Correlation of tibial low-frequency ultrasound velocity with femoral radiographic measurements and BMD in elderly women

Ultrasonic Guided Waves in Bone: A Decade of Advancement in Review

The use of guided wave ultrasonography as a means to assess cortical bone quality has been a significant practice in bone quantitative ultrasound for more than 20 years. In this article, the key developments within the technology of ultrasonic guided waves (UGW) in long bones during the past decade are documented. The covered topics include data acquisition configurations available for measuring bone guided waveforms, signal processing techniques applied to bone UGW, numerical modeling of ultrasonic wave propagation in cortical long bones, formulation of inverse approaches to extract bone properties from observed ultrasonic signals, and clinical studies to establish the technology's application and efficacy. The review concludes by highlighting specific challenging problems and future research directions. In general, the primary purpose of this work is to provide a comprehensive overview of bone guided-wave ultrasound, especially for newcomers to this scientific field.

Influence of guided waves in bone on pulse-inversion contrast-enhanced ultrasound

PURPOSE

Guided waves generated from bone cortex inevitably act on microbubbles flowing through skeletal muscle capillaries in contrast-enhanced ultrasound (CEUS) and might influence the image quality. However, the action mechanism underlying the guided waves influence is still unknown, especially under contrast pulse-inversion transmission mode. This study aimed to clarify the influence of guided waves on pulse-inversion CEUS, which was investigated via in vitro infusion experiments.

METHOD

Tibia guided waves were detected at pulse-inversion transmission and then characterized by using a short-time Fourier transform energy distribution. Using results at normal incidence as a baseline, the influence of guided wave dispersion on the contrast and resolution of pulse-inversion CEUS was investigated at an oblique incidence through continuous microbubbles infusion experiments in a vessel-tibia flow phantom.

RESULTS

Frequency-dispersive property of tibia guided waves was observed at phases 0° and 180°, which improved the contrast of CEUS and reduced its resolution. Pulse-inversion CEUS balanced the contrast enhancement and resolution degeneration induced by guided waves. By contrast, contrast-to-tissue ratio of pulse-inversion CEUS increased by up to 109.1 ± 13.2% (P < 0.05) due to guided waves and its resolution was up to 0.9 ± 0.1 times that of baseline.

CONCLUSIONS

Alterations of contrast and resolution in pulse-inversion CEUS induced by guided waves might provide an additional assessment for the capillary perfusion in the skeletal muscle near the bone cortex.

Associations between radius low-frequency axial ultrasound velocity and bone fragility in elderly men and women

An exploratory study in elderly women and men from the Geneva Retirees Cohort indicates that low-frequency quantitative ultrasound measurement at the radius captures aBMD, bone size, and cortical tissue mineral density and might be used for screening purposes prior to DXA to evaluate fracture risk_. INTRODUCTION: The contribution of distal radius bone mineral density (BMD) and cortical microstructure to fracture risk has recently been demonstrated. In this exploratory study, we investigated whether low-frequency quantitative ultrasound measurement at the distal radius may capture the peripheral determinants of bone fragility assessed with dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT).

METHODS

Low-frequency velocity (V_LF) was measured at the radius using OsCare Sono®, a portable axial transmission ultrasonometer, in 271 community-dwelling postmenopausal women and men (age 71.5 ± 1.4 years) from the Geneva Retirees Cohort. Cortical (Ct) and trabecular (Tb) volumetric (v) BMD and microstructure at the distal radius were assessed by HR-pQCT, in addition to areal (a) BMD by DXA, at the same time point.

RESULTS

V_LF was highly correlated with aBMD at the distal third radius (r = 0.72, p < 0.001). For microstructure parameters, the highest correlation was observed with cortical area (r = 0.59, p < 0.001). V_LF also captured bone geometry (total area) and cortical tissue mineral density independently of aBMD. In models adjusted for age and sex, V_LF was significantly associated with prevalent low-trauma fractures [OR 95%CI for one SD decrease of V_LF 1.50 (1.05, 2.14), p = 0.024], with discrimination performance comparable to femoral neck or distal radius aBMD.

CONCLUSION

Measurement of V_LF at the radius captures aBMD, bone size, and cortical tissue mineral density and might be used for screening purposes prior to DXA to evaluate fracture risk_.

Influence of Guided Waves in Tibia on Non-linear Scattering of Contrast Agents

The aim of this study was to elucidate the linear and non-linear responses of ultrasound contrast agent (UCA) to frequency-dispersive guided waves from the tibia cortex, particularly two individual modes, S0 (1.23 MHz) and A1 (2.06 MHz). The UCA responses to guided waves were illustrated through the Marmottant model derived from measured guided waves, and then verified by continuous infusion experiments in a vessel-tibia flow phantom. These UCA responses were further evaluated by the enhanced ratio of peak values and the resolutions of UCA backscattered echoes. Because of the individual modes S0 and A1 in the tibia, the peak values of the UCA backscattered echoes were enhanced by 83.57 ± 7.35% (p < 0.05) and 80.77 ± 6.60% (p < 0.01) in the UCA subharmonic frequency and subharmonic imaging, respectively. However, corresponding resolutions were 0.78 ± 0.07 (p < 0.05) and 0.72 ± 0.12 (p < 0.01) times those without guided wave disturbances, respectively. Even though the resolution was partly degenerated, the subharmonic detection sensitivity of UCA was improved by the guided waves. Thus, UCA responses to the double-frequency guided waves should be further explored to benefit the detection of capillary perfusion in tissue layers near the bone cortex, particularly for perfusion imaging in the free flaps and skeletal muscles.

Association between low-frequency ultrasound and hip fractures -- comparison with DXA-based BMD

BACKGROUND

New methods for diagnosing osteoporosis and evaluating fracture risk are being developed. We aim to study the association between low-frequency (LF) axial transmission ultrasound and hip fracture risk in a population-based sample of older women.

METHODS

The study population consisted of 490 community-dwelling women (78-82 years). Ultrasound velocity (V(LF)) at mid-tibia was measured in 2006 using a low-frequency scanning axial transmission device. Bone mineral density (BMD) at proximal femur measured using dual-energy x-ray absorptiometry (DXA) was used as the reference method. The fracture history of the participants was collected from December 1997 until the end of 2010. Lifestyle-related risk factors and mobility were assessed at 1997.

RESULTS

During the total follow-up period (1997-2010), 130 women had one or more fractures, and 20 of them had a hip fracture. Low V(LF) (the lowest quartile) was associated with increased hip fracture risk when compared with V(LF) in the normal range (Odds ratio, OR = 3.3, 95% confidence interval (CI) 1.3-8.4). However, V(LF) was not related to fracture risk when all bone sites were considered. Osteoporotic femoral neck BMD was associated with higher risk of a hip fracture (OR = 4.1, 95% CI 1.6-10.5) and higher risk of any fracture (OR = 2.4, 95% CI 1.6-3.8) compared to the non-osteoporotic femoral neck BMD. Decreased VLF remained a significant risk factor for hip fracture when combined with lifestyle-related risk factors (OR = 3.3, 95% CI 1.2-9.0).

CONCLUSION

Low V(LF) was associated with hip fracture risk in older women even when combined with lifestyle-related risk factors. Further development of the method is needed to improve the measurement precision and to confirm the results.

Assessment of risk of femoral neck fracture with radiographic texture parameters: a retrospective study

PURPOSE

To investigate whether femoral neck fracture can be predicted retrospectively on the basis of clinical radiographs by using the combined analysis of bone geometry, textural analysis of trabecular bone, and bone mineral density (BMD).

MATERIALS AND METHODS

Formal ethics committee approval was obtained for the study, and all participants gave informed written consent. Pelvic radiographs and proximal femur BMD measurements were obtained in 53 women aged 79-82 years in 2006. By 2012, 10 of these patients had experienced a low-impact femoral neck fracture. A Laplacian-based semiautomatic custom algorithm was applied to the radiographs to calculate the texture parameters along the trabecular fibers in the lower neck area for all subjects. Intra- and interobserver reproducibility was calculated by using the root mean square average coefficient of variation to evaluate the robustness of the method.

RESULTS

The best predictors of hip fracture were entropy (P = .007; reproducibility coefficient of variation < 1%), the neck-shaft angle (NSA) (P = .017), and the BMD (P = .13). For prediction of fracture, the area under the receiver operating characteristic curve was 0.753 for entropy, 0.608 for femoral neck BMD, and 0.698 for NSA. The area increased to 0.816 when entropy and NSA were combined and to 0.902 when entropy, NSA, and BMD were combined.

CONCLUSION

Textural analysis of pelvic radiographs enables discrimination of patients at risk for femoral neck fracture, and our results show the potential of this conventional imaging method to yield better prediction than that achieved with dual-energy x-ray absorptiometry-based BMD. The combination of the entropy parameter with NSA and BMD can further enhance predictive accuracy.

Discrimination of fractures by low-frequency axial transmission ultrasound in postmenopausal females

SUMMARY

In this cross-sectional study, 95 postmenopausal women, with and without fracture history, were measured by low-frequency axial transmission ultrasound. The measured ultrasound velocity discriminated the fractured subjects from the nonfractured ones equally or better than peripheral quantitative computed tomography (pQCT) and dual energy x-ray absorptiometry (DXA). These results suggest that low-frequency ultrasound is suitable for bone fragility assessment.

INTRODUCTION

Quantitative low-frequency axial transmission ultrasound is a promising modality for assessing mineral density and geometrical properties of long bones such as radius and tibia. The aim of the current study was to evaluate the ability of low-frequency axial transmission ultrasound to discriminate fractures retrospectively in postmenopausal women.

METHODS

A cross-sectional study involved 95 female subjects aged 45-88 years, whose fracture information was gathered retrospectively. The fracture group was defined as subjects with one or more low-/moderate-energy fractures. The radius and tibial shaft were measured with a custom-made ultrasonometer to assess the velocity of the low-frequency first-arriving signal (V (LF)). Site-matched pQCT was used to measure volumetric cortical and subcortical bone mineral density (sBMD), and cortical thickness (CTh). Areal BMD (aBMD) was measured using DXA for the whole body (WB), lumbar spine, and hip.

RESULTS

The majority (19/32; 59 %) of the fractures were in the upper limb. V (LF) in the radius, but not in the tibia, discriminated fractures with an age- and BMI-adjusted odds ratio (OR) of 2.06 (95 % CI 1.21-3.50, p < 0.01). In the radius, CTh and cortical BMD (CBMD) significantly discriminated fractures, as did the total, cortical, and sBMD in the tibia (adjusted OR 1.35-2.15, p < 0.05). Sensitivity and specificity were similar among all the measurements (area under the receiver operating characteristic curve 0.74-0.81, p < 0.001).

CONCLUSIONS

Low-frequency axial transmission ultrasound in the radius was able to discriminate fractured subjects from the nonfractured ones. This suggests that low-frequency axial transmission ultrasound has the potential to assess bone fragility in postmenopausal women.

Analysis of superimposed ultrasonic guided waves in long bones by the joint approximate diagonalization of eigen-matrices algorithm

The parameters of ultrasonic guided waves (GWs) are very sensitive to mechanical and structural changes in long cortical bones. However, it is a challenge to obtain the group velocity and other parameters of GWs because of the presence of mixed multiple modes. This paper proposes a blind identification algorithm using the joint approximate diagonalization of eigen-matrices (JADE) and applies it to the separation of superimposed GWs in long bones. For the simulation case, the velocity of the single mode was calculated after separation. A strong agreement was obtained between the estimated velocity and the theoretical expectation. For the experiments in bovine long bones, by using the calculated velocity and a theoretical model, the cortical thickness (CTh) was obtained. For comparison with the JADE approach, an adaptive Gaussian chirplet time-frequency (ACGTF) method was also used to estimate the CTh. The results showed that the mean error of the CTh acquired by the JADE approach was 4.3%, which was smaller than that of the ACGTF method (13.6%). This suggested that the JADE algorithm may be used to separate the superimposed GWs and that the JADE algorithm could potentially be used to evaluate long bones.

Low-frequency axial ultrasound velocity correlates with bone mineral density and cortical thickness in the radius and tibia in pre- and postmenopausal women

Axial transmission velocity of a low-frequency first arriving signal (V (LF)) was assessed in the radius and tibia of 254 females, and compared to site-matched pQCT measurements. V (LF) best correlated with cortical BMD, but significantly also with subcortical BMD and cortical thickness. Correlations were strongest for the radius in postmenopausal females.

INTRODUCTION

Ultrasonic low-frequency (LF; 0.2-0.4 MHz) axial transmission, based on the first arriving signal (FAS), provides enhanced sensitivity to thickness and endosteal properties of cortical wall of the radius and tibia compared to using higher frequencies (e.g., 1 MHz). This improved sensitivity of the LF approach has not yet been clearly confirmed by an in vivo study on adult subjects. The aims of the present study were to evaluate the extent to which LF measurements reflect cortical thickness and bone mineral density, and to assess whether an individual LF measurement can provide a useful estimate for these bone properties.

METHODS

Velocity of the LF FAS (V (LF)) was assessed in the radius and tibia shaft by a new ultrasonometer (CV(RMS) = 0.5%) in a cross-sectional study involving 159 premenopausal (20-58 years) and 95 postmenopausal females (45-88 years). Site-matched volumetric total bone mineral density (BMD), cortical bone mineral density (CBMD), subcortical bone mineral density (ScBMD) and cortical thickness (CTh) were assessed using pQCT.

RESULTS

For the postmenopausal females, V (LF) correlated best with CBMD in the radius (R = 0.850, p < 0.001), but significantly also with ScBMD and CTh (R = 0.759 and R = 0.761, respectively; p < 0.001). Similar trends but weaker correlations were observed for the tibia and for the premenopausal women.

CONCLUSIONS

The LF assessment, with an optimal excitation frequency, thus provided good prediction of both cortical thickness and subcortical bone material properties. These results suggest that the LF approach does indeed have enhanced sensitivity for detecting osteoporotic changes that occur deep in the endosteal bone.

Guided wave phase velocity measurement using multi-emitter and multi-receiver arrays in the axial transmission configuration

This paper is devoted to a method of extraction of guided waves phase velocities from experimental signals. Measurements are performed using an axial transmission device consisting of a linear arrangement of emitters and receivers placed on the surface of the inspected specimen. The technique takes benefit of using both multiple emitters and receivers and is validated on a reference wave guide. The guided mode phase velocities are obtained using a projection in the singular vectors basis. The singular vectors are determined by the singular values decomposition (SVD) of the response matrix between the two arrays in the frequency domain. This technique enables to recover accurately guided wave phase velocity dispersion curves. The SVD based approach was designed to overcome limitations of spatio-temporal Fourier transform for receiver array of limited spatial extent as in the case of clinical assessment of cortical bone in axial transmission.