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Reschke P, Koch V, Mahmoudi S, Gotta J, Höhne E, Booz C, Yel I, Scholtz JE, Martin SS, Gruber-Rouh T, Eichler K, Vogl TJ, Gruenewald LD. Diagnostic Accuracy of Dual-Energy CT-Derived Metrics for the Prediction of Osteoporosis-Associated Fractures. Acad Radiol 2024:S1076-6332(24)00444-6. [PMID: 39117465 DOI: 10.1016/j.acra.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/02/2024] [Accepted: 07/07/2024] [Indexed: 08/10/2024]
Abstract
RATIONALE AND OBJECTIVES This study aimed to compare the diagnostic value of dual-energy CT (DECT)-based volumetric material decomposition with that of Hounsfield units (HU)-based values and cortical thickness ratio for predicting the 2-year risk of osteoporosis-associated fractures. METHODS The L1 vertebrae of 111 patients (55 men, 56 women; median age, 62 years) who underwent DECT between 01/2015 and 12/2018 were retrospectively analyzed. For phantomless bone mineral density (BMD) assessment, a specialized DECT postprocessing software employing material decomposition was utilized. The digital records of all patients were monitored for two years after the DECT scans to track the incidence of osteoporotic fractures. Diagnostic accuracy parameters were calculated for all metrics using receiver-operating characteristic (ROC) and precision-recall (PR) curves. Logistic regression models were used to determine associations of various predictive metrics with the occurrence of osteoporotic fractures. RESULTS Patients who sustained one or more osteoporosis-associated fractures in a 2-year interval were significantly older (median age 74.5 years [IQR 57-83 years]) compared those without such fractures (median age 50.5 years [IQR 38.5-69.5 years]). According to logistic regression models, DECT-derived BMD was the sole predictive parameter significantly associated with osteoporotic fracture occurrence across all age groups. ROC and PR curve analyses confirmed the highest diagnostic accuracy for DECT-based BMD, with an area under the curve (AUC) of 0.95 [95% CI: 0.89-0.98] for the ROC curve and an AUC of 0.96 [95% CI: 0.85-0.99] for the PR curve. CONCLUSION The diagnostic performance of DECT-based BMD in predicting the 2-year risk of osteoporotic fractures is greater than that of HU-based metrics and the cortical thickness ratio. DECT-based BMD values are highly valuable in identifying patients at risk for osteoporotic fractures.
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Affiliation(s)
- Philipp Reschke
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany.
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Elena Höhne
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
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Reschke P, Gotta J, Stahl A, Koch V, Mader C, Martin SS, Scholtz JE, Booz C, Yel I, Hescheler DA, Gruber-Rouh T, Eichler K, Vogl TJ, Gruenewald LD. Value of Dual-Energy CT-Derived Metrics for the Prediction of Bone Non-union in Distal Radius Fractures. Acad Radiol 2024; 31:3336-3345. [PMID: 38461052 DOI: 10.1016/j.acra.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
RATIONALE AND OBJECTIVES Bone non-union is a serious complication of distal radius fractures (DRF) that can result in functional limitations and persistent pain. However, no accepted method has been established to identify patients at risk of developing bone non-union yet. This study aimed to compare various CT-derived metrics for bone mineral density (BMD) assessment to identify predictive values for the development of bone non-union. MATERIALS AND METHODS CT images of 192 patients with DRFs who underwent unenhanced dual-energy CT (DECT) of the distal radius between 03/2016 and 12/2020 were retrospectively identified. Available follow-up imaging and medical health records were evaluated to determine the occurrence of bone non-union. DECT-based BMD, trabecular Hounsfield unit (HU), cortical HU and cortical thickness ratio were measured in normalized non-fractured segments of the distal radius. RESULTS Patients who developed bone non-union were significantly older (median age 72 years vs. 54 years) and had a significantly lower DECT-based BMD (median 68.1 mg/cm3 vs. 94.6 mg/cm3, p < 0.001). Other metrics (cortical thickness ratio, cortical HU, trabecular HU) showed no significant differences. ROC and PR curve analyses confirmed the highest diagnostic accuracy for DECT-based BMD with an area under the curve (AUC) of 0.83 for the ROC curve and an AUC of 0.46 for the PR curve. In logistic regression models, DECT-based BMD was the sole metric significantly associated with bone non-union. CONCLUSION DECT-derived metrics can accurately predict bone non-union in patients who sustained DRF. The diagnostic performance of DECT-based BMD is superior to that of HU-based metrics and cortical thickness ratio.
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Affiliation(s)
- Philipp Reschke
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adrian Stahl
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christoph Mader
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel A Hescheler
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
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Fuggle NR, Curtis EM, Ward KA, Harvey NC, Dennison EM, Cooper C. Fracture prediction, imaging and screening in osteoporosis. Nat Rev Endocrinol 2019; 15:535-547. [PMID: 31189982 DOI: 10.1038/s41574-019-0220-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Osteoporosis is associated with increased fragility of bone and a subsequent increased risk of fracture. The diagnosis of osteoporosis is intimately linked with the imaging and quantification of bone and BMD. Scanning modalities, such as dual-energy X-ray absorptiometry or quantitative CT, have been developed and honed over the past half century to provide measures of BMD and bone microarchitecture for the purposes of clinical practice and research. Combined with fracture prediction tools such as Fracture Risk Assessment Tool (FRAX) (which use a combination of clinical risk factors for fracture to provide a measure of risk), these elements have led to a paradigm shift in the ability to diagnose osteoporosis and predict individuals who are at risk of fragility fracture. Despite these developments, a treatment gap exists between individuals who are at risk of osteoporotic fracture and those who are receiving therapy. In this Review, we summarize the epidemiology of osteoporosis, the history of scanning modalities, fracture prediction tools and future directions, including the most recent developments in prediction of fractures.
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Affiliation(s)
- Nicholas R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
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Gargiulo P, Edmunds KJ, Gíslason MK, Latour C, Hermannsson Þ, Esposito L, Bifulco P, Cesarelli M, Fraldi M, Cristofolini L, Jónsson H. Patient-specific mobility assessment to monitor recovery after total hip arthroplasty. Proc Inst Mech Eng H 2018; 232:1048-1059. [PMID: 30191747 DOI: 10.1177/0954411918797971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Total hip arthroplasty is a ubiquitously successful orthopedic surgical procedure, whose prevalence is rising worldwide. While many investigations focus on characterizing periprosthetic pathophysiology, the objective of our research is to develop and describe multi-metric assemblies as a first step toward creating a patient-specific mobility index that rehabilitators and orthopedic surgeons can utilize for prescribing their respective procedures. In total, 48 total hip arthroplasty patients (both cemented and uncemented) undergoing unilateral, primary surgery went through computed tomographic scans and gait analysis measurements both before and 1 year following their surgery. Altogether, the reported quantitative metrics include 11 spatial and temporal gait parameters, muscle density, and electromyography signals from the rectus femoris, vastus lateralis, and vastus medialis, and bone mineral density values from bioimage analysis around the implant stem. We found that measured parameters from a subgroup were sensitive to changes observed during patient recovery, implicating the predictive sensitivity of these patient conditions. Most post-operative gait parameters changed significantly, while electromyography data indicated few significant differences. Moreover, results from bioimage analyses indicate a general reduction of periprosthetic bone mineral density after 1 year, in association with increasing density of the quadriceps muscles. Furthermore, this work identifies which quantitative metrics undergo the greatest variation after total hip arthroplasty and demonstrates the clinical feasibility of a multimodal approach to mobility assessment that may ultimately support decision-making for post-surgical rehabilitation protocols.
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Affiliation(s)
- Paolo Gargiulo
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland.,2 Department of Science, Landspítali University Hospital, Reykjavík, Iceland
| | - Kyle Joseph Edmunds
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
| | - Magnús K Gíslason
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
| | - Chase Latour
- 3 Washington University in St. Louis, St. Louis, MO, USA
| | - Þröstur Hermannsson
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
| | - Luca Esposito
- 4 Department of Structures for Engineering and Architecture, University of Naples Federico II, Naples, Italy
| | - Paolo Bifulco
- 5 Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Naples, Italy
| | - Mario Cesarelli
- 5 Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Naples, Italy
| | - Massimiliano Fraldi
- 4 Department of Structures for Engineering and Architecture, University of Naples Federico II, Naples, Italy.,6 Interdisciplinary Research Centre for Biomaterials, University of Naples Federico II, Naples, Italy
| | - Luca Cristofolini
- 7 Department of Industrial Engineering, University of Bologna, Bologna, Italy
| | - Halldór Jónsson
- 8 Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,9 Orthopedic Clinic, Landspítali University Hospital, Reykjavík, Iceland
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