CT-scout based, semi-automated vertebral morphometry after digital image enhancement

Reliability of semi-automated spinal measurement software

PURPOSE

In the treatment of patients with adult spinal deformity, analysis of spinopelvic balance is essential in clinical assessment and surgical planning. There is currently no gold standard for measurement, whether done by hand or with digital software. New semi-automated software exists that purports to increase efficiency, but its reliability is unknown in the literature.

METHODS

Full spine X-rays were retrospectively reviewed from 25 adult patients seen between 2014 and 2017. Patients were included if they had > 5 cm of sagittal imbalance and radiographs of sufficient quality to perform balance measurements, without prior surgical spinal fusion and/or instrumentation. Spinopelvic parameters were measured in two radiographic programs: one with basic, non-spine-specific measurement tools (eUnity, Client Outlook, Waterloo, Canada); and a second with spine-specific semi-automated measurement tools (Sectra, Sectra AB, Linköping, Sweden). Balance parameters included SVA, PI, PT, and LL. Data were compared by examining inter-rater and inter-program reliability using interclass correlation coefficient (ICC).

RESULTS

The subjects' mean age was 67.9 ± 13.8 years old, and 32% were male. The inter-program reliability was strong, with ICC values greater than 0.91 for each parameter. Similarly, there was strong inter-observer reliability with ICC values greater than 0.88. These results persisted on delayed repeat measurement (p < 0.001 for all measurements).

CONCLUSION

There is excellent inter-observer and inter-program reliability between the basic PACS and semi-automated programs. These data demonstrate that the purported efficiency of semi-automated measurement programs does not come at the cost of measurement reliability.

A Quantitative Analysis of Bone Lamellarity and Bone Collagen Linearity Induced by Distinct Dosing and Frequencies of Teriparatide Administration in Ovariectomized Rats and Monkeys

The lamellar structure of bone, which endows biomechanical rigidity to support the host organism, is observed in mammals, including humans. It is therefore essential to develop a quantitative analysis to evaluate the lamellarity of bone, which would especially be useful for the pharmacological evaluation of anti-osteoporotic drugs. This study applied a current system for the semi-automatic recognition of fluorescence signals to the analysis of un-decalcified bone sections from rat and monkey specimens treated with teriparatide (TPTD). Our analyses on bone formation pattern and collagen topology indicated that TPTD augmented bone lamellarity and bone collagen linearity, which were possibly associated with the recovery of collagen cross-linking, thus endowing bone rigidity.

New Developments in Fracture Risk Assessment for Current Osteoporosis Reports

PURPOSE OF REVIEW

Identifying individuals at high fracture risk can be used to target those likely to derive the greatest benefit from treatment. This narrative review examines recent developments in using specific risk factors used to assess fracture risk, with a focus on publications in the last 3 years.

RECENT FINDINGS

There is expanding evidence for the recognition of individual clinical risk factors and clinical use of composite scores in the general population. Unfortunately, enthusiasm is dampened by three pragmatic randomized trials that raise questions about the effectiveness of widespread population screening using clinical fracture prediction tools given suboptimal participation and adherence. There have been refinements in risk assessment in special populations: men, patients with diabetes, and secondary causes of osteoporosis. New evidence supports the value of vertebral fracture assessment (VFA), high resolution peripheral quantitative CT (HR-pQCT), opportunistic screening using CT, skeletal strength assessment with finite element analysis (FEA), and trabecular bone score (TBS). The last 3 years have seen important developments in the area of fracture risk assessment, both in the research setting and translation to clinical practice. The next challenge will be incorporating these advances into routine work flows that can improve the identification of high risk individuals at the population level and meaningfully impact the ongoing crisis in osteoporosis management.