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SOGAWA T, YAMAGUCHI F, MISUMI K, FUJIKI M. Evaluation of cortical bone strength using a quantitative ultrasound measurement device in dogs. J Vet Med Sci 2024; 86:325-332. [PMID: 38311401 PMCID: PMC10963094 DOI: 10.1292/jvms.23-0285] [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: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
This study was performed to evaluate cortical bone strength in dogs using a quantitative ultrasound measurement device. In this study, 16 clinically healthy dogs with no lameness underwent measurement of the ultrasound propagation velocity of cortical bone (namely, speed of sound [SOS]) at the radius and tibia. Additionally, computed tomography examination with a calibration phantom was performed in 10 dogs. We calculated the bone mineral density (BMD) and Young's modulus from the computed tomography data using bone strength evaluation software. SOS, BMD, and Young's modulus were statistically compared between the radius and tibia. In addition, we examined the correlation between SOS and BMD and between SOS and Young's modulus. We also examined the correlation between SOS and age in the 13 dogs whose age was known. BMD and Young's modulus were not significantly different between the radius and tibia, but SOS was significantly different (P<0.05). Moreover, SOS and BMD showed a positive correlation in both radius and tibia. Similarly, SOS and Young's modulus showed a positive correlation. In addition, SOS and age showed a strong positive correlation (radius: r=0.77, P<0.05, tibia: r=0.83, P<0.05). Our finding that SOS of the radius and tibia cortical bone was correlated with BMD and Young's modulus indicates that quantitative ultrasound can be useful for evaluating cortical bone strength in dogs.
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Affiliation(s)
- Takeshi SOGAWA
- Veterinary Teaching Hospital, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Fumi YAMAGUCHI
- Veterinary Teaching Hospital, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Kazuhiro MISUMI
- Laboratory of Surgery, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Makoto FUJIKI
- Veterinary Teaching Hospital, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
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Fu Y, Li C, Luo W, Chen Z, Liu Z, Ding Y. Fragility fracture discriminative ability of radius quantitative ultrasound: a systematic review and meta-analysis. Osteoporos Int 2021; 32:23-38. [PMID: 32728897 PMCID: PMC7755656 DOI: 10.1007/s00198-020-05559-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/21/2020] [Indexed: 01/11/2023]
Abstract
The fragility fracture discriminative ability of radius quantitative ultrasound (QUS) was evaluated in a systematic review of 13 studies, including 16,681 individuals and 1296 fractures. The radial speed of sound (SOS) per standard deviation (SD) decrease contributed to an increased risk of total and hip fracture by 32% and 66% in women. Osteoporotic fracture, as a devastating consequence of osteoporosis, brings severe socio-economic burden. The availability of dual-energy X-ray absorptiometry (DXA), as the gold standard of diagnosis, was quite limited in remote areas. Radius QUS measured by SOS shows potential in fracture discriminative ability where DXA equipment is not available. This study aimed to provide a comprehensive evaluation of the association between radius QUS and fracture risk. A detailed article search was carried out on PubMed, EMBASE, Cochrane Libraries, CNKI, Wan-Fang database, VIP, and SinoMed for studies published between January 1980 and February 2020. We determined the estimated relative risk (RR) for fracture per each radial SOS SD decrease. A meta-analysis of studies was performed under the random-effects model. A total of 16,681 individuals were included in this review. Among the participants, 5892 were male and 10,789 were female. A total of 1296 cases of fragility fracture were included. With each SD decrease in radial SOS, the risk of overall fragility fracture and hip fracture was increased by 21% and 55%, respectively. Particularly, the risk was increased by 32% and 66% for women. The association was even stronger for postmenopausal women. Radius QUS showed great potential as an effective tool for fracture risk evaluation, especially for women.
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Affiliation(s)
- Y Fu
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - C Li
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - W Luo
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Z Chen
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Z Liu
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Y Ding
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.
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Godebo TR, Jeuland M, Tekle-Haimanot R, Shankar A, Alemayehu B, Assefa G, Whitford G, Wolfe A. Bone quality in fluoride-exposed populations: A novel application of the ultrasonic method. Bone Rep 2020; 12:100235. [PMID: 31890757 PMCID: PMC6933268 DOI: 10.1016/j.bonr.2019.100235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Various studies, mostly with animals, have provided evidence of adverse impacts of fluoride (F-) on bone density, collagen and microstructure, yet its effects on overall bone quality (strength) has not been clearly or extensively characterized in human populations. OBJECTIVE In this observational study, we assessed variation in an integrated measures of bone quality in a population exposed to wide-ranging F- levels (0.3 to 15.5 mg/L) in drinking water, using a novel application of non-ionizing ultrasonic method. METHOD We collected 871 speed of sound (SOS) measurements from 341 subjects residing in 25 communities, aged 10-70 years (188 males and 153 females). All subjects received scans of the cortical radius and tibia, and adults over the age of 19 received an additional scan of the phalanx. Associations between F- in drinking water and 24-h urine samples, and SOS as a measure of bone quality, were evaluated in bivariate and multivariable regressions adjusting for age, sex, BMI, smoking, and toothpaste use. RESULTS We found negative associations between F- exposure and bone quality at all three bones. Adult tibial SOS showed the strongest inverse association with F- exposure, which accounted for 20% of the variance in SOS measures (r = 0.45; n = 199; p < 0.0001). In adjusted analysis, a 1 mg/L increase in F- in drinking water was related to a reduction of 15.8 m/s (95% CI: -21.3 to -10.3), whereas a 1 mg/L increase in 24-h urinary F- (range: 0.04-39.5 mg/L) was linked to a reduction of 8.4 m/s (95% CI: -12.7, -4.12) of adult tibial SOS. Among adolescents, in contrast, weaker and non-significant inverse associations between F- exposure and SOS were found, while age, gender, and BMI were more significant predictors than in adults. CONCLUSIONS These results are indicative of a fluoride-induced deterioration of bone quality in humans, likely reflecting a combination of factors related to SOS: net bone loss, abnormal mineralization and collagen formation, or altered microarchitecture. The portable and low-cost ultrasound technique appears potentially useful for assessment of bone quality, and should be tested in other locations and for other bone-related disorders, to assess the feasibility of its more extensive diagnostic use in hard-to-reach rural regions.
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Key Words
- BMI, Body Mass Index
- Bone biomarker
- Bone quality
- Ethiopian Rift Valley
- F-, qFluoride
- Fluoride exposure
- IRB, Institutional Review Board
- ISE, Ion Selective Electrode
- MER, Main Ethiopian Rift
- NOAEL, No-Observed-Adverse-Effects-Level
- Quantitative ultrasound
- SOS, Speed of Sound
- Speed of sound
- TISAB, Total Ionic Strength Adjuster Buffer
- U.S. EPA, U.S. Environmental Protection Agency
- U.S. NRC, U.S. National Research Institute
- WHO, World Health Organization
- bw, body weight
- mg/L, milligram per liter
- mg/kg bw/day, milligram per kilogram body weight per day
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Affiliation(s)
- Tewodros Rango Godebo
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112 USA
| | - Marc Jeuland
- Sanford School of Public Policy, Duke University, Durham, NC 27708 USA
| | - Redda Tekle-Haimanot
- Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Arti Shankar
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112 USA
| | - Biniyam Alemayehu
- Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Assefa
- Department of Radiology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gary Whitford
- Department of Oral Biology, College of Dental Medicine, Augusta University, Augusta, GA, USA
| | - Amy Wolfe
- Kentucky Geological Survey, University of Kentucky, KY, USA
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Vogl F, Friesenbichler B, Hüsken L, Kramers-de Quervain IA, Taylor WR. Can low-frequency guided waves at the tibia paired with machine learning differentiate between healthy and osteopenic/osteoporotic subjects? A pilot study. ULTRASONICS 2019; 94:109-116. [PMID: 30660337 DOI: 10.1016/j.ultras.2018.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/04/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE Axial transmission quantitative acoustics (ax-QA) has shown to be a promising tool for assessing bone health and properties in a safe, inexpensive, and portable manner. This study investigated the efficacy of low-frequency ax-QA measured at the tibia, paired with a support vector machine (SVM) approach for combining multiple acoustic indicators, to diagnose osteoporosis as defined by bone mineral density. METHODS This pilot study measured 41 female subjects using ax-QA (flexural mode, 3 kHz) at the tibia and using dual X-ray absorptiometry (DXA) at the lumbar spine, femoral neck, and distal radius. For each location, a threshold classifier and SVM were trained to differentiate between healthy and non-healthy subjects based on the phase velocity at different frequencies. Receiver Operating Characteristics and area under curve values (AUC) were used to assess the classifiers' performances for various thresholds and class-weights. RESULTS The SVM outperformed the threshold classifier for all three bone locations at low false positive rates. While differentiation between healthy and non-healthy bone states was poor for the spine (AUC: 0.56 ± 0.04), good to moderate performances were observed for the radius (AUC: 0.83 ± 0.03) and hip (AUC: 0.71 ± 0.04). CONCLUSIONS Low-frequency ax-QA has demonstrated potential for complementing DXA in screening for osteoporosis at the radius and hip. Through further addition of acoustic indicators ax-QA could provide a diagnostic alternative in third-world countries, and bring bone health screening and monitoring into the hands of clinicians and general health practitioners everywhere.
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Affiliation(s)
- Florian Vogl
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland.
| | | | - Laura Hüsken
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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Tabor E, Pluskiewicz W, Tabor K. Clinical Conformity Between Heel Ultrasound and Densitometry in Postmenopausal Women: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:363-369. [PMID: 28777482 DOI: 10.1002/jum.14340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the conformity between heel ultrasound and densitometry, and the clinical application of densitometry T-score "gold standard" in quantitative ultrasound as a method of osteoporosis diagnosis in postmenopausal women. METHODS The study is a systematic review of studies published in the last 17 years in PubMed, NLM Gateway, Medline, Embase, and Cochrane Library. Calcaneal quantitative ultrasound sensitivity and specificity were analyzed with regard to densitometry measurements in postmenopausal women. In addition, we summarized the values of ultrasound T-scores, for which their accuracy in osteoporosis diagnosis is the highest. RESULTS The inclusion criteria met 15 research studies conducted on postmenopausal women. In 11 of them, the authors concluded that clinical conformity between heel ultrasound and densitometry is good. The recommended quantitative ultrasound T-score for osteoporosis diagnosis ranged between -1 and -3.65. CONCLUSIONS Heel ultrasound should be considered to be as accurate as densitometry in diagnosing osteoporosis. Nevertheless, it needs to have separate T-score ranges determined, because those used in densitometry are not adequate.
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Affiliation(s)
- Elżbieta Tabor
- School of Medicine, Division of Dentistry, Doctoral Studies, Medical University of Silesia in Katowice, Poland
| | - Wojciech Pluskiewicz
- Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry, Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Zabrze, Poland
| | - Kamil Tabor
- School of Medicine, Division of Dentistry, Doctoral Studies, Medical University of Silesia in Katowice, Poland
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Beattie A, Cournane S, Finucane C, Walsh JB, Stassen LFA. Quantitative Ultrasound of the Mandible as a Novel Screening Approach for Osteoporosis. J Clin Densitom 2018; 21:110-118. [PMID: 28943183 DOI: 10.1016/j.jocd.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/29/2017] [Accepted: 08/09/2017] [Indexed: 11/22/2022]
Abstract
This study used an axial transmission quantitative ultrasound (QUS) device to assess mandibular bone strength. The aim of the study was first to establish the precision and repeatability of the axial transmission QUS measurement for a range of mandibular anatomic sites, and second to investigate the ability of the modality to differentiate between osteoporotic subjects and a control group. Three groups of adult Caucasian women were recruited: (1) healthy premenopausal women (n = 26), (2) healthy postmenopausal women (n = 48), and (3) women with osteoporosis (n = 53). Subjects were excluded from groups 1 and 2 if they had any pre-existing bone conditions. Speed of sound (SOS) measurements were taken from the mandible using an OmniSense multisite QUS device. Group 3 had dual-energy X-ray absorptiometry scans of the lumbar spine and femur. The most suitable site on the mandible was determined by repeat SOS measurements in 10 healthy premenopausal subjects, at 5 different sites. The parasymphysis site had the lowest root mean squared coefficient of variation at 0.74%, and was chosen as the most suitable site for mandibular SOS measurements. Group 1 and group 2 had significantly higher mean SOS measurements than the osteoporotic subjects (group 3), with means of 3683 m/s (210), 3514 m/s (221), and 3312 m/s (264), respectively. A 1-way analysis of variance confirmed a statistically significant difference between mean SOS measurements from the 3 groups (p < 0.0001). Axial transmission QUS of the mandible can differentiate between subjects with osteoporosis and a healthy control group, and shows potential for use as a screening tool for osteoporosis.
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Affiliation(s)
- Anna Beattie
- Dept of Oral and Maxillofacial Surgery, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland.
| | - Seán Cournane
- Medical Physics and Bioengineering Dept, St James's Hospital, James's St, Dublin 8, Ireland
| | - Ciarán Finucane
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin 8, Ireland
| | - J Bernard Walsh
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland; Dept of Medical Gerontology, Trinity College Dublin, Ireland
| | - Leo F A Stassen
- Dept of Oral and Maxillofacial Surgery, St James's Hospital, Dublin 8, Ireland; Department of Oral and Maxillofacial Surgery, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland
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Thomsen K, Jepsen DB, Matzen L, Hermann AP, Masud T, Ryg J. Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis? Osteoporos Int 2015; 26:1459-75. [PMID: 25634771 DOI: 10.1007/s00198-014-3012-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022]
Abstract
Calcaneal quantitative ultrasound (QUS) is attractive as a prescreening tool for osteoporosis, alternative to dual-energy X-ray absorptiometry. We investigated the literature of the usability of calcaneal QUS. We found large heterogeneity between studies and uncertainty about cutoff, device, and measured variable. Despite osteoporosis-related fractures being a major health issue, osteoporosis remains underdiagnosed. Dual-energy X-ray absorptiometry (DXA) of the hip or spine is currently the preferred method for diagnosis of osteoporosis, but the method is limited by low accessibility. QUS is a method for assessing bone alternative to DXA. The aim of this systematic review was to explore the usability of QUS as a prescreen stratification tool for assessment of osteoporosis. Studies that evaluated calcaneal QUS with DXA of the hip or spine as the gold standard was included. We extracted data from included studies to calculate number of DXAs saved and misclassification rates at cutoffs equal to high sensitivity and/or specificity. The number of DXAs saved and percentage of persons misclassified were measures of usability. We included 31 studies. Studies were heterogeneous regarding study characteristics. Analyses showed a wide spectrum of percentage of DXAs saved (2.7-68.8%) and misclassification rates (0-12.4%) depending on prescreen strategy and study characteristics, device, measured variable, and cutoff. Calcaneal QUS is potentially useful as a prescreen tool for assessment of osteoporosis. However, there is no consensus of device, variable, and cutoff. Overall, there is no sufficient evidence to recommend a specific cutoff for calcaneal QUS that provides a certainty level high enough to rule in or out osteoporosis. Calcaneal QUS in a prescreen or stratification algorithm must be based on device-specific cutoffs that are validated in the populations for which they are intended to be used.
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Affiliation(s)
- K Thomsen
- Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29 Entrance 112, 7th floor, 5000, Odense C, Denmark,
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Olszynski WP, Brown JP, Adachi JD, Hanley DA, Ioannidis G, Davison KS. Multisite quantitative ultrasound for the prediction of fractures over 5 years of follow-up: the Canadian Multicentre Osteoporosis Study. J Bone Miner Res 2013; 28:2027-34. [PMID: 23519952 PMCID: PMC5096919 DOI: 10.1002/jbmr.1931] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 02/15/2013] [Accepted: 03/04/2013] [Indexed: 11/08/2022]
Abstract
This study assessed the ability of multisite quantitative ultrasound (mQUS) to predict fracture over a 5-year follow-up. Participants were a subset of the Canadian Multicentre Osteoporosis Study. mQUS-assessed speed of sound (SOS in m/s) at three sites (distal radius, tibia, and phalanx) and extensive questionnaires were completed, after which participants were followed for 5 years and incident fractures recorded. Two survival analyses were completed for each site--a univariate analysis and an adjusted multivariate analysis controlling for age, antiresorptive use, femoral neck bone mineral density, number of diseases, previous fractures, body mass index (BMI), parental history of hip fracture, current smoking, current alcoholic drinks >3 per day, current use of glucocorticoids, and rheumatoid arthritis diagnosis (variables from the FRAX 10-year fracture risk assessment tool). The unit of change for regression analyses was one standard deviation for all measurement sites, specific to site and sex. Separate analyses were completed for all clinical fractures, nonvertebral fractures, and hip fractures by sex. There were 2633 women and 1108 men included, and they experienced 204 incident fractures over 5 years (5.5% fractured). Univariate models revealed statistically significant (p < 0.05) predictive ability of mQUS for all three measurement sites for women alone for all three fracture types (one standard deviation decrease in SOS was associated with a 52% to 130% increase in the risk of fracture), but not for the men's group. The adjusted model found that measures at the distal radius and tibia in the women's group could significantly (p < 0.05) predict all clinical fractures and nonvertebral fractures within the next 5 years (one standard deviation decrease in SOS was associated with a 25% to 31% increase in the risk of fracture). mQUS provided significant 5-year clinical fracture prediction in women, independent of bone mineral density and other significant risk factors for fracture, when measured at the distal radius and tibia sites.
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Huang CM, Su CY, Chien LY, Guo JL. The effectiveness of an osteoporosis prevention program among women in Taiwan. Appl Nurs Res 2011; 24:e29-37. [DOI: 10.1016/j.apnr.2010.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 12/14/2009] [Accepted: 02/15/2010] [Indexed: 11/26/2022]
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Cook R, Curwen C, Tasker T, Zioupos P. Fracture toughness and compressive properties of cancellous bone at the head of the femur and relationships to non-invasive skeletal assessment measurements. Med Eng Phys 2010; 32:991-7. [DOI: 10.1016/j.medengphy.2010.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 06/21/2010] [Accepted: 06/25/2010] [Indexed: 01/26/2023]
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McFarlin BL, Bigelow TA, Laybed Y, O'Brien WD, Oelze ML, Abramowicz JS. Ultrasonic attenuation estimation of the pregnant cervix: a preliminary report. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:218-25. [PMID: 20629011 PMCID: PMC3038471 DOI: 10.1002/uog.7643] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Estimates of ultrasonic attenuation (the loss of energy as an ultrasonic wave propagates through tissue) have been used to evaluate the structure and function of tissues in health and disease. The purpose of this research was to develop a method to estimate ultrasonic cervical attenuation during human pregnancy using a clinical ultrasound system. METHODS Forty women underwent a cervical scan once during pregnancy with the Zonare z.one clinical ultrasound system using a 4-9-MHz endovaginal transducer. This ultrasound system provides access to radiofrequency (RF) image data for processing and analysis. In addition, a scan of a tissue-mimicking phantom with a known attenuation coefficient was acquired and used as a reference. The same settings and transducer used in the clinical scan were used in the reference scan. Digital data of the beam-formed image were saved in Digital Imaging and Communications in Medicine (DICOM) format on a flash drive and converted to RF data on a personal computer using a Matlab program supplied by Zonare. Attenuation estimates were obtained using an algorithm that was independently validated using tissue-mimicking ultrasonic phantoms. RESULTS RF data were acquired and analyzed to estimate attenuation of the human pregnant cervix. Regression analysis revealed that attenuation was: a predictor of the interval from ultrasound examination to delivery (beta = 0.43, P = 0.01); not a predictor of gestational age at time of examination (beta = - 0.23, P = 0.15); and not a predictor of cervical length (beta = 0.077, P = 0.65). CONCLUSIONS Ultrasonic attenuation estimates have the potential to be an early and objective non-invasive method to detect interval between examination and delivery. We hypothesize that a larger sample size and a longitudinal study design will be needed to detect gestational age-associated changes in cervical attenuation.
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Affiliation(s)
- B L McFarlin
- Women, Children and Family Health Science, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Dane C, Dane B, Cetin A, Erginbas M. The role of quantitative ultrasound in predicting osteoporosis defined by dual-energy X-ray absorptiometry in pre- and postmenopausal women. Climacteric 2009; 11:296-303. [DOI: 10.1080/13697130802178471] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Sarvazyan A, Tatarinov A, Egorov V, Airapetian S, Kurtenok V, Gatt CJ. Application of the dual-frequency ultrasonometer for osteoporosis detection. ULTRASONICS 2009; 49:331-7. [PMID: 19036394 PMCID: PMC2788614 DOI: 10.1016/j.ultras.2008.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 09/26/2008] [Accepted: 10/16/2008] [Indexed: 05/10/2023]
Abstract
The paper presents results of a clinical validation study of Bone UltraSonic Scanner (BUSS), a novel dual-frequency axial transmission ultrasonometer, developed by Artann Laboratories. Assessment of bone conditions is based on evaluating relative changes of the axial profiles of ultrasonic characteristics in long bones and utilizes bulk and guided acoustic waves. The objective of this study was to determine the ability of BUSS to discriminate osteoporosis development stages. A total of 93 menopausal and post-menopausal women divided into five groups from normal to advanced osteoporosis according to their DXA hip t-score were enrolled in the study. The 2D waveform profiles at low (0.1 MHz) and high (1 MHz) frequencies were obtained by scanning 15 cm along the proximal tibia. A multi-parametric linear classifier based on a set of the parameters derived from 2D acoustic waveform profiles has been developed. The efficiency of this classifier in differentiating osteoporosis from a normal sample was assessed using a receiver operating characteristic (ROC) curve analysis. Based on the ROC analysis, BUSS demonstrated 76% sensitivity and 70% specificity to DXA-identified osteoporosis. The area under the ROC curve, which is a measure of how well a parameter can distinguish between the two diagnostic groups (diseased/normal) was 79.3%. The study confirmed BUSS's capability to discriminate between stages of bone atrophy and in particular to distinguish early changes induced by osteoporosis.
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Affiliation(s)
- Armen Sarvazyan
- Artann Laboratories, 1459 Lower Ferry Rd, Trenton, New Jersey 08618-1414, USA.
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14
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Minnock E, Cook R, Collins D, Tucker J, Zioupos P. Using risk factors and quantitative ultrasound to identify postmenopausal caucasian women at risk of osteoporosis. J Clin Densitom 2008; 11:485-493. [PMID: 18539491 DOI: 10.1016/j.jocd.2008.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 04/04/2008] [Accepted: 04/07/2008] [Indexed: 11/20/2022]
Abstract
There is a need to prescreen large numbers of individuals for osteoporosis due to current demands on clinical resources. Some previous attempts to predict individuals at risk have used simple indices based on patient information, or Quantitative Ultrasound (QUS) and have shown good sensitivity but also demonstrated low specificity, which means that many individuals with good bone mineral density were also selected. The aim of this study was to determine if a tool based on a combination of risk factors and QUS measurements could also be made to provide improved specificity. A risk factors measurement questionnaire was created and completed for a sample of Caucasian postmenopausal women (n=235) who had undergone Dual-energy X-ray absorptiometry scanning. QUS measurements were also taken at various skeletal sites. Assessment tools were generated using stepwise regression to predict osteoporosis, evaluated by receiver operating characteristic curves, and assessed using area under the curve values. Specificity values were determined at a sensitivity of 0.90 to establish the comparative utility of each assessment tool. Using only a risk factors model the specificities were 0.28 at the lumbar spine, 0.45 for the femoral neck and 0.68 for the total hip. In a risk factors+QUS data model the specificities measured were 0.44 for the lumbar spine, 0.78 for the femoral neck, and 0.84 for the total hip. These novel assessment tools can identify those with low bone mineral density at a number of skeletal sites and help towards avoiding many unnecessary investigations in the future.
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Affiliation(s)
- Enda Minnock
- Biomechanics Laboratories, Department of Materials and Applied Science, Cranfield University, Swindon, UK
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Maia JA, Costa ET, Neto JFM, Button VLSN. Broadband ultrasound attenuation in the calcaneal region: a comparative study of single-position versus scanning systems. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2008; 55:64-73. [PMID: 18334314 DOI: 10.1109/tuffc.2008.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This work describes a system developed to measure the broadband ultrasound attenuation (BUA) in the calcaneal region. The patient's calcanei were inspected using a microcomputer-controlled X-Y axis displacement unit with two 500-kHz, central-frequency, ultrasound transducers. The transducers facing each other are submerged in a small water tank with a support for the patient's foot between them. The system allows data to be collected from a single position or by scanning the calcaneal region to obtain a BUA map. Tests were carried out on 201 patients (110 using the single-position method, and 91 using the scanning method). The results were compared with those of densitometry tests performed using the dual energy X-ray absorptiometry (DEXA) technique (single position: r=0.50; P<0.0001; scanner: r=0.75; P<0.0001). It was concluded that the single position method is more susceptible to errors due to the difficulty in positioning the transducers relative to the calcaneus. The scanning method provides better results and can be used to screen patients before referring them for DEXA.
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Affiliation(s)
- Joaquim A Maia
- Electronic Engineering Department, Graduate School of Electrical Engineering and Applied Computer Sciences, Fed. Univ. of Technol., Curitiba, PR, Brazil.
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16
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Xia Y, Lin W, Qin YX. Bone surface topology mapping and its role in trabecular bone quality assessment using scanning confocal ultrasound. Osteoporos Int 2007; 18:905-13. [PMID: 17361323 DOI: 10.1007/s00198-007-0324-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 12/27/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Quantitative ultrasound (QUS) has been used to assess non-invasively bone quality, in which ultrasound velocity (UV) is a primary acoustic property. METHODS While UV calculation requires the tissue thickness in the ultrasound path, a bone surface topology mapping (STM) method was developed in this study for enhancing the accuracy of the UV measurement. STM accuracy was verified by both aluminum and a QUS heel phantom, indicating that the STM can determine the phantom thickness within 0.02 mm thickness error and the aluminum calibration step within 0.1 mm thickness error. STM performance was further evaluated using 25 cadaveric human calcanei samples. RESULTS The UV calculations using STM had a significant better correlation to bone mineral density (BMD) (r = 0.75, p < 0.05), volume fraction (r = 0.72, p < 0.05) and modulus (r = 0.69, p < 0.05) than the UV with fixed thickness. The later correlation coefficients were r = 0.64 for BMD, r = 0.65 for volume fraction, and r = 0.58 for modulus. The nBUA value determined using STM was also highly correlated to BMD (r(2) = 0.74) and modulus (r(2) = 0.62). This was comparable to the correlation result for BUA (BMD: r(2) = 0.76; Modulus: r(2) = 0.64). CONCLUSION These results suggested that STM technique in scanning ultrasound is capable of determining calcaneus bone thickness and hence enhancing the accuracy of UV measurement.
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Affiliation(s)
- Y Xia
- Department of Biomedical Engineering, Stony Brook University, Psychology-A Bldg, 3rd Floor, Stony Brook, New York, NY 11794-2580, USA
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Turk N, Kastelan D, Cukovic-Cavka S, Kraljevic I, Korsic M, Vucelic B. Discriminatory ability of calcaneal quantitative ultrasound in the assessment of bone status in patients with inflammatory bowel disease. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:863-9. [PMID: 17434664 DOI: 10.1016/j.ultrasmedbio.2007.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 11/27/2006] [Accepted: 01/05/2007] [Indexed: 05/14/2023]
Abstract
A high incidence of bone disease in patients with inflammatory bowel disease (IBD) requires frequent monitoring of skeletal status and, for that reason, evaluation of radiation-free technology is an issue of interest. Our objective was to appraise the parameters of calcaneal quantitative ultrasound (QUS): broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI), and establish their t-score values to investigate discriminatory ability of QUS in IBD patients with metabolic bone disease. The study included 126 patients (Crohn's disease [n = 94] and ulcerative colitis [n = 32]), and 228 age- and sex-matched healthy volunteers. Bone status was evaluated on the same day by calcaneal QUS and dual-energy x-ray absorptiometry (DXA) at spine (L1-L4) and total hip. All QUS measurements were lower in patients compared with healthy controls (BUA p < 0.001; SOS p < 0.001; QUI p < 0.001) and correlated significantly but inversely with disease duration (r = -0.3, p = 0.002). There was no difference with respect to type of disease (Crohn's disease or ulcerative colitis) or corticosteroid therapy. All three QUS t-scores were significantly lower in patients who had previously sustained fragile fractures (n = 28) than in those without fracture in their history (n = 98) (t-scores: BUA -2.0 vs. -1.3, p = 0.008; SOS -2.1 vs. -1.4, p = 0.02: QUI -2.3 vs. -1.5, p = 0.009). Axial DXA was not significantly different between the fracture and nonfracture patients (-1.7 vs. -1.2, p = 0.1), whereas total hip DXA showed a discriminatory power between the two (-1.6 vs. -0.7, p = 0.001). Patients with t-score < -1.0 scanned by DXA were classified as bone disease. The sensitivity of QUS to identify bone disease was 93% and specificity 63%. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Alternatively, lower negative QUS t-score cutoff <or= -1.8 identified 83% of osteoporosis at lumbar spine and 100% at total hip. All three QUS variables had t-scores less than -1.8 when osteoporosis was detected at both spine and hip. However, the subgroup of IBD patients with QUI t-score cutoff <or= -1.8 still included 26% of individuals with normal bone status. Calcaneal QUS measurements may identify patients with IBD who are at a higher risk of fracture independently of DXA measurements. However, QUS showed poor agreement with bone status scanned by DXA and a low discriminatory power between osteopenia and osteoporosis.
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Affiliation(s)
- N Turk
- Department of Gastroenterology, University Department of Medicine, Zagreb University Hospital Center, Zagreb, Croatia.
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