1
|
Dudle A, Ith M, Egli R, Heverhagen J, Gugler Y, Wapp C, Frauchiger DA, Lippuner K, Jackowski C, Zysset P. Asynchronous calibration of a CT scanner for bone mineral density estimation: sources of error and correction. JBMR Plus 2024; 8:ziae096. [PMID: 39183821 PMCID: PMC11344033 DOI: 10.1093/jbmrpl/ziae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/20/2024] [Accepted: 07/12/2024] [Indexed: 08/27/2024] Open
Abstract
The estimation of BMD with CT scans requires a calibration method, usually based on a phantom. In asynchronous calibration, the phantom is scanned separately from the patient. A standardized acquisition protocol must be used to avoid variations between patient and phantom. However, variations can still be induced, for example, by temporal fluctuations or patient characteristics. Based on the further use of 739 forensic and 111 clinical CT scans, this study uses the proximal femur BMD value ("total hip") to assess asynchronous calibration accuracy, using in-scan calibration as ground truth. It identifies the parameters affecting the calibration accuracy and quantifies their impact. For time interval and table height, the impact was measured by calibrating the CT scan twice (once using the phantom scan with closest acquisition parameters and once using a phantom scan with standard values) and comparing the calibration accuracy. For other parameters such as body weight, the impact was measured by computing a linear regression between parameter values and calibration accuracy. Finally, this study proposes correction methods to reduce the effect of these parameters and improve the calibration accuracy. The BMD error of the asynchronous calibration, using the phantom scan with the closest acquisition parameters, was -1.2 ± 1.7% for the forensic and - 1.6 ± 3.5% for the clinical dataset. Among the parameters studied, time interval and body weight were identified as the main sources of error for asynchronous calibration, followed by table height and reconstruction kernel. Based on these results, a correction method was proposed to improve the calibration accuracy.
Collapse
Affiliation(s)
- Alice Dudle
- ARTORG Center for Biomedical Engineering Research, University of Bern, sitem-insel, Freiburgstrasse 3, Bern 3010, Switzerland
| | - Michael Ith
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Rainer Egli
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Johannes Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Yvan Gugler
- ARTORG Center for Biomedical Engineering Research, University of Bern, sitem-insel, Freiburgstrasse 3, Bern 3010, Switzerland
| | - Christina Wapp
- ARTORG Center for Biomedical Engineering Research, University of Bern, sitem-insel, Freiburgstrasse 3, Bern 3010, Switzerland
| | - Daniela A Frauchiger
- ARTORG Center for Biomedical Engineering Research, University of Bern, sitem-insel, Freiburgstrasse 3, Bern 3010, Switzerland
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Freiburgstrsasse 4, Bern 3010, Switzerland
| | - Kurt Lippuner
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Freiburgstrsasse 4, Bern 3010, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Murtenstrasse 28, Bern 3008, Switzerland
| | - Philippe Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, sitem-insel, Freiburgstrasse 3, Bern 3010, Switzerland
| |
Collapse
|
2
|
Rahn S, Skornitzke S, Melzig C, Reiner T, Stiller W, Heussel CP, Kauczor HU, Weber TF, Do TD. The influence of contrast media on calcium-based imaging of the spine in dual-layer CT. Sci Rep 2024; 14:18898. [PMID: 39143146 PMCID: PMC11324893 DOI: 10.1038/s41598-024-69743-3] [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: 03/02/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024] Open
Abstract
This study aimed to evaluate the impact of contrast media application on CT attenuation of the bone using a novel calcium-only imaging technique (VCa) from dual-layer spectral detector CT (DLCT), which enables CT-based bone mineral density measurement unimpeded by soft tissue components. For this, true non-contrast (TNC) and venous phase images (VP) of n = 97 patients were acquired. CT attenuation of the first lumbar vertebra (L1) was measured in TNC-VCa, VP-VCa, and in virtual non-contrast images (VNC). CT attenuation was significantly higher in VP-VCa than in TNC-VCa (p < 0.001), although regression analyses revealed a strong linear association between these measures (R2 = 0.84). A statistical model for the prediction of TNC-VCa CT attenuation was established (TNC-VCa[HU] = - 6.81 + 0.87 × VP-VCa[HU]-0.55 × body weight[kg]) and yielded good agreement between observed and predicted values. Furthermore, a L1 CT attenuation threshold of 293 HU in VP-VCa showed a sensitivity of 90% and a specificity of 96% for detecting osteoporosis. The application of contrast media leads to an overestimation of L1 CT attenuation in VCa. However, CT attenuation values from VP-VCa can be used within CT-based opportunistic osteoporosis screening eighter by applying a separate threshold of 293 HU or by converting measured data to TNC-VCa CT attenuation with the given regression equation.
Collapse
Affiliation(s)
- S Rahn
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - S Skornitzke
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - C Melzig
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T Reiner
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - W Stiller
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - C P Heussel
- Department of Radiology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T F Weber
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Uemura K, Miyamura S, Otake Y, Mae H, Takashima K, Hamada H, Ebina K, Murase T, Sato Y, Okada S. The effect of forearm rotation on the bone mineral density measurements of the distal radius. J Bone Miner Metab 2024; 42:37-46. [PMID: 38057601 DOI: 10.1007/s00774-023-01473-4] [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: 08/16/2023] [Accepted: 10/09/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Forearm dual-energy X-ray absorptiometry (DXA) is often performed in clinics where central DXA is unavailable. Accurate bone mineral density (BMD) measurement is crucial for clinical assessment. Forearm rotation can affect BMD measurements, but this effect remains uncertain. Thus, we aimed to conduct a simulation study using CT images to clarify the effect of forearm rotation on BMD measurements. MATERIALS AND METHODS Forearm CT images of 60 women were analyzed. BMD was measured at the total, ultra-distal (UD), mid-distal (MD), and distal 33% radius regions with the radius located at the neutral position using digitally reconstructed radiographs generated from CT images. Then, the rotation was altered from - 30° to 30° (supination set as positive) with a one-degree increment, and the percent BMD changes from the neutral position were quantified for all regions at each angle for each patient. RESULTS The maximum mean BMD changes were 5.8%, 7.0%, 6.2%, and 7.2% for the total, UD, MD, and distal 33% radius regions, respectively. The analysis of the absolute values of the percent BMD changes from the neutral position showed that BMD changes of all patients remained within 2% when the rotation was between - 5° and 7° for the total region, between - 3° and 2° for the UD region, between - 4° and 3° for the MD region, and between - 3° and 1° for the distal 33% radius region. CONCLUSION Subtle rotational changes affected the BMD measurement of each region. The results showed the importance of forearm positioning when measuring the distal radius BMD.
Collapse
Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Satoshi Miyamura
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshito Otake
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Hirokazu Mae
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuma Takashima
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kosuke Ebina
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshinobu Sato
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Seiji Okada
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
5
|
Hu T, Yang X, Gao L, Liu Y, Zhang W, Wang Y, Zhu X, Liu X, Liu H, Ma X. Feasibility analysis of low-dose CT with asynchronous quantitative computed tomography to assess vBMD. BMC Med Imaging 2023; 23:149. [PMID: 37803293 PMCID: PMC10557302 DOI: 10.1186/s12880-023-01115-1] [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: 11/09/2022] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND To explore the feasibility of low-dose computed tomography (LDCT) with asynchronous quantitative computed tomography (asynchronous QCT) for assessing the volumetric bone mineral density (vBMD). METHODS 416 women patients, categorized into 4 groups, were included and underwent chest CT examinations combined with asynchronous QCT, and CT scanning dose protocols (LDCT or CDCT) were self-determined by the participants. Radiation dose estimations were retrieved from patient protocols, including volume CT dose index (CTDIvol) and dose-length-product (DLP), and then calculated effective dose (ED). Delimiting ED by 1.0 mSv, chest CT examinations were categorized into 2 groups, LDCT group and CDCT group. vBMD of T12-L2 was obtained by transferring the LDCT and CDCT images to the QCT workstation, without extra radiation. RESULTS There was no difference of vBMD among 4 age groups in LDCT group (P = 0.965), and no difference in CDCT group (P = 0.988). In LDCT group and CDCT group, vBMD was not correlated to mAs, CTDIvol and DLP (P > 0.05), respectively. Between LDCT group and CDCT group, there was no difference of vBMD (P ≥ 0.480), while differences of mAs, CTDIvol and DLP. CONCLUSION There was no difference of vBMD between LDCT group and CDCT group and vBMD was not correlated to mAs. While screening for diseases such as lung cancer and mediastinal lesions, LDCT combined with asynchronous QCT can be also used to assess vBMD simultaneously with no extra imaging equipment, patient visit time, radiation dose and no additional economic cost.
Collapse
Affiliation(s)
- Tingting Hu
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| | - Xingyuan Yang
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| | - Lei Gao
- Department of CT/MRI, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| | - Ying Liu
- Department of CT/MRI, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China.
| | - Wei Zhang
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China.
| | - Yan Wang
- Department of Endocrinology, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| | - Xiaona Zhu
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| | - Xiangdong Liu
- Department of Vascular Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| | - Hongran Liu
- Department of CT/MRI, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| | - Xiaohui Ma
- Department of CT/MRI, Hebei Medical University Third Hospital, No. 139 Ziqiang Street, Qiaoxi District, Shijiazhaung, Hebei, 050051, China
| |
Collapse
|
6
|
Gruenewald LD, Koch V, Yel I, Eichler K, Gruber-Rouh T, Alizadeh LS, Mahmoudi S, D'Angelo T, Wichmann JL, Wesarg S, Vogl TJ, Booz C. Association of Phantomless Dual-Energy CT-based Volumetric Bone Mineral Density with the Prevalence of Acute Insufficiency Fractures of the Spine. Acad Radiol 2023; 30:2110-2117. [PMID: 36577605 DOI: 10.1016/j.acra.2022.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the bone mineral density (BMD) of the lumbar spine derived from dual-energy CT (DECT)-based volumetric material decomposition and its association with acute insufficiency fractures of the thoracolumbar spine. MATERIALS AND METHODS L1 of 160 patients (77 men, 83 women; mean age 64.3 years, range, 22-94 years) who underwent third-generation dual-source DECT between January 2016 and December 2021 due to suspected insufficiency fractures was retrospectively analyzed. All depicted vertebrae were examined for signs of recent fractures. A dedicated DECT postprocessing software using material decomposition was applied for phantomless BMD assessment. Receiver-operating characteristic (ROC) analysis identified optimal BMD thresholds. Associations of BMD, sex, and age with the occurrence of insufficiency fractures were examined with logistic regression models. RESULTS A DECT-derived BMD threshold of 120.40 mg/cm³ yielded 90.1% specificity and 59.32% sensitivity to differentiate patients with at least one insufficiency fracture from patients without fracture. No patient without fracture had a DECT-derived BMD below 85 mg/cm3. Lower DECT-derived bone mineral density was associated with an increased risk of insufficiency fractures (Odds ratio of 0.93, 95% CI, 0.91-0.96, p < 0.001). Overall ROC-derived AUC was 0.82 (p < 0.0001) for the differentiation of patients that sustained an insufficiency fracture from the control group. CONCLUSION Dual-Energy CT-based BMD assessment can accurately differentiate patients with acute insufficiency fractures of the thoracolumbar spine from patients without fracture. This algorithm can be used for phantomless risk stratification of patients undergoing routine CT to sustain insufficiency fractures of the thoracolumbar spine The identified cut-off value of 120.4 mg/cm³ is in line with current American College of Radiology (ACR) recommendations to differentiate healthy individuals from those with reduced bone mineral density.
Collapse
Affiliation(s)
- Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Leona S Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, ME, Italy
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | | | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany.
| |
Collapse
|
7
|
Gruenewald LD, Koch V, Martin SS, Yel I, Mahmoudi S, Bernatz S, Eichler K, Gruber-Rouh T, Pinto Dos Santos D, D'Angelo T, Wesarg S, Herrmann E, Golbach R, Handon M, Vogl TJ, Booz C. Dual-Energy CT-based Opportunistic Volumetric Bone Mineral Density Assessment of the Distal Radius. Radiology 2023; 308:e223150. [PMID: 37552067 DOI: 10.1148/radiol.223150] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background In patients with distal radius fractures (DRFs), low bone mineral density (BMD) is associated with bone substitute use during surgery and bone nonunion, but BMD information is not regularly available. Purpose To evaluate the feasibility of dual-energy CT (DECT)-based BMD assessment from routine examinations in the distal radius and the relationship between the obtained BMD values, the occurrence of DRFs, bone nonunion, and use of surgical bone substitute. Materials and Methods Scans in patients who underwent routine dual-source DECT in the distal radius between January 2016 and December 2021 were retrospectively acquired. Phantomless BMD assessment was performed using the delineated trabecular bone of a nonfractured segment of the distal radius and both DECT image series. CT images and health records were examined to determine fracture severity, surgical management, and the occurrence of bone nonunion. Associations of BMD with the occurrence of DRFs, bone nonunion, and bone substitute use at surgical treatment were examined with generalized additive models and receiver operating characteristic analysis. Results This study included 263 patients (median age, 52 years; IQR, 36-64 years; 132 female patients), of whom 192 were diagnosed with fractures. Mean volumetric BMD was lower in patients who sustained a DRF (93.9 mg/cm3 vs 135.4 mg/cm3; P < .001), required bone substitutes (79.6 mg/cm3 vs 95.5 mg/cm3; P < .001), and developed bone nonunion (71.1 mg/cm3 vs 96.5 mg/cm3; P < .001). Receiver operating characteristic curve analysis identified these patients with an area under the curve of 0.71-0.91 (P < .001). Lower BMD increased the risk to sustain DRFs, develop bone nonunion, and receive bone substitutes at surgery (P < .001). Conclusion DECT-based BMD assessment at routine examinations is feasible and could help predict surgical bone substitute use and the occurrence of bone nonunion in patients with DRFs. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Carrino in this issue.
Collapse
Affiliation(s)
- Leon D Gruenewald
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Vitali Koch
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Simon S Martin
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Ibrahim Yel
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Scherwin Mahmoudi
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Simon Bernatz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Katrin Eichler
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Tatjana Gruber-Rouh
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Daniel Pinto Dos Santos
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Tommaso D'Angelo
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Stefan Wesarg
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Eva Herrmann
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Rejane Golbach
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Marlin Handon
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Thomas J Vogl
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Christian Booz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| |
Collapse
|
8
|
Willaume T, Delmas L, Tochon L, Bierry G. A comparison of smooth and sharp kernel CT reconstructions in the detection of unilateral sacral fractures. Skeletal Radiol 2023:10.1007/s00256-023-04313-8. [PMID: 36869891 DOI: 10.1007/s00256-023-04313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE The goal of this study is to determine whether smooth kernel reconstructions are more sensitive than sharp kernel ones for the detection of sacral stress fractures (SF) using MRI as the reference standard. MATERIALS AND METHODS This retrospective study included 100 subjects in whom CT and MR of the pelvis were performed for a clinical suspicion of SF from January 2014 to May 2020 in our institution. MR was used as the reference standard for the presence of SF. Smooth and sharp kernel CT datasets of the 100 patients were pooled and analyzed randomly. Three readers of various experiences in MSK imaging independently evaluated the axial CT images for the presence of a SF. RESULTS SF was present on MR in 31 patients (22 women, 9 men; mean age 73.6 ± 19.6) and absent in 69 (48 women, 21 men; mean age 68.8 ± 19.0). Depending on readers, sensitivities ranged from 58 to 77% for the smooth kernel and from 52 to 74% for the sharp kernel reconstructions. For each reader, sensitivities (as well as negative predictive values) of CT were slightly greater on the smooth kernel reconstructions. CONCLUSION The use of smooth kernel reconstructions improved the sensitivity of CT for the detection of SF compared to the sharp kernel reconstructions usually used and regardless of the experience of the radiologist. Smooth kernel reconstructions should, therefore, be scrutinized in patients with suspicion of SF.
Collapse
Affiliation(s)
- Thibault Willaume
- MSK Imaging, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France
| | - Louis Delmas
- MSK Imaging, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France
| | - Ludivine Tochon
- MSK Imaging, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France
| | - Guillaume Bierry
- MSK Imaging, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France.
| |
Collapse
|
9
|
Zhang Y, Luo W, Zheng L, Hu J, Nie L, Zeng H, Tan X, Jiang Y, Li Y, Zhao T, Yang Z, He TC, Zhang H. Efficient bone regeneration of BMP9-stimulated human periodontal ligament stem cells (hPDLSCs) in decellularized bone matrix (DBM) constructs to model maxillofacial intrabony defect repair. Stem Cell Res Ther 2022; 13:535. [PMID: 36575551 PMCID: PMC9795631 DOI: 10.1186/s13287-022-03221-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND BMP9-stimulated DPSCs, SCAPs and PDLSCs are effective candidates for repairing maxillofacial bone defects in tissue engineering, while the most suitable seed cell source among these three hDMSCs and the optimal combination of most suitable type of hDMSCs and BMP9 have rarely been explored. Moreover, the orthotopic maxillofacial bone defect model should be valuable but laborious and time-consuming to evaluate various candidates for bone regeneration. Thus, inspired from the maxillofacial bone defects and the traditional in vivo ectopic systems, we developed an intrabony defect repair model to recapitulate the healing events of orthotopic maxillofacial bone defect repair and further explore the optimized combinations of most suitable hDMSCs and BMP9 for bone defect repair based on this modified ectopic system. METHODS Intrabony defect repair model was developed by using decellularized bone matrix (DBM) constructs prepared from the cancellous part of porcine lumbar vertebral body. We implanted DBM constructs subcutaneously on the flank of each male NU/NU athymic nude mouse, followed by directly injecting the cell suspension of different combinations of hDMSCs and BMP9 into the central hollow area of the constructs 7 days later. Then, the quality of the bony mass, including bone volume fraction (BV/TV), radiographic density (in Hounsfield units (HU)) and the height of newly formed bone, was measured by micro-CT. Furthermore, the H&E staining and immunohistochemical staining were performed to exam new bone and new blood vessel formation in DBM constructs. RESULTS BMP9-stimulated periodontal ligament stem cells (PDLSCs) exhibited the most effective bone regeneration among the three types of hDMSCs in DBM constructs. Furthermore, an optimal dose of PDLSCs with a specific extent of BMP9 stimulation was confirmed for efficacious new bone and new blood vessel formation in DBM constructs. CONCLUSIONS The reported intrabony defect repair model can be used to identify optimized combinations of suitable seed cells and biological factors for bone defect repair and subsequent development of efficacious bone tissue engineering therapies.
Collapse
Affiliation(s)
- Yuxin Zhang
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Wenping Luo
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Liwen Zheng
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Jing Hu
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Li Nie
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Huan Zeng
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Xi Tan
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Yucan Jiang
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Yeming Li
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Tianyu Zhao
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Zhuohui Yang
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Tong-Chuan He
- grid.412578.d0000 0000 8736 9513Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637 USA
| | - Hongmei Zhang
- grid.203458.80000 0000 8653 0555Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, The Affiliated Hospital of Stomatology of Chongqing Medical University, 426 Songshibei Road, Chongqing, 401147 China ,grid.203458.80000 0000 8653 0555Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| |
Collapse
|
10
|
Wang M, Wu Y, Zhou Y, Dong J, Hu S, Hou P, Gao J. Application of Dual-Energy Spectral Computed Tomography in Bone Mineral Density Measurement: Phantom and Clinical Research. Int J Gen Med 2022; 15:6887-6896. [PMID: 36061965 PMCID: PMC9439073 DOI: 10.2147/ijgm.s381857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mingyue Wang
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yan Wu
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yue Zhou
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Junqiang Dong
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Shenshen Hu
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Ping Hou
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Jianbo Gao
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
- Correspondence: Jianbo Gao, Email
| |
Collapse
|
11
|
Requist MR, Sripanich Y, Rolvien T, Lenz AL, Barg A. Micro-CT analysis of the Lisfranc complex reveals higher bone mineral density in dorsal compared to plantar regions. J Orthop Res 2022; 40:1457-1469. [PMID: 34406675 DOI: 10.1002/jor.25164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/02/2021] [Accepted: 08/08/2021] [Indexed: 02/04/2023]
Abstract
Injuries to the Lisfranc complex may require surgical fixation, the stability of which may be correlated with bone mineral density (BMD). However, there is limited research on regional BMD variations in the Lisfranc complex. This study used quantitative micro-CT to characterize regional BMD in the four bones (medial cuneiform, intermediate cuneiform, first metatarsal, and second metatarsal) of this complex. Twenty-four cadaveric specimens were imaged with a calibration phantom using micro-CT. Each bone was segmented and divided into eight regions based on an anatomical coordinate system. BMD for each octant was calculated using scan-specific calibration equations and average image intensity. Differences between regions were analyzed using ANOVA with post hoc analysis and differences between groups of four octants in each plane were analyzed with t-tests with significance level α = 0.05. The highest density region in the medial cuneiform was the distal-dorsal-lateral and dorsal regions showed significantly higher BMD than plantar regions. The intermediate cuneiform had the highest density in the distal-dorsal-medial region and the dorsal and medial regions had higher BMD than the plantar and lateral regions, respectively. The densest region of the first metatarsal was the distal-dorsal-lateral and distal regions had significantly higher BMD than proximal regions. In the second metatarsal, the distal-dorsal-medial region had the highest density, and the distal, dorsal, and medial regions had significantly higher BMD than the proximal, plantar, and lateral regions, respectively. The predominant finding was a pattern of increased density in the dorsal bone regions, which may be relevant in the surgical management of Lisfranc injuries.
Collapse
Affiliation(s)
- Melissa R Requist
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Yantarat Sripanich
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
12
|
Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population. Clin Radiol 2022; 77:e540-e548. [PMID: 35550303 DOI: 10.1016/j.crad.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022]
Abstract
AIM To assess the utility of osteoporosis screening using abdominal computed tomography (CT) versus dual-energy X-ray absorptiometry (DXA) T-scores as the reference. MATERIALS AND METHODS Patients ≥30 years undergoing abdominal CT and DXA within 12 months were assessed retrospectively. Bone mineral density (BMD) was measured using axial CT attenuation at L1, correlating with DXA T-scores. Sensitivity, specificity, area under the curve (AUC), and odds ratio (OR) were calculated. RESULTS The study cohort comprised 407 CT-DXA pairs (58.2% women). The prevalence of osteoporosis was 11.8%. L1 density and T-score were significantly correlated in both women (r=0.35, p<0.001) and men (r=0.15, p=0.04). The AUC to distinguish osteoporosis from osteopenia and normal BMD was 0.64 (95% CI: 0.56-0.71). In women, a threshold of 190 HU detected T-scores ≤ -2.5 with a negative predictive value (NPV) of 94.4% (OR=4.4, p<0.01). In the entire cohort, a threshold of 180 HU detected T-scores ≤ -2.5 with a NPV of 96.2% (OR=4.7, p<0.01). CONCLUSIONS CT L1 attenuation correlates with L1 DXA T-scores. Density values < 190 and 180 HU increased the probability of an osteoporosis diagnosis in Australian women and the overall cohort, respectively. Opportunistic screening for osteoporosis using abdominal CT is feasible, enabling identification of at-risk subjects for formal DXA imaging, thereby improving treatment initiation and reducing fracture risk.
Collapse
|
13
|
Youssefian S, Bressner JA, Osanov M, Guest JK, Zbijewski WB, Levin AS. Sensitivity of the stress field of the proximal femur predicted by CT-based FE analysis to modeling uncertainties. J Orthop Res 2022; 40:1163-1173. [PMID: 34191377 PMCID: PMC8716646 DOI: 10.1002/jor.25138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/25/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Proximal femur anatomy and bone mineral density vary widely among individuals, precluding the use of one predefined finite element (FE) model to determine the stress field for all proximal femurs. This variability poses a challenge in current prosthetic hip design approach. Given the numerous options for generating computed tomography (CT)-based FE models, selecting the best methods for defining the mechanical behavior of the proximal femur is difficult. In this study, a combination of computational and experimental approaches was used to explore the susceptibility of the predicted stress field of the proximal femur to different combinations of density-elasticity relationships, element type, element size, and calibration error. Our results suggest that FE models with first-order voxelized elements generated by the Keyak and Falkinstein density-elasticity relationship or quadratic tetrahedral elements generated by the Morgan density-elasticity relationship lead to accurate estimations of the mechanical behavior of human femurs. Other combinations of element size, element type, and mathematical relationships produce less accurate results, especially in the cortical bone of the femoral neck and calcar region. The voxelized model was more susceptible to variation of element size and density-elasticity relationships than FE models with quadratic tetrahedral elements. Regardless of element type, the stress fields predicted by the Keyak and Falkinstein and the Morgan relationships were the most robust to calibration error when deriving material density from CT-generated Hounsfield data. These results provide insight into the implementation of a robust platform for designing patient-specific implants capable of maintaining or modifying the stress in bones.
Collapse
Affiliation(s)
- Sina Youssefian
- Department of Civil and Systems Engineering The Johns Hopkins University Baltimore Maryland USA
| | - Jarred A. Bressner
- Department of Orthopaedic Surgery The Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Mikhail Osanov
- Department of Civil and Systems Engineering The Johns Hopkins University Baltimore Maryland USA
| | - James K. Guest
- Department of Civil and Systems Engineering The Johns Hopkins University Baltimore Maryland USA
| | - Wojciech B. Zbijewski
- Department of Biomedical Engineering The Johns Hopkins University Baltimore Maryland USA
| | - Adam S. Levin
- Department of Orthopaedic Surgery The Johns Hopkins University School of Medicine Baltimore Maryland USA
| |
Collapse
|
14
|
Wagner PP, Roux JP, Chuzel Q, Szulc P, Bermond F, Duboeuf F, Chapurlat R, Follet H, Pialat JB. Dual-energy CT hybridation and kernel processing effects on the estimation of bone mineral mass and density: a calcination study on ex vivo human femur. Osteoporos Int 2022; 33:909-920. [PMID: 34837503 DOI: 10.1007/s00198-021-06210-z] [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: 02/02/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recent technological advances with dual-energy quantitative computed tomography (DEQCT) allow to combine two images of different level of energy to obtain simulated mono-energetic images at 60 keV (SIM60KeV-QCT) with improved image contrast in clinical practice. This study includes three topics: (1) compare bone mineral content (BMC), areal and volumetric bone mineral density (aBMD, vBMD) obtained with SIM60KeV-QCT, single-energy QCT (SEQCT), and dual X-ray absorptiometry (DXA); (2) compare ash density and weight with respective vBMD and BMC assessed on SIM60KeV-QCT, SEQCT, and DXA; and (3) compare the influence of reconstruction kernels on the accuracy of vBMD and BMC using ash density and ash weight as the reference values. METHODS DXA, SEQCT, and DEQCT acquisitions were performed ex vivo on 42 human femurs. Standard kernel (SK) and bone kernel (BK) were applied to each stack of images. Ten diaphyses and 10 femoral necks were cut, scanned, and reconstructed using the techniques described above. Finally, the bone specimens were calcined to obtain the ash weight. RESULTS QCT analysis (SEQCT, SIM60KeV-QCT) underestimated BMC value compared to DXA. For femoral necks, all QCT analyses provided an unbiased estimate of ash weight but underestimated ash density regardless of the kernel used. For femoral diaphysis, SEQCT BK, SIM60KeV-QCT BK, and SK underestimated ash weight but not ash density. CONCLUSION BMC and vBMD quantifications with the SIM60KeV-QCT gave similar results as the SEQCT. Further studies are needed to optimize the use of SIM60KeV-QCT in clinical situations. SK should be used given the effect of kernels on QCT assessment.
Collapse
Affiliation(s)
- Philippe Paul Wagner
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Jean-Paul Roux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Quentin Chuzel
- Department of Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Pawel Szulc
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - François Bermond
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
| | - François Duboeuf
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Roland Chapurlat
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
- Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Hélène Follet
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Jean-Baptiste Pialat
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France.
- Department of Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France.
- Department of Radiology, Hospices Civils de Lyon, Service de Radiologie, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand Revoyet 69310, Pierre-Bénite, France.
| |
Collapse
|
15
|
Ataei A, Eikhout J, van Leeuwen RGH, Tanck E, Eggermont F. The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration. PLoS One 2022; 17:e0265524. [PMID: 35303026 PMCID: PMC8932617 DOI: 10.1371/journal.pone.0265524] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Recently, it was shown that fracture risk assessment in patients with femoral bone metastases using Finite Element (FE) modeling can be performed using a calibration phantom or air-fat-muscle calibration and that non-patient-specific calibration was less favorable. The purpose of this study was to investigate if phantomless calibration can be used instead of phantom calibration when different CT protocols are used. Differences in effect of CT protocols on Hounsfield units (HU), calculated bone mineral density (BMD) and FE failure loads between phantom and two methods of phantomless calibrations were studied. Five human cadaver lower limbs were scanned atop a calibration phantom according to a standard scanning protocol and seven additional commonly deviating protocols including current, peak kilovoltage (kVp), slice thickness, rotation time, field of view, reconstruction kernel, and reconstruction algorithm. The HUs of the scans were calibrated to BMD (in mg/cm3) using the calibration phantom as well as using air-fat-muscle and non-patient-specific calibration, resulting in three models for each scan. FE models were created, and failure loads were calculated by simulating an axial load on the femur. HU, calculated BMD and failure load of all protocols were compared between the three calibration methods. The different protocols showed little variation in HU, BMD and failure load. However, compared to phantom calibration, changing the kVp resulted in a relatively large decrease of approximately 10% in mean HU and BMD of the trabecular and cortical region of interest (ROI), resulting in a 13.8% and 13.4% lower failure load when air-fat-muscle and non-patient-specific calibrations were used, respectively. In conclusion, while we observed significant correlations between air-fat-muscle calibration and phantom calibration as well as between non-patient-specific calibration and phantom calibration, our sample size was too small to prove that either of these calibration approaches was superior. Further studies are necessary to test whether air-fat-muscle or non-patient-specific calibration could replace phantom calibration in case of different scanning protocols.
Collapse
Affiliation(s)
- Ali Ataei
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Jelle Eikhout
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud G. H. van Leeuwen
- Department of Radiotherapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther Tanck
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Florieke Eggermont
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
16
|
Development of an open-source measurement system to assess the areal bone mineral density of the proximal femur from clinical CT images. Arch Osteoporos 2022; 17:17. [PMID: 35038079 DOI: 10.1007/s11657-022-01063-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/07/2022] [Indexed: 02/08/2023]
Abstract
Commercial software is generally needed to measure the areal bone mineral density (aBMD) of the proximal femur from clinical computed tomography (CT) images. This study developed and verified an open-source reproducible system to quantify CT-aBMD to screen osteoporosis using clinical CT images. PURPOSE For existing CT images acquired for various reasons other than osteoporosis, it might be beneficial to estimate areal BMD as assessed by dual-energy X-ray absorptiometry (DXA-based BMD) to ascertain the bone status based on DXA. In this study, we aimed to (1) develop an open-source reproducible measurement system to quantify DXA-based BMD from CT images and (2) validate its accuracy. METHODS This study analyzed 75 pairs of hip CT and DXA images of women that were acquired for the preoperative assessment of total hip arthroplasty. From the CT images, the femur and a calibration phantom were automatically segmented using pre-trained codes/models available at https://github.com/keisuke-uemura . The proximal femoral region was isolated by manually selected landmarks and was projected onto the coronal plane to measure the areal density (CT-aHU). The calibration phantom was employed to convert the CT-aHU into CT-aBMD. Each parameter was correlated with DXA-based BMD, and the residual errors of CT images to estimate the T-scores in DXA were calculated using the standard error of estimate (SEE). RESULTS The correlation coefficients of DXA-based BMD with CT-aHU and CT-aBMD were 0.947 and 0.950, respectively (both p < 0.001). The SEE for quantifying the T-scores in DXA were 0.51 and 0.50 for CT-aHU and CT-aBMD, respectively. CONCLUSION With the method developed herein, CT permits estimation of the DXA-based BMD of the proximal femur within the standard DXA total hip region of interest with an SEE of 0.5 in T-scores. The radiation dose for CT acquisition needs consideration; therefore, our data do not provide a rationale for performing CT for screening osteoporosis. However, on CT images already acquired for clinical indications other than osteoporosis, researchers may use this open-source system to investigate osteoporosis status through the estimated DXA-based BMD of the proximal femur.
Collapse
|
17
|
Diagnostic accuracy of quantitative dual-energy CT-based volumetric bone mineral density assessment for the prediction of osteoporosis-associated fractures. Eur Radiol 2021; 32:3076-3084. [PMID: 34713330 PMCID: PMC9038932 DOI: 10.1007/s00330-021-08323-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the predictive value of volumetric bone mineral density (BMD) assessment of the lumbar spine derived from phantomless dual-energy CT (DECT)-based volumetric material decomposition as an indicator for the 2-year occurrence risk of osteoporosis-associated fractures. METHODS L1 of 92 patients (46 men, 46 women; mean age, 64 years, range, 19-103 years) who had undergone third-generation dual-source DECT between 01/2016 and 12/2018 was retrospectively analyzed. For phantomless BMD assessment, dedicated DECT postprocessing software using material decomposition was applied. Digital files of all patients were sighted for 2 years following DECT to obtain the incidence of osteoporotic fractures. Receiver operating characteristic (ROC) analysis was used to calculate cut-off values and logistic regression models were used to determine associations of BMD, sex, and age with the occurrence of osteoporotic fractures. RESULTS A DECT-derived BMD cut-off of 93.70 mg/cm3 yielded 85.45% sensitivity and 89.19% specificity for the prediction to sustain one or more osteoporosis-associated fractures within 2 years after BMD measurement. DECT-derived BMD was significantly associated with the occurrence of new fractures (odds ratio of 0.8710, 95% CI, 0.091-0.9375, p < .001), indicating a protective effect of increased DECT-derived BMD values. Overall AUC was 0.9373 (CI, 0.867-0.977, p < .001) for the differentiation of patients who sustained osteoporosis-associated fractures within 2 years of BMD assessment. CONCLUSIONS Retrospective DECT-based volumetric BMD assessment can accurately predict the 2-year risk to sustain an osteoporosis-associated fracture in at-risk patients without requiring a calibration phantom. Lower DECT-based BMD values are strongly associated with an increased risk to sustain fragility fractures. KEY POINTS •Dual-energy CT-derived assessment of bone mineral density can identify patients at risk to sustain osteoporosis-associated fractures with a sensitivity of 85.45% and a specificity of 89.19%. •The DECT-derived BMD threshold for identification of at-risk patients lies above the American College of Radiology (ACR) QCT guidelines for the identification of osteoporosis (93.70 mg/cm3 vs 80 mg/cm3).
Collapse
|
18
|
Chatzaraki V, Born C, Kubik-Huch RA, Froehlich JM, Thali MJ, Niemann T. Influence of Radiation Dose and Reconstruction Kernel on Fat Fraction Analysis in Dual-energy CT: A Phantom Study. In Vivo 2021; 35:3147-3155. [PMID: 34697145 DOI: 10.21873/invivo.12609] [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: 06/28/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The quantitative evaluation of fat tissue, mainly for the determination of liver steatosis, is possible by using dual-energy computed tomography. Different photon energy acquisitions allow for estimation of attenuation coefficients. The effect of variation in radiation doses and reconstruction kernels on fat fraction estimation was investigated. MATERIALS AND METHODS A six-probe-phantom with fat concentrations of 0%, 20%, 40%, 60%, 80%, and 100% were scanned in Sn140/100 kV with radiation doses ranging between 20 and 200 mAs before and after calibration. Images were reconstructed using iterative kernels (I26,Q30,I70). RESULTS Fat fractions measured in dual-energy computed tomography (DECT) were consistent with the 20%-stepwise varying actual concentrations. Variation in radiation dose resulted in 3.1% variation of fat fraction. Softer reconstruction kernel (I26) underestimated the fat fraction (-9.1%), while quantitative (Q30) and sharper kernel (I70) overestimated fat fraction (10,8% and 13,1, respectively). CONCLUSION The fat fraction in DECT approaches the actual fat concentration when calibrated to the reconstruction kerneö. Variation of radiation dose caused an acceptable 3% variation.
Collapse
Affiliation(s)
| | - Corinna Born
- Hospital Pharmacy, Kantonsspital Baden, Baden, Switzerland
| | | | | | - Michael J Thali
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland;
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Gehweiler D, Schultz M, Schulze M, Riesenbeck O, Wähnert D, Raschke MJ. Material properties of human vertebral trabecular bone under compression can be predicted based on quantitative computed tomography. BMC Musculoskelet Disord 2021; 22:709. [PMID: 34407777 PMCID: PMC8375123 DOI: 10.1186/s12891-021-04571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background The prediction of the stability of bones is becoming increasingly important. Especially osteoporotic vertebral body fractures are a growing problem and an increasing burden on the health system. Therefore, the aim of this study was to provide the best possible description of the relationship between the material properties of human vertebral trabecular bone measured under the most physiological conditions possible and the bone mineral density (BMD) determined by clinical quantitative computed tomography (QCT). Methods Forty eight cylindric cancellous bone samples with a diameter of 7.2 mm obtained from 13 human fresh-frozen lumbar vertebrae from 5 donors (3 men, 2 women) have been used for this study. After the specimens were temporarily reinserted into the vertebral body, the QCT was performed. For mechanical testing, the samples were embedded in a load-free manner using polymethylmetacrylate (PMMA). The surrounding test chamber was filled with phosphate buffered saline (PBS) and heated to 37 °C during the test. After 10 preconditioning load cycles, destructive testing was performed under axial compression. After determining the fracture site, BMD has been evaluated in this region only. Regression analyses have been performed. Results Fracture site had an average length of 2.4 (±1.4) mm and a position of 43.9 (±10.9) percent of the measurement length from the cranial end. No fracture reached the embedding. The average BMD at the fracture site was 80.2 (±28.7 | min. 14.5 | max. 137.8) mgCaHA/ml. In summary the results of the regression analyses showed for all three parameters a very good quality of fit by a power regression. Conclusion The results of this study show that QCT-based bone density measurements have a good predictive power for the material properties of the vertebral cancellous bone measured under near to physiological conditions. The mechanical bone properties of vertebral cancellous bone could be modelled with high accuracy in the investigated bone density range.
Collapse
Affiliation(s)
- Dominic Gehweiler
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.,University Hospital Muenster, Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Marius Schultz
- University Hospital Muenster, Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Martin Schulze
- Department of Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Oliver Riesenbeck
- University Hospital Muenster, Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Dirk Wähnert
- University Hospital Muenster, Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany. .,Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33627, Bielefeld, Germany.
| | - Michael J Raschke
- University Hospital Muenster, Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| |
Collapse
|
21
|
Yong TH, Yang S, Lee SJ, Park C, Kim JE, Huh KH, Lee SS, Heo MS, Yi WJ. QCBCT-NET for direct measurement of bone mineral density from quantitative cone-beam CT: a human skull phantom study. Sci Rep 2021; 11:15083. [PMID: 34301984 PMCID: PMC8302740 DOI: 10.1038/s41598-021-94359-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to directly and quantitatively measure BMD from Cone-beam CT (CBCT) images by enhancing the linearity and uniformity of the bone intensities based on a hybrid deep-learning model (QCBCT-NET) of combining the generative adversarial network (Cycle-GAN) and U-Net, and to compare the bone images enhanced by the QCBCT-NET with those by Cycle-GAN and U-Net. We used two phantoms of human skulls encased in acrylic, one for the training and validation datasets, and the other for the test dataset. We proposed the QCBCT-NET consisting of Cycle-GAN with residual blocks and a multi-channel U-Net using paired training data of quantitative CT (QCT) and CBCT images. The BMD images produced by QCBCT-NET significantly outperformed the images produced by the Cycle-GAN or the U-Net in mean absolute difference (MAD), peak signal to noise ratio (PSNR), normalized cross-correlation (NCC), structural similarity (SSIM), and linearity when compared to the original QCT image. The QCBCT-NET improved the contrast of the bone images by reflecting the original BMD distribution of the QCT image locally using the Cycle-GAN, and also spatial uniformity of the bone images by globally suppressing image artifacts and noise using the two-channel U-Net. The QCBCT-NET substantially enhanced the linearity, uniformity, and contrast as well as the anatomical and quantitative accuracy of the bone images, and demonstrated more accuracy than the Cycle-GAN and the U-Net for quantitatively measuring BMD in CBCT.
Collapse
Affiliation(s)
- Tae-Hoon Yong
- grid.31501.360000 0004 0470 5905Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Su Yang
- grid.31501.360000 0004 0470 5905Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Sang-Jeong Lee
- grid.31501.360000 0004 0470 5905Dental Research Institute, Seoul National University, Seoul, Korea
| | - Chansoo Park
- grid.31501.360000 0004 0470 5905Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jo-Eun Kim
- grid.459982.b0000 0004 0647 7483Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Kyung-Hoe Huh
- grid.31501.360000 0004 0470 5905Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- grid.31501.360000 0004 0470 5905Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- grid.31501.360000 0004 0470 5905Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- grid.31501.360000 0004 0470 5905Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| |
Collapse
|
22
|
Anderson PA, Freedman BA, Brox WT, Shaffer WO. Osteoporosis: Recent Recommendations and Positions of the American Society for Bone and Mineral Research and the International Society for Clinical Densitometry. J Bone Joint Surg Am 2021; 103:741-747. [PMID: 33587517 DOI: 10.2106/jbjs.20.01248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Osteoporosis is common in orthopaedic patients, not only in those sustaining fragility fractures but also in patients ≥50 years old who are having elective orthopaedic surgery. ➤ The American Society for Bone and Mineral Research (ASBMR) has developed consensus-based recommendations for secondary fracture prevention for all patients who are ≥65 years old with a hip or spine fracture. ➤ The ASBMR encourages orthopaedic surgeons to "Own the Bone," by beginning prevention of a secondary fracture during hospitalization for a fragility fracture, if practicable, and arranging follow-up for continued bone health care after discharge. ➤ The International Society for Clinical Densitometry (ISCD) recognized that many poor outcomes and complications of elective orthopaedic surgery are related to osteoporosis. ➤ The ISCD used an evidence-based approach to create official positions to identify which patients ≥50 years old who are having elective orthopaedic surgery should undergo assessment of bone health and how this should be performed.
Collapse
Affiliation(s)
- Paul A Anderson
- Department of Orthopedic Surgery & Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - Brett A Freedman
- Department of Orthopedic Surgery & Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - W Timothy Brox
- Department of Orthopedic Surgery & Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - William O Shaffer
- Department of Orthopedic Surgery & Rehabilitation, University of Wisconsin, Madison, Wisconsin
| |
Collapse
|
23
|
Automated segmentation of an intensity calibration phantom in clinical CT images using a convolutional neural network. Int J Comput Assist Radiol Surg 2021; 16:1855-1864. [PMID: 33730352 DOI: 10.1007/s11548-021-02345-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In quantitative computed tomography (CT), manual selection of the intensity calibration phantom's region of interest is necessary for calculating density (mg/cm3) from the radiodensity values (Hounsfield units: HU). However, as this manual process requires effort and time, the purposes of this study were to develop a system that applies a convolutional neural network (CNN) to automatically segment intensity calibration phantom regions in CT images and to test the system in a large cohort to evaluate its robustness. METHODS This cross-sectional, retrospective study included 1040 cases (520 each from two institutions) in which an intensity calibration phantom (B-MAS200, Kyoto Kagaku, Kyoto, Japan) was used. A training dataset was created by manually segmenting the phantom regions for 40 cases (20 cases for each institution). The CNN model's segmentation accuracy was assessed with the Dice coefficient, and the average symmetric surface distance was assessed through fourfold cross-validation. Further, absolute difference of HU was compared between manually and automatically segmented regions. The system was tested on the remaining 1000 cases. For each institution, linear regression was applied to calculate the correlation coefficients between HU and phantom density. RESULTS The source code and the model used for phantom segmentation can be accessed at https://github.com/keisuke-uemura/CT-Intensity-Calibration-Phantom-Segmentation . The median Dice coefficient was 0.977, and the median average symmetric surface distance was 0.116 mm. The median absolute difference of the segmented regions between manual and automated segmentation was 0.114 HU. For the test cases, the median correlation coefficients were 0.9998 and 0.999 for the two institutions, with a minimum value of 0.9863. CONCLUSION The proposed CNN model successfully segmented the calibration phantom regions in CT images with excellent accuracy.
Collapse
|
24
|
Corona-Castuera J, Rodriguez-Delgado D, Henao J, Castro-Sandoval JC, Poblano-Salas CA. Design and Fabrication of a Customized Partial Hip Prosthesis Employing CT-Scan Data and Lattice Porous Structures. ACS OMEGA 2021; 6:6902-6913. [PMID: 33748604 PMCID: PMC7970571 DOI: 10.1021/acsomega.0c06144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/23/2021] [Indexed: 05/22/2023]
Abstract
As a larger elderly human population is expected worldwide in the next 30 years, the occurrence of aging-associated illnesses will also be increased. The use of prosthetic devices by this population is currently important and will be even more dramatic in the near future. Hence, the design of prosthetic devices able to reduce some of the problems associated with the use of current components, such as stress shielding, reduced mobility, infection, discomfort, etc., becomes relevant. The use of additive manufacturing (AM) and the design fabrication of self-supported cellular structures in the biomedical area have opened up important opportunities for controlling the physical and mechanical properties of hip implants, resulting in specific benefits for the patients. Different studies have reported the development of hip prosthetic designs employing AM, although there are still opportunities for improvement when it comes to customized design and tuning of the physical and mechanical properties of such implants. This work shows the design and manufacture by AM of a personalized stainless-steel partial hip implant using tomography data and self-supported triply periodic minimal surface (TPMS) cell structures; the design considers dimensional criteria established by international standards. By employing tomography data, the external dimensions of the implant were established and the bone density of a specific patient was calculated; the density and mechanical properties in compression of the implant were modulated by employing an internal gyroid-type cell structure. Using such a cell structure, the patient's bone density was emulated; also, the mechanical properties of the implant were fine-tuned in order to make them comparable to those reported for the bone tissue replaced by the prosthesis. The implant design and manufacturing methodology developed in this work considered the clinical condition of a specific patient and can be reproduced and adjusted for different types of bone tissue qualities for specific clinical requirements.
Collapse
Affiliation(s)
- Jorge Corona-Castuera
- CIATEQ
A.C., Av. Manantiales
23-A, Parque Industrial Bernardo Quintana, El Marqués, Querétaro 76246, Mexico
| | - Daniela Rodriguez-Delgado
- CIATEQ
A.C., Av. Manantiales
23-A, Parque Industrial Bernardo Quintana, El Marqués, Querétaro 76246, Mexico
| | - John Henao
- CONACyT-CIATEQ
A.C., Av. Manantiales
23-A, Parque Industrial Bernardo Quintana, El Marqués, Querétaro 76246, Mexico
| | | | - Carlos A. Poblano-Salas
- CIATEQ
A.C., Av. Manantiales
23-A, Parque Industrial Bernardo Quintana, El Marqués, Querétaro 76246, Mexico
| |
Collapse
|
25
|
Requist MR, Sripanich Y, Peterson AC, Rolvien T, Barg A, Lenz AL. Semi-automatic micro-CT segmentation of the midfoot using calibrated thresholds. Int J Comput Assist Radiol Surg 2021; 16:387-396. [PMID: 33606178 DOI: 10.1007/s11548-021-02318-z] [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: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE In the field of skeletal research, accurate and reliable segmentation methods are necessary for quantitative micro-CT analysis to assess bone quality. We propose a method of semi-automatic image segmentation of the midfoot, using the cuneiform bones as a model, based on thresholds set by phantom calibration that allows reproducible results in low cortical thickness bones. METHODS Manual and semi-automatic segmentation methods were compared in micro-CT scans of the medial and intermediate cuneiforms of 24 cadaveric specimens. The manual method used intensity thresholds, hole filling, and manual cleanup. The semi-automatic method utilized calibrated bone and soft tissue thresholds Boolean subtraction to cleanly identify edges before hole filling. Intra- and inter-rater reliability was tested for the semi-automatic method in all specimens. Mask volume and average bone mineral density (BMD) were measured for all masks, and the three-dimensional models were compared to the initial semi-automatic segmentation using an unsigned distance part comparison analysis. Segmentation methods were compared with paired t-tests with significance level 0.05, and reliability was analyzed by calculating intra-class correlation coefficients. RESULTS There were statistically significant differences in mask volume and BMD between the manual and semi-automatic segmentation methods in both bones. The intra- and inter-reliability was excellent for mask volume and bone density in both bones. Part comparisons showed a higher maximum distance between surfaces for the manual segmentation than the repeat semi-automatic segmentations. CONCLUSION We developed a semi-automatic micro-CT segmentation method based on calibrated thresholds. This method was designed specifically for use in bones with high rates of curvature and low cortical bone density, such as the cuneiforms, where traditional threshold-based segmentation is more challenging. Our method shows improvement over manual segmentation and was highly reliable, making it appropriate for use in quantitative micro-CT analysis.
Collapse
Affiliation(s)
- Melissa R Requist
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.,Department of Biomedical Engineering, University of Arizona, 1127 E James E Rogers Way, Tucson, AZ, 85721, USA
| | - Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.,Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Andrew C Peterson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA. .,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
26
|
Winsor C, Li X, Qasim M, Henak CR, Pickhardt PJ, Ploeg H, Viceconti M. Evaluation of patient tissue selection methods for deriving equivalent density calibration for femoral bone quantitative CT analyses. Bone 2021; 143:115759. [PMID: 33212317 DOI: 10.1016/j.bone.2020.115759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 01/22/2023]
Abstract
Osteoporosis affects an increasing number of people every year and patient specific finite element analysis of the femur has been proposed to identify patients that could benefit from preventative treatment. The aim of this study was to demonstrate, verify, and validate an objective process for selecting tissues for use as the basis of phantomless calibration to enable patient specific finite element analysis derived hip fracture risk prediction. Retrospective reanalysis of patient computed tomography (CT) scans has the potential to yield insights into more accurate prediction of osteoporotic fracture. Bone mineral density (BMD) specific calibration scans are not typically captured during routine clinical practice. Tissue-based BMD calibration can therefore empower the retrospective study of patient CT scans captured during routine clinical practice. Together the method for selecting tissues as the basis for phantomless calibration coupled with the post-processing steps for deriving a calibration equation using the selected tissues provide an estimation of quantitative equivalent density results derived using calibration phantoms. Patient tissues from a retrospective cohort of 211 patients were evaluated. The best phantomless calibration resulted in a femoral strength (FS) [N] bias of 0.069 ± 0.07% over FS derived from inline calibration and a BMD [kg/cm3] bias of 0.038 ± 0.037% over BMD derived from inline calibration. The phantomless calibration slope for the best method presented was within the range of patient specific calibration curves available for comparison and demonstrated a small bias of 0.028 ± 0.054 HU/(mg/cm3), assuming the Mindways Model 3 BMD inline calibration phantom as the gold standard. The presented method of estimating a calibration equation from tissues showed promise for CT-based femoral fracture analyses of retrospective cohorts without readily available calibration data.
Collapse
Affiliation(s)
- C Winsor
- Mechanical Engineering, University of Wisconsin, USA
| | - X Li
- Mechanical Engineering, University of Sheffield, UK; INSIGNEO Institute for in silico Medicine, University of Sheffield, UK.
| | - M Qasim
- Mechanical Engineering, University of Sheffield, UK; INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
| | - C R Henak
- Mechanical Engineering, University of Wisconsin, USA
| | | | - H Ploeg
- Mechanical Engineering, University of Wisconsin, USA; Mechanical and Materials Engineering, Queen's University, Canada
| | - M Viceconti
- Mechanical Engineering, University of Sheffield, UK; INSIGNEO Institute for in silico Medicine, University of Sheffield, UK; Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy; Medical Technology Lab, IRCCS Rizzoli Orthopaedic Institute, Italy
| |
Collapse
|
27
|
Bonnevialle N, Geais L, Müller JH, Berhouet J. Effect of RSA glenoid baseplate central fixation on micromotion and bone stress. JSES Int 2020; 4:979-986. [PMID: 33345244 PMCID: PMC7738598 DOI: 10.1016/j.jseint.2020.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background In reverse shoulder arthroplasties (RSA), osseous in-growth is promoted if glenoid micromotion does not exceed 150 μm. The purpose of this study was to determine whether the configuration of central fixation for RSA glenoid baseplates reduces implant micromotion or changes scapula bone stresses. Methods Using finite element analysis, glenoid baseplate fixation was tested in a cohort of 3 male and 2 female patients who were to undergo RSA. Computer models were created for 3 different RSA glenoid baseplate and 84 glenosphere designs, a central threaded peg (1 variant, D-TP), a central unthreaded peg (2 variants, I- 85 P(15) and I-P(25)), and a central peg with a screw (2 variants, A-PS and I-PS). A compressive and shear force of 756 N was distributed across the glenosphere with the scapula anchored. Results Displacement was within 20-130 μm at the glenosphere baseplate-bone interface for all baseplates. The glenospheres with unthreaded pegs had intermediate displacement values (I-P(15): median, 89 μm; range, 32-112 μm; and I-P(25): median, 93 μm; range, 31-109 μm). The von Mises stresses were 1.8-7.0 MPa within cortical bone and 0.6-1.6 MPa within trabecular bone. Cortical bone stresses were similar with unthreaded pegs (I-P(15): median, 4.2 MPa; range, 1.8-6.0 MPa; and I-P(25): median, 4.2 MPa; range, 1.8-6.1 MPa), whereas mean trabecular stresses were similar for all configurations. Conclusions All configurations yielded adequate stability, with micromotions being below 150 μm. The unthreaded pegged designs provided a valid alternative to the stable threaded pegged convex baseplates in terms of micromotions and bone stresses.
Collapse
Affiliation(s)
| | | | | | | | - Julien Berhouet
- Faculté de Médecine de Tours, CHRU Trousseau Service d'Orthopédie Traumatologie, Université de Tours, Tours, France.,Laboratoire d'Informatique Fondamentale et Appliquée de Tours (EA6300), Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Tours, France
| |
Collapse
|
28
|
Benca E, Amini M, Pahr DH. Effect of CT imaging on the accuracy of the finite element modelling in bone. Eur Radiol Exp 2020; 4:51. [PMID: 32869123 PMCID: PMC7458968 DOI: 10.1186/s41747-020-00180-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022] Open
Abstract
The finite element (FE) analysis is a highly promising tool to simulate the behaviour of bone. Skeletal FE models in clinical routine rely on the information about the geometry and bone mineral density distribution from quantitative computed tomography (CT) imaging systems. Several parameters in CT imaging have been reported to affect the accuracy of FE models. FE models of bone are exclusively developed in vitro under scanning conditions deviating from the clinical setting, resulting in variability of FE results (< 10%). Slice thickness and field of view had little effect on FE predicted bone behaviour (≤ 4%), while the reconstruction kernels showed to have a larger effect (≤ 20%). Due to large interscanner variations (≤ 20%), the translation from an experimental model into clinical reality is a critical step. Those variations are assumed to be mostly caused by different “black box” reconstruction kernels and the varying frequency of higher density voxels, representing cortical bone. Considering the low number of studies together with the significant effect of CT imaging on the finite element model outcome leading to high variability in the predicted behaviour, we propose further systematic research and validation studies, ideally preceding multicentre and longitudinal studies.
Collapse
Affiliation(s)
- Emir Benca
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Morteza Amini
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.,Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.,Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria
| |
Collapse
|
29
|
Prado M, Rezaei A, Giambini H. Density-Dependent Material and Failure Criteria Equations Highly Affect the Accuracy and Precision of QCT/FEA-Based Predictions of Osteoporotic Vertebral Fracture Properties. Ann Biomed Eng 2020; 49:663-672. [PMID: 32820381 DOI: 10.1007/s10439-020-02595-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
About 700,000 vertebral fractures occur in the US as a result of bone loss. Quantitative computed tomography (QCT)-based finite element analysis (FEA) is a promising tool for fracture risk prediction that is becoming attractive in the clinical setting. The goals of this study were (1) to perform individual and pooled specimen optimization using inverse QCT/FEA modeling to obtain ash density-elastic modulus equations incorporating the whole vertebral body and accounting for all variables used during FE modeling, and (2) to determine the effect of material equations and failure criteria on the accuracy and precision of mechanical properties. Fifty-four (54) human vertebrae were used to optimize material equations based on experimental outcomes and, together with a previously proposed material equation, were implemented in our models using three different failure criteria to obtain fracture loads. Our robust QCT/FEA approach predicted 78% of the failure loads. Material equations resulted in poor accuracy in the predicted stiffness, yet yielded good precision and, more importantly, strong correlations with fracture loads. Both material and fracture criterion equations are equally important in estimating accurate and precise QCT/FEA predictions. Results suggest that both elastic modulus and fracture criterion equations should be validated against experimental outcomes to better explain the response of the tissue under various conditions.
Collapse
Affiliation(s)
- Maria Prado
- Department of Biomedical and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA.
| |
Collapse
|
30
|
Falcinelli C, Whyne C. Image-based finite-element modeling of the human femur. Comput Methods Biomech Biomed Engin 2020; 23:1138-1161. [PMID: 32657148 DOI: 10.1080/10255842.2020.1789863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fracture is considered a critical clinical endpoint in skeletal pathologies including osteoporosis and bone metastases. However, current clinical guidelines are limited with respect to identifying cases at high risk of fracture, as they do not account for many mechanical determinants that contribute to bone fracture. Improving fracture risk assessment is an important area of research with clear clinical relevance. Patient-specific numerical musculoskeletal models generated from diagnostic images are widely used in biomechanics research and may provide the foundation for clinical tools used to quantify fracture risk. However, prior to clinical translation, in vitro validation of predictions generated from such numerical models is necessary. Despite adopting radically different models, in vitro validation of image-based finite element (FE) models of the proximal femur (predicting strains and failure loads) have shown very similar, encouraging levels of accuracy. The accuracy of such in vitro models has motivated their application to clinical studies of osteoporotic and metastatic fractures. Such models have demonstrated promising but heterogeneous results, which may be explained by the lack of a uniform strategy with respect to FE modeling of the human femur. This review aims to critically discuss the state of the art of image-based femoral FE modeling strategies, highlighting principal features and differences among current approaches. Quantitative results are also reported with respect to the level of accuracy achieved from in vitro evaluations and clinical applications and are used to motivate the adoption of a standardized approach/workflow for image-based FE modeling of the femur.
Collapse
Affiliation(s)
- Cristina Falcinelli
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Canada
| | - Cari Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Canada
| |
Collapse
|
31
|
Saldarriaga S, Cataño SJ, Rezaei A, Giambini H. Effect of metastatic lesion size and location on the load-bearing capacity of vertebrae using an optimized ash density-modulus equation. Comput Methods Biomech Biomed Engin 2020; 23:601-610. [PMID: 32310687 DOI: 10.1080/10255842.2020.1754808] [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] [Indexed: 10/24/2022]
Abstract
About 1.8 million new cancer cases are estimated in the US in 2019 from which 50-85% might metastasize to the thoracic and lumbar spines. Subject-specific quantitative computed tomography-based finite element analysis (QCT/FEA) is a promising used tool to predict vertebral fracture properties. The aims of this study were twofold: First, to develop an optimized equation for the elastic modulus accounting for all input parameters in FE modeling of fracture properties. Second, to assess the effect of lesion size and location on the predicted fracture loads. An inverse QCT/FEA method was implemented to determine optimal coefficients for the modulus equation as a function of ash density. Lesions of 16 and 20 mm were then virtually located at the center, off-centered, anterior, and posterior regions of the vertebrae. A total of 6426 QCT/FEA models were run to optimize the coefficients and evaluate the effect of lesions on fracture properties. QCT/FEA predicted stiffness showed high correlations (50%) with the experimentally measured values. Compared to a 16 mm lesion size, a 20 mm lesion had a reduction in failure load of 55%, 57%, 52%, and 44% at the center, off-centered, anterior cortex, and pedicle, respectively (p < 0.001). Lesions affecting mostly trabecular bone showed the largest reduction in predicted failure loads (about 55%), and females presented weaker outcomes than males. An optimal elastic modulus equation resulted in accurate vertebral stiffness predictions. A deterioration of the trabecular bone due to the presence of a lesion highly affected the predicted fracture loads, and this reduction was significantly higher in females compared to males.
Collapse
Affiliation(s)
- Sebastian Saldarriaga
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Simon Jimenez Cataño
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| |
Collapse
|
32
|
Mechanical Effects of Bone Substitute and Far-Cortical Locking Techniques in 2-Part Proximal Humerus Fracture Reconstruction: A Cadaveric Study. J Orthop Trauma 2020; 34:199-205. [PMID: 32197036 DOI: 10.1097/bot.0000000000001668] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To make direct comparisons of the biomechanical properties of a control (CTL) group and implants that were augmented with far cortical locking (FCL), bone substitute material (BSM), and a combination of both (ALL) to determine which fixation is most effective in reducing implant failure. METHODS The constructs were tested with osteopenic cadaveric specimens in a two-part fracture model. Specimens were subjected to a battery of nondestructive torsion and axial compression tests, followed by a cyclic test. Construct stiffness and cycles to failure were documented, pre- and post-test fluoroscopy was performed, and implant and bone kinematics were quantified. RESULTS During nondestructive testing, the BSM group exhibited significantly increased torsional and axial stiffness compared with the FCL (P = 0.006, P < 0.001) group and ALL group (P < 0.001, P = 0.006). There were no significant differences in resistance to cyclic loading between groups. Fluoroscopic analysis indicated significant differences in the motions of nonlocked cannulated screws (used in BSM and ALL) versus locked screws (used in CTL and FCL). CONCLUSIONS Patients with poor bone quality and proximal humerus fracture may necessitate added compliance or rigidity to achieve fixation. Both have exhibited favorable biomechanical characteristics in this cadaveric 2-part proximal humerus fracture model.
Collapse
|
33
|
Yu T, Gao H, Liu T, Huang Y, Wang C. Effects of immediately static loading on osteointegration and osteogenesis around 3D-printed porous implant: A histological and biomechanical study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 108:110406. [PMID: 31924051 DOI: 10.1016/j.msec.2019.110406] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/25/2019] [Accepted: 11/06/2019] [Indexed: 11/19/2022]
Abstract
The 3D-printed porous implant is capable of achieving favorable osteointegration and osteogenesis in the absence of mechanical stimulation during the early healing period. The purpose of this study is to evaluate the impact of immediately static loading on bone osteointegration and osteogenesis around the 3D-printed porous implant. Thirty porous implants with optimal configuration were installed bilaterally into femurs of 15 rabbits. The Load group on the left side was applied the maximal initial load of 10 N offered by a diminutive and built-in loading device and the Non-load group was on the contralateral side. At 2, 4, and 8 weeks post-operatively, the explants were harvested for push-out test to measure the biological fixation strength. The quantity and quality of new bone were evaluated by the means of histological examination, Micro-CT and bone density analysis. Moreover, the animal data were integrated into finite element models to assess the biomechanics of peri-implant bone. The results indicated that the quantity, quality and biomechanical properties of the new bone increased and optimized along with the healing time. It also demonstrated that the immediately static loading increased the volume of new bone with inferior quality in 2 weeks after implantation and the adverse influence emerged gradually as time extended. Moreover, finite element results demonstrated that the early structures of new bone around porous implant were not suitable for functional loading. This study indicated the mineralization modes of distance osteogenesis and contact osteogenesis around the porous implant. Accordingly, the delay and progressive loading protocol was recommended.
Collapse
Affiliation(s)
- Ti Yu
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Hui Gao
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Ting Liu
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yuanding Huang
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
| | - Chao Wang
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.
| |
Collapse
|
34
|
Reeves JM, Knowles NK, Athwal GS, Johnson JA. Methods for Post Hoc Quantitative Computed Tomography Bone Density Calibration: Phantom-Only and Regression. J Biomech Eng 2019; 140:2680998. [PMID: 29801170 DOI: 10.1115/1.4040122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Indexed: 11/08/2022]
Abstract
Quantitative computed tomography (qCT) relies on calibrated bone mineral density data. If a calibration phantom is absent from the CT scan, post hoc calibration becomes necessary. Scanning a calibration phantom after-the-fact and applying that calibration to uncalibrated scans has been used previously. Alternatively, the estimated density is known to vary with CT settings, suggesting that it may be possible to predict the calibration terms using CT settings. This study compares a novel CT setting regression method for post hoc calibration to standard and post hoc phantom-only calibrations. Five cadaveric upper limbs were scanned at 11 combinations of peak tube voltage and current (80-140 kV and 100-300 mA) with two calibration phantoms. Density calibrations were performed for the cadaver scans, and scans of the phantoms alone. Stepwise linear regression determined if the calibration equation terms were predictable using peak tube voltage and current. Peak tube voltage, but not current, was significantly correlated with regression calibration terms. Calibration equation slope was significantly related to the type of phantom (p < 0.001), calibration method (p = 0.026), and peak tube voltage (p < 0.001), but not current (p = 1.000). The calibration equation vertical intercept was significantly related to the type of phantom (p < 0.001), and peak tube voltage (p = 0.006), but not calibration method (p = 0.682), or current (p = 0.822). Accordingly, regression can correlate peak tube voltage with density calibration terms. Suggesting that, while standard qCT calibration is preferable, regression calibration may be an acceptable post hoc method when necessary.
Collapse
Affiliation(s)
- Jacob M Reeves
- Department of Mechanical Engineering, Western University Canada, 1151 Richmond Street, London, ON N6A3K7, Canada e-mail:
| | - Nikolas K Knowles
- Department of Biomedical Engineering, Western University Canada, 1151 Richmond Street, London, ON N6A3K7, Canada e-mail:
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, 268 Grosvenor Street, London, ON N6A4V2, Canada e-mail:
| | - James A Johnson
- Department of Mechanical Engineering, Western University Canada, 1151 Richmond Street, London, ON N6A3K7, Canada e-mail:
| |
Collapse
|
35
|
Eggermont F, Verdonschot N, van der Linden Y, Tanck E. Calibration with or without phantom for fracture risk prediction in cancer patients with femoral bone metastases using CT-based finite element models. PLoS One 2019; 14:e0220564. [PMID: 31361790 PMCID: PMC6667162 DOI: 10.1371/journal.pone.0220564] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/18/2019] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to develop a new calibration method that enables calibration of Hounsfield units (HU) to bone mineral densities (BMD) without the use of a calibration phantom for fracture risk prediction of femurs with metastases using CT-based finite element (FE) models. Fifty-seven advanced cancer patients (67 femurs with bone metastases) were CT scanned atop a separate calibration phantom using a standardized protocol. Non-linear isotropic FE models were constructed based on the phantom calibration and on two phantomless calibration methods: the “air-fat-muscle” and “non-patient-specific” calibration. For air-fat-muscle calibration, peaks for air, fat and muscle tissue were extracted from a histogram of the HU in a standardized region of interest including the patient’s right leg and surrounding air. These CT peaks were linearly fitted to reference “BMD” values of the corresponding tissues to obtain a calibration function. For non-patient-specific calibration, an average phantom calibration function was used for all patients. FE failure loads were compared between phantom and phantomless calibrations. There were no differences in failure loads between phantom and air-fat-muscle calibration (p = 0.8), whereas there was a significant difference between phantom and non-patient-specific calibration (p<0.001). Although this study was not designed to investigate this, in four patients who were scanned using an aberrant reconstruction kernel, the effect of the different kernel seemed to be smaller for the air-fat-muscle calibration compared to the non-patient-specific calibration. With the air-fat-muscle calibration, clinical implementation of the FE model as tool for fracture risk assessment will be easier from a practical and financial viewpoint, since FE models can be made using everyday clinical CT scans without the need of concurrent scanning of calibration phantoms.
Collapse
Affiliation(s)
- Florieke Eggermont
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Laboratory of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Tanck
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
36
|
Michalski AS, Edwards WB, Boyd SK. The Influence of Reconstruction Kernel on Bone Mineral and Strength Estimates Using Quantitative Computed Tomography and Finite Element Analysis. J Clin Densitom 2019; 22:219-228. [PMID: 29054559 DOI: 10.1016/j.jocd.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 11/15/2022]
Abstract
Quantitative computed tomography has been posed as an alternative imaging modality to investigate osteoporosis. We examined the influence of computed tomography convolution back-projection reconstruction kernels on the analysis of bone quantity and estimated mechanical properties in the proximal femur. Eighteen computed tomography scans of the proximal femur were reconstructed using both a standard smoothing reconstruction kernel and a bone-sharpening reconstruction kernel. Following phantom-based density calibration, we calculated typical bone quantity outcomes of integral volumetric bone mineral density, bone volume, and bone mineral content. Additionally, we performed finite element analysis in a standard sideways fall on the hip loading configuration. Significant differences for all outcome measures, except integral bone volume, were observed between the 2 reconstruction kernels. Volumetric bone mineral density measured using images reconstructed by the standard kernel was significantly lower (6.7%, p < 0.001) when compared with images reconstructed using the bone-sharpening kernel. Furthermore, the whole-bone stiffness and the failure load measured in images reconstructed by the standard kernel were significantly lower (16.5%, p < 0.001, and 18.2%, p < 0.001, respectively) when compared with the image reconstructed by the bone-sharpening kernel. These data suggest that for future quantitative computed tomography studies, a standardized reconstruction kernel will maximize reproducibility, independent of the use of a quantitative calibration phantom.
Collapse
Affiliation(s)
- Andrew S Michalski
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - W Brent Edwards
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
37
|
Katz Y, Dahan G, Sosna J, Shelef I, Cherniavsky E, Yosibash Z. Scanner influence on the mechanical response of QCT-based finite element analysis of long bones. J Biomech 2019; 86:149-159. [DOI: 10.1016/j.jbiomech.2019.01.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/03/2019] [Accepted: 01/30/2019] [Indexed: 01/30/2023]
|
38
|
Entezari A, Roohani I, Li G, Dunstan CR, Rognon P, Li Q, Jiang X, Zreiqat H. Architectural Design of 3D Printed Scaffolds Controls the Volume and Functionality of Newly Formed Bone. Adv Healthc Mater 2019; 8:e1801353. [PMID: 30536610 DOI: 10.1002/adhm.201801353] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/17/2018] [Indexed: 02/01/2023]
Abstract
The successful regeneration of functional bone tissue in critical-size defects remains a significant clinical challenge. To address this challenge, synthetic bone scaffolds are widely developed, but remarkably few are translated to the clinic due to poor performance in vivo. Here, it is demonstrated how architectural design of 3D printed scaffolds can improve in vivo outcomes. Ceramic scaffolds with different pore sizes and permeabilities, but with similar porosity and interconnectivity, are implanted in rabbit calvaria for 12 weeks, and then the explants are harvested for microcomputed tomography evaluation of the volume and functionality of newly formed bone. The results indicate that scaffold pores should be larger than 390 µm with an upper limit of 590 µm to enhance bone formation. It is also demonstrated that a bimodal pore topology-alternating large and small pores-enhances the volume and functionality of new bone substantially. Moreover, bone formation results indicate that stiffness of new bone is highly influenced by the scaffold's permeability in the direction concerned. This study demonstrates that manipulating pore size and permeability in a 3D printed scaffold architecture provides a useful strategy for enhancing bone regeneration outcomes.
Collapse
Affiliation(s)
- Ali Entezari
- Australian Research Council Centre in Innovative BioEngineering School of Aerospace Mechanical and Mechatronic Engineering University of Sydney NSW 2006 Australia
- Shanghai‐Sydney Joint Bioengineering and Regenerative Medicine Lab at Shanghai JiaoTong Shanghai 200011 China
| | - Iman Roohani
- School of Chemistry University of New South Wales NSW 2052 Australia
| | - Guanglong Li
- Shanghai‐Sydney Joint Bioengineering and Regenerative Medicine Lab at Shanghai JiaoTong Shanghai 200011 China
- Department of Prosthodontics Oral Bioengineering and Regenerative Medicine Lab Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine 639 Zhizaoju Road Shanghai 200011 China
| | - Colin R. Dunstan
- Australian Research Council Centre in Innovative BioEngineering School of Aerospace Mechanical and Mechatronic Engineering University of Sydney NSW 2006 Australia
- Shanghai‐Sydney Joint Bioengineering and Regenerative Medicine Lab at Shanghai JiaoTong Shanghai 200011 China
| | - Pierre Rognon
- School of Civil Engineering University of Sydney NSW 2006 Australia
| | - Qing Li
- Australian Research Council Centre in Innovative BioEngineering School of Aerospace Mechanical and Mechatronic Engineering University of Sydney NSW 2006 Australia
- Shanghai‐Sydney Joint Bioengineering and Regenerative Medicine Lab at Shanghai JiaoTong Shanghai 200011 China
| | - Xinquan Jiang
- Shanghai‐Sydney Joint Bioengineering and Regenerative Medicine Lab at Shanghai JiaoTong Shanghai 200011 China
- Department of Prosthodontics Oral Bioengineering and Regenerative Medicine Lab Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine 639 Zhizaoju Road Shanghai 200011 China
| | - Hala Zreiqat
- Australian Research Council Centre in Innovative BioEngineering School of Aerospace Mechanical and Mechatronic Engineering University of Sydney NSW 2006 Australia
- Shanghai‐Sydney Joint Bioengineering and Regenerative Medicine Lab at Shanghai JiaoTong Shanghai 200011 China
| |
Collapse
|
39
|
Malekzadeh M, Abbasi-Rad S, Shahgholi M, Naghdi P, Hoseini MS, Yazdi NA, Shiran MB, Rad HS. Design and Validation of Synchronous QCT Calibration Phantom: Practical Methodology. J Med Imaging Radiat Sci 2018; 50:157-162. [PMID: 30777238 DOI: 10.1016/j.jmir.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Quantitative computed tomography (QCT) can supplement dual x-ray absorptiometry by enabling geometric and compartmental bone assessments. Whole-body spiral CT scanners are widely available and require a short scanning time of seconds, in contrast to peripheral QCT scanners, which require several minutes of scanning time. This study designed and evaluated the accuracy and precision of a homemade QCT calibration phantom using a whole-body spiral CT scanner. MATERIALS AND METHODS The QCT calibration phantom consisted of K2HPO4 solutions as reference. The reference material with various concentrations of 0, 50, 100, 200, 400, 1000, and 1200 mg/cc of K2HPO4 in water were used. For designing the phantom, we used the ABAQUS software. RESULTS The phantoms were used for performance assessment of QCT method through measurement of accuracy and precision errors, which were generally less than 5.1% for different concentrations. The correlation between CT numbers and concentration were close to one (R2 = 0.99). DISCUSSION Because whole-body spiral CT scanners allow central bone densitometry, evaluating the accuracy and precision for the easy to use calibration phantom may improve the QCT bone densitometry test. CONCLUSION This study provides practical directions for applying a homemade calibration phantom for bone mineral density quantification in QCT technique.
Collapse
Affiliation(s)
- Malakeh Malekzadeh
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Abbasi-Rad
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Shahgholi
- Young Researchers and Elite Club, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Parisa Naghdi
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Sadat Hoseini
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Ayoobi Yazdi
- Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagher Shiran
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Saligheh Rad
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
40
|
Tanaka H, Yamako G, Kurishima H, Yamashita S, Mori Y, Chiba D, Chosa E, Itoi E. Biomechanical analysis of supra-acetabular insufficiency fracture using finite element analysis. J Orthop Sci 2018; 23:825-833. [PMID: 29866524 DOI: 10.1016/j.jos.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 03/29/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supra-acetabular insufficiency fractures (SAIFs) occur in the upper acetabulum and are rare compared with insufficiency sacral, femoral head, or ischial fractures. However, SAIFs are known to occur in low grade trauma, and the underlying mechanism is still remained unclear. METHODS We performed biomechanical analysis using finite element analysis to clarify the mechanisms underlying the development of SAIFs. Patient-specific models and bone mineral density (BMD) were derived from pelvic computed tomography data from two patients with SAIF (unaffected side) and two healthy young adults. The bone was assumed to be an isotropic, linearly elastic body. We assigned Young's modulus of each element to the pelvis based on the BMD, and reported the relationships for BMD-modulus. Clinically relevant loading conditions-walking and climbing stairs-were applied to the models. We compared the region of failure risk in each acetabulum using a maximum principal strain criterion. RESULTS The average supra-acetabular BMD was less than that of the hemi-pelvis and femoral head, but was higher than that of the femoral neck and greater trochanter. Greater minimum principal strain was concentrated in the supra-acetabular portion in both the SAIF and healthy models. In the SAIF models, the higher region of the failure risk matched the fracture site on the acetabulum. CONCLUSIONS Relative fragility causes compressive strain to concentrate in the upper acetabulum when walking and climbing stairs. When presented with a patient complaining of hip pain without apparent trauma or abnormal X-ray findings, physicians should consider the possibility of SAIF and perform magnetic resonance imaging for the diagnosis of SAIF.
Collapse
Affiliation(s)
- Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Go Yamako
- Department of Mechanical Design Systems, Faculty of Engineering, University of Miyazaki, Miyazaki, 889-2192, Japan.
| | - Hiroaki Kurishima
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shutaro Yamashita
- Department of Mechanical Design Systems, Faculty of Engineering, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Etsuo Chosa
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| |
Collapse
|
41
|
Troy KL, Edwards WB. Practical considerations for obtaining high quality quantitative computed tomography data of the skeletal system. Bone 2018; 110:58-65. [PMID: 29339151 DOI: 10.1016/j.bone.2018.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/20/2022]
Abstract
Quantitative CT (QCT) analysis involves the calculation of specific parameters such as bone volume and density from CT image data, and can be a powerful tool for understanding bone quality and quantity. However, without careful attention to detail during all steps of the acquisition and analysis process, data can be of poor- to unusable-quality. Good quality QCT for research requires meticulous attention to detail and standardization of all aspects of data collection and analysis to a degree that is uncommon in a clinical setting. Here, we review the literature to summarize practical and technical considerations for obtaining high quality QCT data, and provide examples of how each recommendation affects calculated variables. We also provide an overview of the QCT analysis technique to illustrate additional opportunities to improve data reproducibility and reliability. Key recommendations include: standardizing the scanner and data acquisition settings, minimizing image artifacts, selecting an appropriate reconstruction algorithm, and maximizing repeatability and objectivity during QCT analysis. The goal of the recommendations is to reduce potential sources of error throughout the analysis, from scan acquisition to the interpretation of results.
Collapse
Affiliation(s)
- Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States.
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
42
|
Eggermont F, Derikx LC, Free J, van Leeuwen R, van der Linden YM, Verdonschot N, Tanck E. Effect of different CT scanners and settings on femoral failure loads calculated by finite element models. J Orthop Res 2018; 36:2288-2295. [PMID: 29508905 PMCID: PMC6120464 DOI: 10.1002/jor.23890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/02/2018] [Indexed: 02/04/2023]
Abstract
In a multi-center patient study, using different CT scanners, CT-based finite element (FE) models are utilized to calculate failure loads of femora with metastases. Previous studies showed that using different CT scanners can result in different outcomes. This study aims to quantify the effects of (i) different CT scanners; (ii) different CT protocols with variations in slice thickness, field of view (FOV), and reconstruction kernel; and (iii) air between calibration phantom and patient, on Hounsfield Units (HU), bone mineral density (BMD), and FE failure load. Six cadaveric femora were scanned on four CT scanners. Scans were made with multiple CT protocols and with or without an air gap between the body model and calibration phantom. HU and calibrated BMD were determined in cortical and trabecular regions of interest. Non-linear isotropic FE models were constructed to calculate failure load. Mean differences between CT scanners varied up to 7% in cortical HU, 6% in trabecular HU, 6% in cortical BMD, 12% in trabecular BMD, and 17% in failure load. Changes in slice thickness and FOV had little effect (≤4%), while reconstruction kernels had a larger effect on HU (16%), BMD (17%), and failure load (9%). Air between the body model and calibration phantom slightly decreased the HU, BMD, and failure loads (≤8%). In conclusion, this study showed that quantitative analysis of CT images acquired with different CT scanners, and particularly reconstruction kernels, can induce relatively large differences in HU, BMD, and failure loads. Additionally, if possible, air artifacts should be avoided. © 2018 Orthopaedic Research Society. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res.
Collapse
Affiliation(s)
- Florieke Eggermont
- 611 Orthopaedic Research LaboratoryRadboud Institute for Health SciencesRadboud university medical centerP.O. Box 9101Nijmegen6500 HBThe Netherlands
| | - Loes C. Derikx
- 611 Orthopaedic Research LaboratoryRadboud Institute for Health SciencesRadboud university medical centerP.O. Box 9101Nijmegen6500 HBThe Netherlands
| | - Jeffrey Free
- Radiotherapeutic Institute FrieslandLeeuwardenThe Netherlands
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Ruud van Leeuwen
- Department of RadiotherapyRadboud university medical centerNijmegenThe Netherlands
| | | | - Nico Verdonschot
- 611 Orthopaedic Research LaboratoryRadboud Institute for Health SciencesRadboud university medical centerP.O. Box 9101Nijmegen6500 HBThe Netherlands
- Laboratory of Biomechanical EngineeringUniversity of TwenteEnschedeThe Netherlands
| | - Esther Tanck
- 611 Orthopaedic Research LaboratoryRadboud Institute for Health SciencesRadboud university medical centerP.O. Box 9101Nijmegen6500 HBThe Netherlands
| |
Collapse
|
43
|
Sadasivan C, Lieber BB, Woo HH. Physical Simulators and Replicators in Endovascular Neurosurgery Training. COMPREHENSIVE HEALTHCARE SIMULATION: NEUROSURGERY 2018. [DOI: 10.1007/978-3-319-75583-0_3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
44
|
Giambini H, Dragomir-Daescu D, Nassr A, Yaszemski MJ, Zhao C. Quantitative Computed Tomography Protocols Affect Material Mapping and Quantitative Computed Tomography-Based Finite-Element Analysis Predicted Stiffness. J Biomech Eng 2017; 138:2536525. [PMID: 27428281 DOI: 10.1115/1.4034172] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Indexed: 11/08/2022]
Abstract
Quantitative computed tomography-based finite-element analysis (QCT/FEA) has become increasingly popular in an attempt to understand and possibly reduce vertebral fracture risk. It is known that scanning acquisition settings affect Hounsfield units (HU) of the CT voxels. Material properties assignments in QCT/FEA, relating HU to Young's modulus, are performed by applying empirical equations. The purpose of this study was to evaluate the effect of QCT scanning protocols on predicted stiffness values from finite-element models. One fresh frozen cadaveric torso and a QCT calibration phantom were scanned six times varying voltage and current and reconstructed to obtain a total of 12 sets of images. Five vertebrae from the torso were experimentally tested to obtain stiffness values. QCT/FEA models of the five vertebrae were developed for the 12 image data resulting in a total of 60 models. Predicted stiffness was compared to the experimental values. The highest percent difference in stiffness was approximately 480% (80 kVp, 110 mAs, U70), while the lowest outcome was ∼1% (80 kVp, 110 mAs, U30). There was a clear distinction between reconstruction kernels in predicted outcomes, whereas voltage did not present a clear influence on results. The potential of QCT/FEA as an improvement to conventional fracture risk prediction tools is well established. However, it is important to establish research protocols that can lead to results that can be translated to the clinical setting.
Collapse
|
45
|
Knowles NK, Reeves JM, Ferreira LM. Quantitative Computed Tomography (QCT) derived Bone Mineral Density (BMD) in finite element studies: a review of the literature. J Exp Orthop 2016; 3:36. [PMID: 27943224 PMCID: PMC5234499 DOI: 10.1186/s40634-016-0072-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/30/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Finite element modeling of human bone provides a powerful tool to evaluate a wide variety of outcomes in a highly repeatable and parametric manner. These models are most often derived from computed tomography data, with mechanical properties related to bone mineral density (BMD) from the x-ray energy attenuation provided from this data. To increase accuracy, many researchers report the use of quantitative computed tomography (QCT), in which a calibration phantom is used during image acquisition to improve the estimation of BMD. Since model accuracy is dependent on the methods used in the calculation of BMD and density-mechanical property relationships, it is important to use relationships developed for the same anatomical location and using the same scanner settings, as these may impact model accuracy. The purpose of this literature review is to report the relationships used in the conversion of QCT equivalent density measures to ash, apparent, and/or tissue densities in recent finite element (FE) studies used in common density-modulus relationships. For studies reporting experimental validation, the validation metrics and results are presented. RESULTS Of the studies reviewed, 29% reported the use of a dipotassium phosphate (K2HPO4) phantom, 47% a hydroxyapatite (HA) phantom, 13% did not report phantom type, 7% reported use of both K2HPO4 and HA phantoms, and 4% alternate phantom types. Scanner type and/or settings were omitted or partially reported in 31% of studies. The majority of studies used densitometric and/or density-modulus relationships derived from different anatomical locations scanned in different scanners with different scanner settings. The methods used to derive various densitometric relationships are reported and recommendations are provided toward the standardization of reporting metrics. CONCLUSIONS This review assessed the current state of QCT-based FE modeling with use of clinical scanners. It was found that previously developed densitometric relationships vary by anatomical location, scanner type and settings. Reporting of all parameters used when referring to previously developed relationships, or in the development of new relationships, may increase the accuracy and repeatability of future FE models.
Collapse
Affiliation(s)
- Nikolas K. Knowles
- Graduate Program in Biomedical Engineering, The University of Western Ontario, 1151 Richmond St, London, ON Canada
- Roth|McFarlane Hand and Upper Limb Centre, Surgical Mechatronics
Laboratory, St. Josephs Health Care, 268 Grosvenor St, London, ON Canada
- Collaborative Training Program in Musculoskeletal Health Research, and
Bone and Joint Institute, The University of Western Ontario, 1151 Richmond St, London, ON Canada
| | - Jacob M. Reeves
- Roth|McFarlane Hand and Upper Limb Centre, Surgical Mechatronics
Laboratory, St. Josephs Health Care, 268 Grosvenor St, London, ON Canada
- Collaborative Training Program in Musculoskeletal Health Research, and
Bone and Joint Institute, The University of Western Ontario, 1151 Richmond St, London, ON Canada
- Department of Mechanical and Materials Engineering, The University of Western Ontario, 1151 Richmond St, London, ON Canada
| | - Louis M. Ferreira
- Graduate Program in Biomedical Engineering, The University of Western Ontario, 1151 Richmond St, London, ON Canada
- Roth|McFarlane Hand and Upper Limb Centre, Surgical Mechatronics
Laboratory, St. Josephs Health Care, 268 Grosvenor St, London, ON Canada
- Collaborative Training Program in Musculoskeletal Health Research, and
Bone and Joint Institute, The University of Western Ontario, 1151 Richmond St, London, ON Canada
| |
Collapse
|
46
|
Giambini H, Fang Z, Zeng H, Camp JJ, Yaszemski MJ, Lu L. Noninvasive Failure Load Prediction of Vertebrae with Simulated Lytic Defects and Biomaterial Augmentation. Tissue Eng Part C Methods 2016; 22:717-24. [PMID: 27260559 DOI: 10.1089/ten.tec.2016.0078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The spine is the most common site for secondary bone metastases, and clinical management for fractures is based on size and geometry of the defect. About 75% of the bone needs to be damaged before lesions are detectable, so clinical tools should measure changes in both geometry and material properties. We have developed an automated, user-friendly, Spine Cancer Assessment (SCA) image-based analysis method that builds on a platform designed for clinical practice providing failure characteristics of vertebrae. The objectives of this study were to (1) validate SCA predictions with experimental failure load outcomes; (2) evaluate the planning capabilities for prophylactic vertebroplasty procedures; and (3) investigate the effect of computed tomography (CT) protocols on predicted failure loads. Twenty-one vertebrae were randomly divided into two groups: (1) simulated defect without treatment (negative control) [n = 9] and (2) with treatment [n = 12]. Defects were created and a polymeric biomaterial was injected into the vertebrae in the treated-defect group. Spines were scanned, reconstructed with two algorithms, and analyzed for fracture loads. To virtually plan for prophylactic intervention, vertebrae with empty lesions were simulated to be augmented with either poly(methyl methacrylate) (PMMA) or a novel bone replacement copolymer, poly(propylene fumarate-co-caprolactone) [P(PF-co-CL)]. Axial rigidities were calculated from the CT images. Failure loads, determined from the cross section with the lowest axial rigidity, were compared with experimental values. Predicted loads correlated well with experimental outcomes (R(2) = 0.73, p < 0.0001). Predictions from negative control specimens highly correlated with measured values (R(2) = 0.90, p < 0.0001). Although a similar correlation was obtained using both algorithms, the smooth reconstruction (B30) tended to underestimate predicted failure loads by ∼50% compared with the ∼10% underestimate of the sharp reconstruction (B70). Percent increase in failure loads after virtual vertebroplasty showed a higher increase in samples with PMMA compared with those with copolymer. The SCA method developed in this study calculated failure loads from quantitative computed tomography scans in vertebrae with simulated metastatic lytic defects, with or without treatment, facilitating clinical applicability and providing more reliable guidelines for physicians to select appropriate treatment options. Furthermore, the analysis could accommodate augmentation planning procedures that aimed to determine the optimum material that would increase vertebral body failure load.
Collapse
Affiliation(s)
- Hugo Giambini
- 1 Department of Orthopedic Surgery, Mayo Clinic , Rochester, Minnesota
| | - Zhong Fang
- 1 Department of Orthopedic Surgery, Mayo Clinic , Rochester, Minnesota
- 2 Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Heng Zeng
- 1 Department of Orthopedic Surgery, Mayo Clinic , Rochester, Minnesota
- 2 Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Jon J Camp
- 3 Biomedical Imaging Resource, Mayo Clinic , Rochester, Minnesota
| | - Michael J Yaszemski
- 1 Department of Orthopedic Surgery, Mayo Clinic , Rochester, Minnesota
- 4 Department of Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota
| | - Lichun Lu
- 1 Department of Orthopedic Surgery, Mayo Clinic , Rochester, Minnesota
- 4 Department of Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota
| |
Collapse
|