controls undergoing routine thoracic and abdominal MDCT were included (average effective dose: 10 mSv). Ultra-low radiation examinations were achieved by simulating lower tube currents and sparse samplings at 50%, 25% and 10% of the original dose. BMD and trabecular bone parameters were extracted in T10–L5. Results Except for BMD measurements in sparse sampling data, absolute values of all parameters derived from ultra-low-dose data were significantly different from those derived from original dose images (p<0.05). BMD, apparent bone fraction and trabecular thickness were still consistently lower in subjects with than in those without fractures (p<0.05). Conclusion In ultra-low-dose scans, BMD and microstructure parameters were able to differentiate subjects with and without vertebral fractures, suggesting osteoporosis diagnosis is feasible. However, absolute values differed from original values. BMD from sparse sampling appeared to be more robust. This dose-dependency of parameters should be considered for future clinical use. Key Points • BMD and quantitative bone parameters are assessable in ultra-low-dose in vivo MDCT scans. • Bone mineral density does not change significantly when sparse sampling is applied. • Quantitative trabecular bone microstructure measurements are sensitive to dose reduction. • Osteoporosis subjects could be differentiated even at 10% of original dose. • Radiation exposure should be considered when comparing quantitative bone parameters. Electronic supplementary material The online version of this article (doi:10.1007/s00330-017-4904-y) contains supplementary material, which is available to authorized users.
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Bone Mineral Density Estimations From Routine Multidetector Computed Tomography: A Comparative Study of Contrast and Calibration Effects. J Comput Assist Tomogr 2017; 41:217-223. [PMID: 27798444 PMCID: PMC5359785 DOI: 10.1097/rct.0000000000000518] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Phantom-based (synchronous and asynchronous) and phantomless (internal tissue calibration based) assessment of bone mineral density (BMD) in routine MDCT (multidetector computed tomography) examinations potentially allows for diagnosis of osteoporosis. Although recent studies investigated the effects of contrast-medium application on phantom-calibrated BMD measurements, it remains uncertain to what extent internal tissue-calibrated BMD measurements are also susceptible to contrast-medium associated density variation. The present study is the first to systemically evaluate BMD variations related to contrast application comparing different calibration techniques. Purpose To compare predicative performance of different calibration techniques for BMD measurements obtained from triphasic contrast-enhanced MDCT. Materials and Methods Bone mineral density was measured on nonenhanced (NE), arterial (AR) and portal-venous (PV) contrast phase MDCT images of 46 patients using synchronous (SYNC) and asynchronous (ASYNC) phantom calibration as well as internal calibration (IC). Quantitative computed tomography (QCT) served as criterion standard. Density variations were analyzed for each contrast phase and calibration technique, and respective linear fitting was performed. Results Both asynchronous calibration-derived BMD values (NE-ASYNC) and values estimated using IC (NE-IC) on NE MDCT images did reasonably well in predicting QCT BMD (root-mean-square deviation, 8.0% and 7.8%, respectively). Average NE-IC BMD was 2.7% lower when compared with QCT (P = 0.017), whereas no difference could be found for NE-ASYNC (P = 0.957). All average BMD estimates derived from contrast-enhanced scans differed significantly from QCT BMD (all P < 0.005) and led to notable systemic BMD biases (mean difference at least > 6.0 mg/mL). All regression fits revealed a consistent linear dependency (R2 range, 0.861–0.963). Overall accuracy and goodness of fit tended to decrease from AR to PV contrast phase. Highest precision and best linear fit could be reached using a synchronously scanned phantom (root-mean-square deviation, 9.4% for AR and 14.4% for PV). Both ASYNC and IC estimations performed comparably accurate and precise. Conclusions Our data suggest that internal calibration driven BMD measurements derived from contrast-enhanced MDCT need the same amount of post hoc contrast-effect adjustment as measurements using phantom calibration. Adjustment using linear correction equations can correct for systematic bias of bone density variations related to contrast application, irrespective of the calibration technique used.
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Jørgensen HS, Winther S, Bøttcher M, Thygesen J, Rejnmark L, Hauge EM, Svensson M, Ivarsen P. Effect of Intravenous Contrast on Volumetric Bone Mineral Density in Patients with Chronic Kidney Disease. J Clin Densitom 2016; 19:423-429. [PMID: 27174315 DOI: 10.1016/j.jocd.2016.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
Volumetric bone mineral density (vBMD) can be measured from clinical computed tomography (CT) scans, facilitating screening for osteoporosis. However, use of X-ray contrast media may influence vBMD analyses, and previous studies reported as much as a 30% increase in lumbar spine (LS) vBMD after contrast administration. At the total hip (TH), an increase of only 4.1% was reported, indicating less sensitivity to contrast enhancement at this site. This study aimed to investigate the changes in vBMD after intravenous contrast media administration at both the LS and proximal femur in patients with chronic kidney disease. Seventy-one patients underwent CT angiography of the chest, abdomen, and pelvis as part of the cardiac workup before kidney transplantation. vBMD of the LS and proximal femur were calculated before and after administration of 95 mL ioversol intravenously. XY- and Bland-Altman plots and paired Student's t-test were used to evaluate changes in vBMD. After contrast media administration vBMD increased both at the LS and proximal femur. Although the absolute difference was comparable, the relative difference was almost twice as high at the LS (10.2% [6.1-14.1]) compared to the TH (5.9% [2.4-9.3], p <0.001) and femoral neck (FN) (5.3% [0.5-9.9], p <0.001). Women had a greater increase in LS-vBMD than men (13.4 ± 8.0 vs 9.8 ± 4.8 mg/cc, p = 0.02). Based on FN T-scores, 11 patients (16%) changed osteoporotic status after contrast enhancement. In conclusion vBMD of the spine and hip increased after contrast media administration in a cohort of patients with chronic kidney disease. FN T-scores from contrast-enhanced clinical CT scans should therefore be interpreted with caution. The proximal femur may be the preferred region for vBMD analysis from clinical CT scans, as sensitivity to contrast enhancement seem less at this site. These results may not be applicable to other patient populations.
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Affiliation(s)
| | - Simon Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Bøttcher
- Department of Internal Medicine, Hospital Unit West, Herning, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | | | - My Svensson
- Department of Nephrology, Division of Medicine, Akershus University Hospital, Oslo, Norway
| | - Per Ivarsen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
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Wagner D, Kamer L, Sawaguchi T, Richards RG, Noser H, Rommens PM. Sacral Bone Mass Distribution Assessed by Averaged Three-Dimensional CT Models: Implications for Pathogenesis and Treatment of Fragility Fractures of the Sacrum. J Bone Joint Surg Am 2016; 98:584-90. [PMID: 27053587 DOI: 10.2106/jbjs.15.00726] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fragility fractures of the sacrum are increasing in prevalence due to osteoporosis and epidemiological changes and are challenging in their treatment. They exhibit specific fracture patterns with unilateral or bilateral fractures lateral to the sacral foramina, and sometimes an additional transverse fracture leads to spinopelvic dissociation. The goal of this study was to assess sacral bone mass distribution and corresponding changes with decreased general bone mass. METHODS Clinical computed tomography (CT) scans of intact pelves in ninety-one individuals (mean age and standard deviation, 61.5 ± 11.3 years) were used to generate three-dimensional (3D) models of the sacrum averaging bone mass in Hounsfield units (HU). Individuals with decreased general bone mass were identified by measuring bone mass in L5 (group 1 with <100 HU; in contrast to group 2 with ≥100 HU). RESULTS In group 1, a large zone of negative Hounsfield units was located in the paraforaminal lateral region from S1 to S3. Along the trans-sacral corridors, a Hounsfield unit peak was observed laterally, corresponding to cortical bone of the auricular surface. The lowest Hounsfield unit values were found in the paraforaminal lateral region in the sacral ala. An intermediate level of bone mass was observed in the area of the vertebral bodies, which also demonstrated the largest difference between groups 1 and 2. Overall, the Hounsfield units were lower at S2 than S1. CONCLUSIONS The models of averaged bone mass in the sacrum revealed a distinct 3D distribution pattern. CLINICAL RELEVANCE The negative values in the paraforaminal lateral region may explain the specific fracture patterns in fragility fractures of the sacrum involving the lateral areas of the sacrum. Transverse fractures located between S1 and S2 leading to spinopelvic dissociation may occur because of decreased bone mass in S2. The largest difference between the studied groups was found in the vertebral bodies and might support the use of transsacral or cement-augmented implants.
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Affiliation(s)
- Daniel Wagner
- AO Research Institute Davos, Davos, Switzerland Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Lukas Kamer
- AO Research Institute Davos, Davos, Switzerland
| | - Takeshi Sawaguchi
- Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan
| | | | | | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
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Engelke K, Lang T, Khosla S, Qin L, Zysset P, Leslie WD, Shepherd JA, Shousboe JT. Clinical Use of Quantitative Computed Tomography-Based Advanced Techniques in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part III. J Clin Densitom 2015; 18:393-407. [PMID: 26277853 DOI: 10.1016/j.jocd.2015.06.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 01/22/2023]
Abstract
The International Society for Clinical Densitometry (ISCD) has developed new official positions for the clinical use of computed tomography (CT) scans acquired without a calibration phantom, for example, CT scans obtained for other diagnosis such as colonography. This also addresses techniques suggested for opportunistic screening of osteoporosis. The ISCD task force for quantitative CT reviewed the evidence for clinical applications of these new techniques and presented a report with recommendations at the 2015 ISCD Position Development Conference. Here we discuss the agreed upon ISCD official positions with supporting medical evidence, rationale, controversy, and suggestions for further study. Advanced techniques summarized as statistical parameter mapping methods were also reviewed. Their future use is promising but the clinical application is premature. The clinical use of QCT of the hip is addressed in part I and of finite element analysis of the hip and spine in part II.
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Affiliation(s)
- Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany; Bioclinica, Hamburg, Germany.
| | - Thomas Lang
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - Sundeep Khosla
- Center for Clinical and Translational Science, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Philippe Zysset
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - John T Shousboe
- Park Nicollet Clinic/HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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Liebl H, Garcia EG, Holzner F, Noel PB, Burgkart R, Rummeny EJ, Baum T, Bauer JS. In-vivo assessment of femoral bone strength using Finite Element Analysis (FEA) based on routine MDCT imaging: a preliminary study on patients with vertebral fractures. PLoS One 2015; 10:e0116907. [PMID: 25723187 PMCID: PMC4344329 DOI: 10.1371/journal.pone.0116907] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 12/16/2014] [Indexed: 01/26/2023] Open
Abstract
Purpose To experimentally validate a non-linear finite element analysis (FEA) modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT) data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD) measurements as gold standard. Methods One fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects. Results In-vitro simulations showed good correlation with the experimentally measured strains both in stance (R2 = 0.963) and fall configuration (R2 = 0.976). The simulated maximum stress overestimated the experimental failure load (4743 N) by 14.7% (5440 N) while the simulated maximum strain overestimated by 4.7% (4968 N). The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366), but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028). Conclusion FEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our data suggests, that MDCT derived FEA models may assess bone strength more accurately than BMD measurements alone, providing a valuable in-vivo fracture risk assessment tool.
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Affiliation(s)
- Hans Liebl
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Eduardo Grande Garcia
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany; Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Fabian Holzner
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Peter B Noel
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Rainer Burgkart
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Thomas Baum
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Jan S Bauer
- Section of Neuroradiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
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Link TM, Lang TF. Axial QCT: clinical applications and new developments. J Clin Densitom 2014; 17:438-48. [PMID: 24880494 DOI: 10.1016/j.jocd.2014.04.119] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/22/2023]
Abstract
Quantitative computed tomography (QCT) is currently undergoing a renaissance, with an increasing number of studies being published and the definition of both QCT-specific osteoporosis thresholds and treatment criteria. Compared with dual-energy X-ray absorptiometry, the current standard bone mineral density technique, QCT has a number of pertinent advantages, including volumetric measurements, less susceptibility to degenerative spine changes, and higher sensitivity to changes in bone mass. Disadvantages include the higher radiation doses and less experience with fracture prediction and therapy monitoring. Over the last 10 yr, a number of novel applications have been described allowing assessment of bone mineral density and bone quality in larger patient populations, developments that may substantially improve patient care.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Intravenous contrast injection significantly affects bone mineral density measured on CT. Eur Radiol 2014; 25:283-9. [PMID: 25187384 DOI: 10.1007/s00330-014-3408-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 08/12/2014] [Accepted: 08/21/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective is to evaluate the effect of intravenous contrast media on bone mineral density (BMD) assessment by comparing unenhanced and contrast-enhanced computed tomography (CT) examinations performed for other indications. METHODS One hundred and fifty-two patients (99 without and 53 with malignant neoplasm) who underwent both unenhanced and two contrast-enhanced (arterial and portal venous phase) abdominal CT examinations in a single session between June 2011 and July 2013 were included. BMD was evaluated on the three examinations as CT-attenuation values in Hounsfield Units (HU) in the first lumbar vertebra (L1). RESULTS CT-attenuation values were significantly higher in both contrast-enhanced phases, compared to the unenhanced phase (p < 0.01). In patients without malignancies, mean ± standard deviation (SD) HU-values increased from 128.8 ± 48.6 HU for the unenhanced phase to 142.3 ± 47.2 HU for the arterial phase and 147.0 ± 47.4 HU for the portal phase (p < 0.01). In patients with malignancies, HU-values increased from 112.1 ± 38.1 HU to 126.2 ± 38.4 HU and 130.1 ± 37.3 HU (p < 0.02), respectively. With different thresholds to define osteoporosis, measurements in the arterial and portal phase resulted in 7-25% false negatives. CONCLUSIONS Our study showed that intravenous contrast injection substantially affects BMD-assessment on CT and taking this into account may improve routine assessment of low BMD in nonquantitative CT. KEY POINTS • Routine CT may gain a role in bone attenuation measurements for osteoporosis • Contrast media injection has substantial influence on CT-derived bone density • Contrast-enhanced CT leads to underestimation of osteoporosis compared to unenhanced CT • Adjusting for contrast injection phase may improve CT screening protocols for osteoporosis.
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Schwaiger BJ, Gersing AS, Baum T, Noël PB, Zimmer C, Bauer JS. Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol 2014; 35:1628-33. [PMID: 24627455 DOI: 10.3174/ajnr.a3893] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Established methods of assessing bone mineral density are associated with additional radiation exposure to the patient. In this study, we aimed to validate a method of assessing bone mineral density in routine multidetector row CT of the lumbar spine. MATERIALS AND METHODS In 38 patients, bone mineral density was assessed in quantitative CT as a standard of reference and in sagittal reformations derived from standard multidetector row CT studies without IV contrast. MDCT-to-quantitative CT conversion equations were calculated and then applied to baseline multidetector row scans of another 62 patients. After a mean follow-up of 15 ± 6 months, patients were re-assessed for incidental fractures and screw loosening after spondylodesis (n = 49). RESULTS We observed conversion equations bone mineral densityMDCT = 0.78 × Hounsfield unitMDCTmg/mL (correlation with bone mineral densityquantitative CT, R(2) = 0.92, P < .001) for 120 kV(peak) tube voltage and bone mineral densityMDCT = 0.86 × Hounsfield unitMDCTmg/mL (R(2) = 0.81, P < .001) for 140 kVp, respectively. Seven patients (11.3%) had existing osteoporotic vertebral fractures at baseline, while 8 patients (12.9%) showed incidental osteoporotic vertebral fractures. Screw loosening was detected in 28 patients (57.1% of patients with spondylodesis). Patients with existing vertebral fractures showed significantly lower bone mineral densityMDCT than patients without fractures (P < .01). At follow-up, patients with incidental fractures and screw loosening after spondylodesis, respectively, showed significantly lower baseline bone mineral densityMDCT (P < .001 each). CONCLUSIONS This longitudinal study demonstrated that converted bone mineral density values derived from routine lumbar spine multidetector row CT adequately differentiated patients with and without osteoporotic fractures and could predict incidental fractures and screw loosening after spondylodesis.
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Affiliation(s)
- B J Schwaiger
- From the Abteilung für Neuroradiologie (B.J.S., A.S.G., C.Z., J.S.B.)
| | - A S Gersing
- From the Abteilung für Neuroradiologie (B.J.S., A.S.G., C.Z., J.S.B.)
| | - T Baum
- Institut für Radiologie (T.B., P.B.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - P B Noël
- Institut für Radiologie (T.B., P.B.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - C Zimmer
- From the Abteilung für Neuroradiologie (B.J.S., A.S.G., C.Z., J.S.B.)
| | - J S Bauer
- From the Abteilung für Neuroradiologie (B.J.S., A.S.G., C.Z., J.S.B.)
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Ojanen X, Borra RJH, Havu M, Cheng SM, Parkkola R, Nuutila P, Alen M, Cheng S. Comparison of vertebral bone marrow fat assessed by 1H MRS and inphase and out-of-phase MRI among family members. Osteoporos Int 2014; 25:653-62. [PMID: 23943163 DOI: 10.1007/s00198-013-2472-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/24/2013] [Indexed: 12/11/2022]
Abstract
UNLABELLED Inphase and out-of-phase magnetic resonance imaging is a robust and fast method which can provide similar vertebral bone marrow fat estimation as (1)H proton magnetic resonance spectroscopy, indicating that this technique is a potentially useful tool in both research and clinical practice. INTRODUCTION The importance of evaluating bone marrow fat lies in the fact that osteoporosis and obesity, two disorders of body composition, are growing in prevalence. Bone fat mass can be reliably assessed using proton magnetic resonance spectroscopy ((1)H MRS), but this method is technically demanding and needs advanced post-processing unlike inphase and out-of-phase magnetic resonance imaging (MRI), which is a robust and fast method. METHODS We compared vertebral bone marrow fat (BMF) content assessed by inphase and out-of-phase MRI and (1)H MRS using a 1.5-T MRI scanner in mothers (n = 34, aged 49.4 years), fathers (n = 31, aged 53.1 years) and their daughters (n = 40, aged 20.3 years) who participated in the CALEX family study. Signal intensity on the inphase and out-of-phase MRI was analyzed from the same location and size of the single-voxel (1)H MRS measurement. RESULTS Positive correlations were found between (1)H MRS and inphase and out-of-phase MRI in the axial plane (r = 0.746, p < 0.001) and sagittal plane (r = 0.804, p < 0.001). The mean differences between (1)H MRS and inphase and out-of-phase MRI in the axial and sagittal planes were relatively small, at 4.13 and 2.67 %, and the agreement between techniques was 89.4 and 93.2 %, respectively. Girls had a significantly lower vertebral BMF than mothers and fathers with both methods (for all, p < 0.001). CONCLUSIONS We conclude that inphase and out-of-phase MRI can provide similar vertebral BMF estimation as (1)H MRS, indicating that this technique is a potentially useful tool in both research and clinical practice.
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Affiliation(s)
- X Ojanen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, 40014, Finland,
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Acu K, Scheel M, Issever AS. Time dependency of bone density estimation from computed tomography with intravenous contrast agent administration. Osteoporos Int 2014; 25:535-42. [PMID: 23877871 DOI: 10.1007/s00198-013-2440-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 07/03/2013] [Indexed: 01/22/2023]
Abstract
UNLABELLED Our study has demonstrated that in contrast-enhanced multi-detector computed tomography (MDCT)-based bone density measurements, the scan delay time after contrast agent administration is a statistically significant variable for the derivation of quantitative computed tomography (QCT)-equivalent bone mineral density (BMD) values. INTRODUCTION Earlier investigators have proposed to derive QCT-equivalent BMD values from contrast-enhanced MDCT scans by using a merely density-based conversion equation. The purpose of this study was to investigate whether the scan delay after intravenous (IV) contrast agent administration might affect BMD values derived in this way. METHODS A retrospective data analysis was performed on 198 subjects who underwent standardized biphasic MDCT. Average densities values (in Hounsfield units) of lumbar vertebral bodies 1 to 3 (L1-L3) were compared between phases I and II of the biphasic MDCT scan. Furthermore, QCT-equivalent BMD (BMDQCT) values were calculated using a previously published conversion equation. RESULTS Paired t-test analysis revealed that IV contrast agent administration leads to a statistically significant increase (8.6 %; p < 0.0001) in overall density of L1-L3 from phases I to II. Moreover, comparison of BMDQCT values between phases I and II reveals a change from osteoporotic to osteopenic in 4.5 % of the study population and from osteopenic to normal for 11.1 % of the subjects. Furthermore, it was revealed that the density increase from phases I to II shows a weak, yet statistically significant (p < 0.001) age dependency. CONCLUSIONS Our study demonstrates that the use of a mere density-based conversion equation for deriving BMDQCT from MDCT scans ignores time dependency as an important variable. Furthermore, our results indicate that the actual age-dependent BMD itself might be another relevant variable that needs to be included in a MDCT-to-QCT conversion equation.
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Affiliation(s)
- K Acu
- Department of Radiology, Charite Campus Mitte, Universitaetsmedizin Berlin, Berlin, Germany
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Gruber M, Bauer JS, Dobritz M, Beer AJ, Wolf P, Woertler K, Rummeny EJ, Baum T. Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry. Eur Radiol 2012; 23:505-12. [PMID: 22932742 DOI: 10.1007/s00330-012-2629-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/13/2012] [Accepted: 07/25/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. METHODS Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. RESULTS A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD(MDCT) values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 × BMD(MDCT) - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 × BMD(MDCT) - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). CONCLUSION BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures.
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Affiliation(s)
- M Gruber
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Baum T, Müller D, Dobritz M, Wolf P, Rummeny EJ, Link TM, Bauer JS. Converted lumbar BMD values derived from sagittal reformations of contrast-enhanced MDCT predict incidental osteoporotic vertebral fractures. Calcif Tissue Int 2012; 90:481-7. [PMID: 22484555 DOI: 10.1007/s00223-012-9596-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/20/2012] [Indexed: 01/13/2023]
Abstract
We obtained baseline and follow-up bone mineral density (BMD) values of the lumbar spine from sagittal reformations of routine abdominal contrast-enhanced multidetector computed tomography (MDCT) using a reference phantom and assessed their performance in differentiating patients with no, existing, and incidental osteoporotic fractures of the spine. A MDCT-to-QCT (quantitative computed tomography) conversion equation for lumbar BMD measurements was developed by using 15 postmenopausal women (63 ± 12 years), who underwent standard lumbar QCT (L1-L3) and afterward routine abdominal contrast-enhanced MDCT. Sagittal reformations were used for corresponding lumbar BMD measurements. The MDCT-to-QCT conversion equation was applied to baseline and follow-up routine abdominal contrast-enhanced MDCT scans of 149 postmenopausal women (63 ± 10 years). Their vertebral fracture status (no, existing, or incidental osteoporotic fracture) was assessed in the sagittal reformations. A correlation coefficient of r = 0.914 (p < 0.001) was calculated for the BMD values of MDCT and standard QCT with the conversion equation BMD(QCT) = 0.695 × BMD(MDCT) - 7.9 mg/mL. Mean follow-up time of the 149 patients was 20 ± 12 months. Fifteen patients (10.1 %) had an existing osteoporotic vertebral fracture at baseline. Incidental osteoporotic vertebral fractures were diagnosed in 13 patients (8.7 %). Patients with existing and incidental fractures showed significantly (p < 0.05) lower converted BMD values (averaged over L1-L3) than patients without fracture at baseline and at follow-up. In this longitudinal study, BMD values of the lumbar spine derived from sagittal reformations of routine abdominal contrast-enhanced MDCT predicted incidental osteoporotic vertebral fractures.
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Affiliation(s)
- Thomas Baum
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318256e7f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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