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Ripolin A, Volpe-Zanutto F, Sabri AH, Dos Santos VAB, Figueroba SR, Bezerra AAC, Vinicius Rodrigues Louredo B, Agustin Vargas P, McGuckin MB, Hutton ARJ, Larrañeta E, Franz-Montan M, Donnelly RF. Transdermal delivery of bisphosphonates using dissolving and hydrogel-forming microarray patches: Potential for enhanced treatment of osteoporosis. Int J Pharm 2024; 665:124642. [PMID: 39208953 DOI: 10.1016/j.ijpharm.2024.124642] [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: 06/10/2024] [Revised: 08/23/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
As of 2023, more than 200 million people worldwide are living with osteoporosis. Oral bisphosphonates (BPs) are the primary treatment but can cause gastrointestinal (GI) side effects, reducing patient compliance. Microarray (MAP) technology has the potential to overcome GI irritation by facilitating the transdermal delivery of BPs. This study examines the delivery of alendronic acid (ALN) and risedronate sodium (RDN) using dissolving and hydrogel-forming MAPs for osteoporosis treatment. In vivo testing on osteoporotic female Sprague Dawley rats demonstrated the efficacy of MAPs, showing significant improvements in mean serum and bone alkaline phosphatase levels, bone volume, and porosity compared to untreated bilateral ovariectomy (OVX) controls. Specifically, MAP treatment increased mean bone volume to 55.04 ± 2.25 % versus 47.16 ± 1.71 % in OVX controls and reduced porosity to 44.30 ± 2.97 % versus 52.84 ± 1.70 % in the distal epiphysis of the femur. In the distal metaphysis, bone volume increased to 43.32 ± 3.24 % in MAP-treated rats compared to 24.31 ± 3.21 % in OVX controls, while porosity decreased to 55.39 ± 5.81 % versus 75.69 ± 3.21 % in OVX controls. This proof-of-concept study indicates that MAP technology has the potential to be a novel, patient-friendly alternative for weekly osteoporosis management.
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Affiliation(s)
- Anastasia Ripolin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Fabiana Volpe-Zanutto
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Faculty of Pharmaceutical Sciences, R. Cândido Portinari, 200 - Cidade Universitária, Campinas - SP, 13083-871, Universidade Estadual de Campinas-UNICAMP, Brazil
| | - Akmal H Sabri
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | | | - Sidney R Figueroba
- Department of Biosciences, Piracicaba Dental School, Universidade Estadual de Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Arthur A C Bezerra
- Department of Biosciences, Piracicaba Dental School, Universidade Estadual de Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | | | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Mary B McGuckin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Aaron R J Hutton
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, UK
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Michelle Franz-Montan
- Department of Biosciences, Piracicaba Dental School, Universidade Estadual de Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Poiană IR, Dobre R, Pițuru SM, Bucur A. The Utility of Radiomorphometric Mandibular Indices on Cone Beam Computer Tomography in the Assessment of Bone Mass in Postmenopausal Women: A Cross-Sectional Study. J Pers Med 2024; 14:843. [PMID: 39202034 PMCID: PMC11355488 DOI: 10.3390/jpm14080843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/15/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND The present study examined the potential use of computed tomography radiomorphometric mandibular indices on cone beam CT (CBCT) for the assessment of bone density in postmenopausal women with low bone mass. METHODS We included 104 postmenopausal women who received dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen (MF) region CBCT using a NewTom VGi EVO Cone Beam 3D system. We assessed the relationships between the following DXA parameters: lumbar, femoral neck, and total hip T-scores, bone mineral density (BMD), lumbar trabecular bone score (TBS), and mandibular inferior cortical bone thickness at 4 sites. The cross-sectional images were obtained, as follows: anterior (A)-10 mm anterior from the MF; molar (M)-10 mm posterior from the MF; posterior (P)-25 mm posterior from the MF; symphysis (S)-equidistant from the centers of the right and left MF. RESULTS We found that A and M indices showed statistically significant moderate positive correlations with lumbar spine, femoral neck, and total hip BMD, as well as TBS. The P index demonstrated moderate positive correlations with these measurements, while the S index did not show significant correlations with BMD or TBS in postmenopausal women. CONCLUSIONS These findings support the potential usefulness of CBCT-derived radiomorphometric mandibular indices for non-invasive bone health assessment in clinical practice.
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Affiliation(s)
- Ioana Ruxandra Poiană
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (S.-M.P.); (A.B.)
| | - Ramona Dobre
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (S.-M.P.); (A.B.)
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
| | - Silviu-Mirel Pițuru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (S.-M.P.); (A.B.)
| | - Alexandru Bucur
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (S.-M.P.); (A.B.)
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Klintström E, Klintström B, Smedby Ö, Moreno R. Automated region growing-based segmentation for trabecular bone structure in fresh-frozen human wrist specimens. BMC Med Imaging 2024; 24:101. [PMID: 38693510 PMCID: PMC11061919 DOI: 10.1186/s12880-024-01281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/23/2024] [Indexed: 05/03/2024] Open
Abstract
Bone strength depends on both mineral content and bone structure. Measurements of bone microstructure on specimens can be performed by micro-CT. In vivo measurements are reliably performed by high-resolution peripheral computed tomography (HR-pQCT) using dedicated software. In previous studies from our research group, trabecular bone properties on CT data of defatted specimens from many different CT devices have been analyzed using an Automated Region Growing (ARG) algorithm-based code, showing strong correlations to micro-CT.The aim of the study was to validate the possibility of segmenting and measuring trabecular bone structure from clinical CT data of fresh-frozen human wrist specimens. Data from micro-CT was used as reference. The hypothesis was that the ARG-based in-house built software could be used for such measurements.HR-pQCT image data at two resolutions (61 and 82 µm isotropic voxels) from 23 fresh-frozen human forearms were analyzed. Correlations to micro-CT were strong, varying from 0.72 to 0.99 for all parameters except trabecular termini and nodes. The bone volume fraction had correlations varying from 0.95 to 0.98 but was overestimated compared to micro-CT, especially at the lower resolution. Trabecular separation and spacing were the most stable parameters with correlations at 0.80-0.97 and mean values in the same range as micro-CT.Results from this in vitro study show that an ARG-based software could be used for segmenting and measuring 3D trabecular bone structure from clinical CT data of fresh-frozen human wrist specimens using micro-CT data as reference. Over-and underestimation of several of the bone structure parameters must however be taken into account.
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Affiliation(s)
- Eva Klintström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, SE-58185, Sweden.
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE-58185, Sweden.
| | - Benjamin Klintström
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, SE-14157, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, SE-14157, Sweden
| | - Rodrigo Moreno
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, SE-14157, Sweden
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Poiana IR, Dobre R, Popescu RI, Pituru SM, Bucur A. Utility of Cone-Beam Computed Tomography in the Detection of Low Bone Mass-A Systematic Review. J Clin Med 2023; 12:5890. [PMID: 37762831 PMCID: PMC10531931 DOI: 10.3390/jcm12185890] [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: 08/21/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass density. MATERIALS AND METHODS A systematic review of the literature was performed using the PubMed and SCOPUS databases, with terms referring to low bone mass and cone-beam computed tomography (CBCT). RESULTS Sixteen studies were included in the review. The results show different perspectives, but the evidence favors the use of CBCT, combined with dual-energy X-ray absorptiometry bone density scan (DXA) evaluation, for the assessment of the osteoporosis status of the aging population and, more specifically, in postmenopausal women. Radiographic density (RD) values of the dens and the left part of the first cervical vertebra show the strongest correlation coefficients and the highest sensitivity, specificity, and accuracy for predicting osteoporosis (OP) in the lumbar vertebrae and the femoral neck. CONCLUSIONS Our review suggests the potential of CBCT as a screening tool for patients with low bone mass using different radiomorphometric indices. Linear measurements of the inferior mandibular cortex were lower in osteoporotic individuals, indicating the perspective of CBCT also as a diagnostic tool for this disease.
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Affiliation(s)
- Ioana Ruxandra Poiana
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
| | - Ramona Dobre
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
| | - Razvan-Ionut Popescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Silviu-Mirel Pituru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
| | - Alexandru Bucur
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
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Klintström E, Klintström B, Spångeus A, Sandborg M, Woisetschläger M. Trabecular bone microstructure analysis on data from a novel twin robotic X-ray device. Acta Radiol 2022; 64:1566-1572. [PMID: 36373570 PMCID: PMC10088033 DOI: 10.1177/02841851221134973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Bone strength is related to both mineral density (BMD) and the bone microstructure. However, only the assessment of BMD is available in clinical routine care today. Purpose To analyze and study the correlation of trabecular bone microstructure from the imaging data of a prototype Multitom Rax system, using micro-computed tomography (CT) data as the reference method (Skyscan 1176). Material and Methods Imaging data from 14 bone samples from the human radius were analyzed regarding six bone structure parameters, i.e. trabecular nodes, separation, spacing, and thickness as well as bone volume (BV/TV) and structural model index (SMI). Results All six structure parameters showed strong correlations to micro-CT with Spearman correlation coefficients in the range of 0.83–0.93. BV/TV and SMI had a correlation >0.90. Two of the parameters, namely, separation and number, had mean values in the same range as micro-CT. The other four were either over- or underestimated. Conclusion The strong correlation between micro-CT and the clinical imaging system, indicates the possibility for analyzing bone microstructure with potential to add value in fracture assessment using the studied device in a clinical workflow.
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Affiliation(s)
- Eva Klintström
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Benjamin Klintström
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Anna Spångeus
- Department of Acute Internal Medicine and Geriatrics/Department of Endocrinology, Linköping University Hospital, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michael Sandborg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Medical Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mischa Woisetschläger
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Klintström B, Henriksson L, Moreno R, Malusek A, Smedby Ö, Woisetschläger M, Klintström E. Photon-counting detector CT and energy-integrating detector CT for trabecular bone microstructure analysis of cubic specimens from human radius. Eur Radiol Exp 2022; 6:31. [PMID: 35882679 PMCID: PMC9325937 DOI: 10.1186/s41747-022-00286-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background As bone microstructure is known to impact bone strength, the aim of this in vitro study was to evaluate if the emerging photon-counting detector computed tomography (PCD-CT) technique may be used for measurements of trabecular bone structures like thickness, separation, nodes, spacing and bone volume fraction. Methods Fourteen cubic sections of human radius were scanned with two multislice CT devices, one PCD-CT and one energy-integrating detector CT (EID-CT), using micro-CT as a reference standard. The protocols for PCD-CT and EID-CT were those recommended for inner- and middle-ear structures, although at higher mAs values: PCD-CT at 450 mAs and EID-CT at 600 (dose equivalent to PCD-CT) and 1000 mAs. Average measurements of the five bone parameters as well as dispersion measurements of thickness, separation and spacing were calculated using a three-dimensional automated region growing (ARG) algorithm. Spearman correlations with micro-CT were computed. Results Correlations with micro-CT, for PCD-CT and EID-CT, ranged from 0.64 to 0.98 for all parameters except for dispersion of thickness, which did not show a significant correlation (p = 0.078 to 0.892). PCD-CT had seven of the eight parameters with correlations ρ > 0.7 and three ρ > 0.9. The dose-equivalent EID-CT instead had four parameters with correlations ρ > 0.7 and only one ρ > 0.9. Conclusions In this in vitro study of radius specimens, strong correlations were found between trabecular bone structure parameters computed from PCD-CT data when compared to micro-CT. This suggests that PCD-CT might be useful for analysing bone microstructure in the peripheral human skeleton.
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Affiliation(s)
- Benjamin Klintström
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, SE-14157, Huddinge, Sweden.
| | - Lilian Henriksson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-58185, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-58185, Linköping, Sweden
| | - Rodrigo Moreno
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, SE-14157, Huddinge, Sweden
| | - Alexandr Malusek
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-58185, Linköping, Sweden.,Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, SE-58183, Linköping, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, SE-14157, Huddinge, Sweden
| | - Mischa Woisetschläger
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-58185, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-58185, Linköping, Sweden
| | - Eva Klintström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-58185, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-58185, Linköping, Sweden
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Micro-computed tomography assessment of bone structure in aging mice. Sci Rep 2022; 12:8117. [PMID: 35581227 PMCID: PMC9114112 DOI: 10.1038/s41598-022-11965-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
High-resolution computed tomography (CT) is widely used to assess bone structure under physiological and pathological conditions. Although the analytic protocols and parameters for micro-CT (μCT) analyses in mice are standardized for long bones, vertebrae, and the palms in aging mice, they have not yet been established for craniofacial bones. In this study, we conducted a morphometric assessment of craniofacial bones, in comparison with long bones, in aging mice. Although age-related changes were observed in the microarchitecture of the femur, tibia, vertebra, and basisphenoid bone, and were more pronounced in females than in males, the microarchitecture of both the interparietal bone and body of the mandible, which develop by intramembranous ossification, was less affected by age and sex. By contrast, the condyle of the mandible was more affected by aging in males compared to females. Taken together, our results indicate that mouse craniofacial bones are uniquely affected by age and sex.
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Diba SF, Gracea RS, Shantiningsih RR, Hidjah K. Analysis of mandible trabecular structure using digital periapical radiographs to assess low bone quality in postmenopausal women. Saudi Dent J 2021; 33:997-1003. [PMID: 34938042 PMCID: PMC8665195 DOI: 10.1016/j.sdentj.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/22/2021] [Accepted: 07/04/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze the quality of mandibular trabecular structure in postmenopausal women using periapical radiographs. Postmenopausal women are subjected to low bone quality; hence, early detection methods are needed. In addition to bone mineral density (BMD), trabecular architecture must be assessed to determine bone quality. The mandible represents bone quality and allows the assessment of trabecular structure from periapical radiographs. MATERIAL AND METHODS Lumbar (BMDL) and femoral BMD (BMDF) examinations were performed using dual-energy X-ray absorptiometry (DXA) in 31 postmenopausal women and divided into normal, osteopenia, and osteoporotic groups. Periapical radiographs were taken at both posterior sites of the mandible. The region of interest was taken 2 mm from the apical root of the first molar. Trabecular parameters consisting of trabecular thickness (Tb.Th) and bone percentage (BA/TA) were measured using BoneJ. RESULTS Both trabecular parameters were significantly correlated with BMDF [BA/TA (r = 0.3796; p < 0.05) and Tb.Th (r = 0.508; p < 0.05)]. BA/TA and Tb.Th were significantly different between the osteoporosis and normal groups (p < 0.05) contrast to osteopenia and normal groups (p > 0.05). CONCLUSION Changes in mandibular trabeculae structure in postmenopausal women can be assessed using periapical radiographs.
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Affiliation(s)
- Silviana Farrah Diba
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rellyca Sola Gracea
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rurie Ratna Shantiningsih
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Khasnur Hidjah
- Department of Computer Science, Faculty of Engineering and Design, Universitas Bumigora, Mataram, Indonesia
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Fan Q, Bai J, Shan H, Fei Z, Chen H, Xu J, Ma Q, Zhou X, Wang C. Implantable blood clot loaded with BMP-2 for regulation of osteoimmunology and enhancement of bone repair. Bioact Mater 2021; 6:4014-4026. [PMID: 33997490 PMCID: PMC8085758 DOI: 10.1016/j.bioactmat.2021.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
The treatment of large-area bone defects still faces many difficulties and challenges. Here, we developed a blood clot delivery platform loaded with BMP-2 protein (BMP-2@BC) for enhanced bone regeneration. Blood clot gel platform as natural biomaterials can be engineered from autologous blood. Once implanted into the large bone defect site, it can be used for BMP-2 local delivery, as well as modulating osteoimmunology by recruiting a great number of macrophages and regulating their polarization at different stages. Moreover, due to the deep-red color of blood clot gel, mild localized hyperthermia under laser irradiation further accelerated bone repair and regeneration. We find that the immune niche within the bone defect microenvironment can be modulated in a controllable manner by the blood clots implantation and laser treatment. We further demonstrate that the newly formed bone covered almost 95% of the skull defect area by our strategy in both mice and rat disease models. Due to the great biocompatibility, photothermal potential, and osteoimmunomodulation capacity, such technology shows great promise to be used in further clinical translation.
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Affiliation(s)
- Qin Fan
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou, Jiangsu, 215123, China
- Key Laboratory for Organic Electronics & Information Displays (KLOEID), Institute of Advanced Materials (IAM) and School of Materials Science and Engineering, Nanjing University of Posts & Telecommunications, Nanjing, 210000, China
| | - Jinyu Bai
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Huajian Shan
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Ziying Fei
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Hao Chen
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Jialu Xu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Qingle Ma
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Chao Wang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou, Jiangsu, 215123, China
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He SK, Ning LJ, Yao X, Hu RN, Cui J, Zhang Y, Ding W, Luo JC, Qin TW. Hierarchically Demineralized Cortical Bone Combined With Stem Cell-Derived Extracellular Matrix for Regeneration of the Tendon-Bone Interface. Am J Sports Med 2021; 49:1323-1332. [PMID: 33667131 DOI: 10.1177/0363546521994511] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Poor healing of the tendon-bone interface after rotator cuff repair is one of the main causes of surgical failure. Previous studies demonstrated that demineralized cortical bone (DCB) could improve healing of the enthesis. PURPOSE To evaluate the outcomes of hierarchically demineralized cortical bone (hDCB) coated with stem cell-derived extracellular matrix (hDCB-ECM) in the repair of the rotator cuff in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS Tendon-derived stem cells (TDSCs) were isolated, cultured, and identified. Then, hDCB was prepared by the graded demineralization procedure. Finally, hDCB-ECM was fabricated via 2-week cell culture and decellularization, and the morphologic features and biochemical compositions of the hDCB-ECM were evaluated. A total of 24 rabbits (48 samples) were randomly divided into 4 groups: control, DCB, hDCB, and hDCB-ECM. All rabbits underwent bilateral detachment of the infraspinatus tendon, and the tendon-bone interface was repaired with or without scaffolds. After surgery, 8 rabbits were assessed by immunofluorescence staining at 2 weeks, and the others were assessed by micro-computed tomography (CT) examination, immunohistochemical staining, histological staining, and biomechanical testing at 12 weeks. RESULTS TDSCs were identified to have universal stem cell characteristics including cell markers, clonogenicity, and multilineage differentiation. The hDCB-ECM contained 3 components (bone, partial DCB, and DCB coated with ECM) with a gradient of calcium and phosphorus elements, and the ECM had stromal cell-derived factor 1, biglycan, and fibromodulin. Macroscopic observations demonstrated the absence of infection and rupture around the enthesis. The results of immunofluorescence staining showed that hDCB-ECM promoted stromal cell recruitment. Results of micro-CT analysis, immunohistochemical staining, and histological staining showed that hDCB-ECM enhanced bone and fibrocartilage formation at the tendon-bone interface. Biomechanical analysis showed that the hDCB-ECM group had higher ultimate tensile stress and Young modulus than the DCB group. CONCLUSION The administration of hDCB-ECM promoted healing of the tendon-bone interface. CLINICAL RELEVANCE hDCB-ECM could provide useful information for the design of scaffolds to repair the tendon-bone interface, and further studies are needed to determine its effectiveness.
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Affiliation(s)
- Shu-Kun He
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.,Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Liang-Ju Ning
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Xuan Yao
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.,Department of Clinical Hematology, Faculty of Laboratory Medicine, Army Medical University, Chongqing, China
| | - Ruo-Nan Hu
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Jing Cui
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yi Zhang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Wei Ding
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Jing-Cong Luo
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Ting-Wu Qin
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
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11
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Min CK, Kim KA. Quantitative analysis of metal artefacts of dental implant in CBCT image by correlation analysis to micro-CT: A microstructural study. Dentomaxillofac Radiol 2021; 50:20200365. [PMID: 33002369 DOI: 10.1259/dmfr.20200365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Quantification of dental implant metal artefacts in CBCT images using correlation analysis of trabecular microstructural parameters from CBCT and micro-CT, and analysis of the effect of varying the angular position of the subject. METHODS Polyurethane synthetic bone blocks were first scanned without implants by micro-CT and CBCT. Two dental implants were then placed parallel in the bone blocks and these specimens were scanned by CBCT with different alpha angles. Three volumes of interest (VOI) were set for further analysis. Six microstructural parameters were measured: trabecular thickness (TbTh), trabecular spacing (ThSp), bone volume per total volume (BV/TV), bone surface per total volume (BS/TV), connectivity density (CD) andfractal dimension (FD). Micro-CT measurements were used as a gold standard for CBCT. Spearman correlation coefficients for each microstructural parameter from CBCT and micro-CT were calculated and compared using Steiger's Z test. RESULTS Without the implants, in VOI1, the Spearman correlation coefficients of TbTh, TbSp, BV/TV, BS/TV, CD and FD were 0.599, 0.76, 0.552, 0.566, 0.664 and 0.607, respectively. With the implants, the correlation coefficients decreased sharply in VOI1. As the alpha angle increased from zero to 90°, the correlation coefficients increased and became significant. Similar results appeared in VOI2. In contrast, in VOI3, the correlation coefficient decreased as the alpha angle increased. CONCLUSIONS Metal artefacts were successfully quantified using microstructural parameters in terms of the image quality of the CBCT. Changes in alpha angle affected the quality of the CBCT image.
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Affiliation(s)
- Chang-Ki Min
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, South Korea.,Department of Oral and Maxillofacial Radiology, School of Dentistry, Backjedaero 567, School of Dentistry, Jeonbuk National University, Jeonju, South Korea
| | - Kyoung-A Kim
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, South Korea.,Department of Oral and Maxillofacial Radiology, School of Dentistry, Backjedaero 567, School of Dentistry, Jeonbuk National University, Jeonju, South Korea
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12
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Franco CS, Sexton C, Flores-Mir C, Healey D. A comparison of 2- and 3-dimensional mandibular superimposition techniques against Björk's structural superimposition method. Am J Orthod Dentofacial Orthop 2021; 159:e253-e273. [PMID: 33541785 DOI: 10.1016/j.ajodo.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 08/01/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this research was to compare mandibular growth rotation relative to the cranial base in different vertical facial patterns on the basis of multiple 2-dimensional (2D) and 3-dimensional (3D) superimposition methods. METHODS Cone-beam computed tomography (CBCT) images taken at a mean interval of 54.8 ± 16.8 months were assessed from a sample of 70 growing patients. Three mandibular superimposition methods were compared against Björk's structural method: (1) a 2D landmark method (2D-M1), (2) a voxel-based 3D method based on a previously reported method (3D-M1), and (3) a voxel-based 3D method incorporating symphyseal structures as references (3D-M2). After superimposition, the relative change in cranial base lines as depicted in sagittal views were measured for true mandibular rotation. Agreement between methods was assessed with Lin's concordance correlation coefficient, Bland-Altman's limits of agreement, and the Bradley-Blackwood test. RESULTS Lin's concordance correlation coefficients ranged between 0.924 for the 2D-M1 method, 0.695 for the 3D-M1 method, and 0.965 for the 3D-M2 method. Bland-Altman limits of agreement were wide for all but the 3D-M2 method. Finally, the Bradley-Blackwood test of equality of means and variances was significant in all except the 3D-M2 method. CONCLUSIONS For time intervals between CBCT volume acquisitions >3 years, the use of the 2D-M1 and 3D-M1 methods is not recommended. There was a high concordance between the 3D-M2 method and Björk's structural method when assessing mandibular growth rotation using relative changes in cranial base lines. The high concordance was displayed across all vertical facial types and for all time differences between first and second CBCT data acquisitions.
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Affiliation(s)
- Christopher Stephen Franco
- Discipline of Orthodontics, School of Dentistry, University of Queensland, Brisbane, Queensland, Australia.
| | - Christopher Sexton
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Carlos Flores-Mir
- Division of Orthodontics, University of Alberta, Edmonton, Alberta, Canada
| | - David Healey
- Discipline of Orthodontics, School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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13
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McGuigan MB, Theodorakou C, Duncan HF, Davies J, Sengupta A, Horner K. An investigation into dose optimisation for imaging root canal anatomy using cone beam CT. Dentomaxillofac Radiol 2020; 49:20200072. [PMID: 32464075 DOI: 10.1259/dmfr.20200072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify a dose as low as diagnostically acceptable and a threshold level of image quality for cone beam CT (CBCT) imaging root canals, using maxillary first molar (M1M) second mesiobuccal (MB2) canals of varying complexity for two CBCT scanners. METHODS Dose-area product (DAP) and contrast-to-noise ratio (CNR) were measured for two scanners at a range of exposure parameters. Subjective-image-quality assessment at the same exposures was performed for three M1Ms of varying MB2 complexity, positioned in an anthropomorphic phantom. Nine raters (three endodontists, three dental radiologists and three junior staff) assessed canal visibility, using a 5-point confidence scale rating. RESULTS Identification of simple-moderate MB2 canal complexity was achieved at a range of protocols, with DAP values of ≥209.3 and ≥203.2 mGy cm² and CNRs of 3 and 7.6 for Promax®3D and Accuitomo-F170® respectively. For complex canal anatomy, target subjective image quality was not achieved, even at the highest DAP values for both scanners. Junior staff classified significantly more images as undiagnostic compared with senior staff (p = 0.043). CONCLUSIONS In this first study to address optimisation of CBCT imaging of root canal anatomy, a similar threshold dose for both scanners was identified for M1Ms with simple-moderate MB2 canal complexity. Increasing dose to enhance visualisation of more complex canal anatomy was ineffective. Selection of standard protocols (while avoiding lower kV/mA protocols) instead of high-resolution scans was a practical means of reducing patient dose. CNR is not a transferable measure of image quality.
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Affiliation(s)
| | - Christie Theodorakou
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Henry F Duncan
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Jonathan Davies
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Keith Horner
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.,Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
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14
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Mys K, Varga P, Gueorguiev B, Hemmatian H, Stockmans F, van Lenthe GH. Correlation Between Cone-Beam Computed Tomography and High-Resolution Peripheral Computed Tomography for Assessment of Wrist Bone Microstructure. J Bone Miner Res 2019; 34:867-874. [PMID: 30912861 DOI: 10.1002/jbmr.3673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 11/10/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) is considered as the best technique to measure bone microarchitecture in vivo. However, a breakthrough for medical applications is inhibited because of the restricted field of view (∼9 mm) and a relatively long acquisition time (∼3 minutes). The goal of this study was to compare the accuracy of cone-beam computed tomography (CBCT) and HR-pQCT and to determine the agreement between CBCT and HR-pQCT in quantifying bone structural parameters. Nineteen trapezia of arthritic patients were scanned four times ex vivo: 1) CBCT (NewTom 5G, Cefla, at 75 μm); 2) HR-pQCT (XTremeCT-I, Scanco, at 82 μm); 3) HR-pQCT (XTremeCT-II, Scanco, at 60.7 μm); and 4) microCT (SkyScan1172, Bruker, at 19.84 μm). XTremeCT-I and XtremeCT-II were reconstructed, segmented, and analyzed following the manufacturer's guidelines. CBCT was reconstructed with in-house developed software and analyzed twice: once with an adaptive segmentation technique combined with a direct analysis method (AT-DM) and once with a Laplace-Hamming filtering technique combined with an indirect analysis method (LH-IM). Parameters of interest included bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp), and number (Tb.N). The analyses of the CBCT data showed that the AT-DM analysis correlated better with microCT for BV/TV, Tb.Sp, and Tb.N, whereas the LH-IM technique correlated better for Tb.Th. Evaluated over all parameters, the coefficient of determination for XtremeCT-I, XtremeCT-II, and CBCT were higher as R2 = 0.68, 0.72, and 0.67, respectively. For CBCT, the correlations improved when three samples with very thin trabeculae close to each other were excluded and became similar to those for XtremeCT-I and XtremeCT-II. Interesting for clinical practice is that those bones could be identified automatically with the CBCT scanner. We conclude that CBCT produced similar accuracy as HR-pQCT in bone morphometric analyses of trapezia. The broader range of application, larger field of view, and shorter acquisition time make CBCT a valuable alternative to HR-pQCT. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium.,Biomedical Development AO Research Institute Davos, Davos, Switzerland
| | - Peter Varga
- Biomedical Development AO Research Institute Davos, Davos, Switzerland
| | - Boyko Gueorguiev
- Biomedical Development AO Research Institute Davos, Davos, Switzerland
| | - Haniyeh Hemmatian
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Filip Stockmans
- Muscles and Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
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15
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Peña-Solórzano CA, Albrecht DW, Paganin DM, Harris PC, Hall CJ, Bassed RB, Dimmock MR. Development of a simple numerical model for trabecular bone structures. Med Phys 2019; 46:1766-1776. [PMID: 30740701 DOI: 10.1002/mp.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/18/2019] [Accepted: 02/01/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Advances in additive manufacturing processes are enabling the fabrication of surrogate bone structures for applications including use in high-resolution anthropomorphic phantoms. In this research, a simple numerical model is proposed that enables the generation of microarchitecture with similar statistical distribution to trabecular bone. METHODS A human humerus, radius, ulna, and several vertebrae were scanned on the Imaging and Medical beamline at the Australian Synchrotron and the proposed numerical model was developed through the definition of two complex functions that encode the trabecular thickness and position-dependant spacing to generate volumetric surrogate trabecular structures. The structures reproduced those observed at 19 separate axial locations through the experimental bone volumes. The applicability of the model when incorporating a two-material approximation to absorption- and phase-contrast CT was also investigated through simulation. RESULTS The synthetic structures, when compared with the real trabecular microarchitecture, yielded an average mean thickness error of 2 μm, and a mean difference in standard deviation of 33 μm for the humerus, 24 μm for the ulna and radius, and 15 μm for the vertebrae. Simulated absorption- and propagation-based phase contrast CT projection data were generated and reconstructed using the derived mathematical simplifications from the two-material approximation, and the phase-contrast effects were successfully demonstrated. CONCLUSIONS The presented model reproduced trabecular distributions that could be used to generate phantoms for quality assurance and validation processes. The implication of utilizing a two-material approximation results in simplification of the additive manufacturing process and the generation of synthetic data that could be used for training of machine learning applications.
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Affiliation(s)
- Carlos A Peña-Solórzano
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Vic., 3800, Australia
| | - David W Albrecht
- Faculty of Information Technology, Monash University, Melbourne, Vic., 3800, Australia
| | - David M Paganin
- School of Physics and Astronomy, Monash University, Melbourne, Vic., 3800, Australia
| | - Peter C Harris
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Melbourne, Vic., 3011, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Vic., 3052, Australia
| | - Chris J Hall
- Imaging and Medical Beam Line, ANSTO Australian Synchrotron, Melbourne, Vic., 3168, Australia
| | - Richard B Bassed
- Victorian Institute of Forensic Medicine, Melbourne, Vic., 3006, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Vic., 3800, Australia
| | - Matthew R Dimmock
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Vic., 3800, Australia
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16
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Kim H, Kim C, Kook KE, Yanti, Choi S, Kang W, Hwang JK. Inhibitory Effects of Standardized Boesenbergia pandurata Extract and Its Active Compound Panduratin A on Lipopolysaccharide-Induced Periodontal Inflammation and Alveolar Bone Loss in Rats. J Med Food 2018; 21:961-970. [DOI: 10.1089/jmf.2017.4155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Haebom Kim
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
| | - Changhee Kim
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
| | - Kyo Eun Kook
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
| | - Yanti
- Food Technology, Faculty of Biotechnology, Atma Jaya Catholic University, Jakarta, Indonesia
| | - Seungmok Choi
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Wonku Kang
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Jae-Kwan Hwang
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
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17
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Mys K, Stockmans F, Vereecke E, van Lenthe GH. Quantification of bone microstructure in the wrist using cone-beam computed tomography. Bone 2018; 114:206-214. [PMID: 29909060 DOI: 10.1016/j.bone.2018.06.006] [Citation(s) in RCA: 22] [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: 03/08/2018] [Revised: 05/15/2018] [Accepted: 06/10/2018] [Indexed: 11/19/2022]
Abstract
Due to the rising life expectancy, bone diseases (e.g. osteoporosis, osteoarthritis) and trauma (e.g. fracture) have become an important socio-economic burden. Accurate visualization and quantification of the bone microstructure in vivo is seen as an important step to enhance diagnosis and treatment. Micro-computed tomography (microCT) has become the gold standard in three-dimensional (3D) imaging of trabecular bone structure. Yet, usage is limited to ex vivo analyses, hence, it cannot be used to evaluate bone and bone adaptive responses in a patient. High-resolution peripheral computed tomography (HR-pQCT) is considered the best technique to measure the bone microarchitecture in vivo. By design HR-pQCT is limited to scanning extremities, such as the distal radius and distal tibia with a limited field of view and long scanning time (~2 à 3 min. for a stack of 0.9 cm). Cone-beam computed tomography (CBCT) is a promising alternative with a much larger field of view. Yet, CBCT is challenged by artefacts that reduce image contrast, such that it is currently being used for qualitative evaluation only. Therefore, the aims of this work were first to enhance image contrast and second to determine the accuracy of high-resolution CBCT for bone microarchitectural assessment. Trapezia of nineteen female arthritic patients were scanned twice ex vivo; once using CBCT (NewTom 5G, Cefla, Verona, Italy) at a nominal voxel size of 75 μm and once using microCT (SkyScan 1172, Bruker, Kontich, Belgium) at a voxel size of 19.84 μm. The CBCT-scans were reconstructed following 2 protocols: (1) using the commercial software delivered with the scanner and (2) using in-house developed software. After reconstruction and image processing, the images were segmented using adaptive thresholding. Bone morphometric parameters including bone volume (BV), total tissue volume (TV), bone volume fraction (BV/TV), bone surface density (BS/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N) were calculated. Statistical evaluations were made at a significance level of 5%. Significant correlations were found between the CBCT-based bone parameters and the microCT-based parameters with R2 > 0.68 The in-house reconstructed software outperformed the commercial software. Smaller bias (overestimation of Tb.Th decreased from 114.24% to 59.96%) as well as higher correlations were observed for the in-house processed images. Still, a significant overestimation was observed for BV/TV and Tb. Th and an underestimation for Tb.N. We conclude that our CBCT image reconstruction improved image contrast which allowed for an accurate quantification of trabecular bone microarchitecture.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Department of Mechanical engineering, KU Leuven, Leuven, Belgium.
| | - Filip Stockmans
- Muscles & Movement, Department of development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie Vereecke
- Muscles & Movement, Department of development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Department of Mechanical engineering, KU Leuven, Leuven, Belgium
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18
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Shokri A, Jamalpour MR, Eskandarloo A, Godiny M, Amini P, Khavid A. Performance of Cone Beam Computed Tomography Systems in Visualizing the Cortical Plate in 3D Image Reconstruction: An In Vitro Study. Open Dent J 2018; 12:586-595. [PMID: 30288182 PMCID: PMC6142658 DOI: 10.2174/1874210601812010586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 08/10/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cortical bone is an important anatomical structure and its thickness needs to be determined prior to many dental procedures to ensure treatment success. Imaging modalities are necessarily used in dentistry for treatment planning and dental procedures. Three-dimensional image reconstruction not only provides visual information but also enables accurate measurement of anatomical structures; thus, it is necessarily required for maxillofacial examination and in case of skeletal problems in this region. AIMS This study aimed to assess the ability of three Cone Beam Computed Tomography (CBCT) systems including Cranex 3D, NewTom 3G and 3D Promax for Three-Dimensional (3D) image reconstruction of the cortical plate with variable thicknesses. METHODS Depending on the cortical bone thickness, samples were evaluated in three groups of ≤ 0. 5 mm, 0.6 -1 mm and 1.1-1.5 mm cortical bone thickness. The CBCT scans were obtained from each sample using three systems, their respective FOVs, and 3D scans were reconstructed using their software programs. Two observers viewed the images twice with a two-week interval. The ability of each system in the 3D reconstruction of different thicknesses of cortical bone was determined based on its visualization on the scans. The data were analyzed using SPSS and Kappa test. RESULTS The three systems showed the greatest difference in the 3D reconstruction of cortical bone with < 0.5 mm thickness. Cranex 3D with 4×6 cm2 FOV had the highest and 3D Promax with 8×8 cm2 FOV had the lowest efficacy for 3D reconstruction of cortical bone. Cranex 3D with 4×6 cm2 and 6×8 cm2 FOVs and NewTom 3G with 5×5 cm2 and 8×5 cm2 FOVs showed significantly higher efficacy for 3D reconstruction of cortical bone with 0.6-1mm thickness while 3D Promax followed by NewTom 3G with 8×8 cm2 FOV had the lowest efficacy for this purpose. CONCLUSION Most CBCT systems have high efficacy for 3D image reconstruction of cortical bone with thicknesses over 1 mm while they have poor efficacy for image reconstruction of cortical bone with less than 0.5 mm thickness. Thus, for accurate visualization of anatomical structures on CBCT scans, systems with smaller FOVs and consequently smaller voxel size are preferred.
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Affiliation(s)
- Abbas Shokri
- Department of Oral and Maxillofacial Radiology, Dental Research Center, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Jamalpour
- Department of Oral and Maxillofacial Radiology, Dental Research Center, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Eskandarloo
- Department of Oral and Maxillofacial Radiology, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Godiny
- Department of Endodontics, Dental school , Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Atefeh Khavid
- Department of Oral and Maxillofacial Radiology, Dental School, Kermanshah University of Medical Sciences, Kermanshah, Iran
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19
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Klintström E, Klintström B, Moreno R, Brismar TB, Pahr DH, Smedby Ö. Predicting Trabecular Bone Stiffness from Clinical Cone-Beam CT and HR-pQCT Data; an In Vitro Study Using Finite Element Analysis. PLoS One 2016; 11:e0161101. [PMID: 27513664 PMCID: PMC4981445 DOI: 10.1371/journal.pone.0161101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022] Open
Abstract
Stiffness and shear moduli of human trabecular bone may be analyzed in vivo by finite element (FE) analysis from image data obtained by clinical imaging equipment such as high resolution peripheral quantitative computed tomography (HR-pQCT). In clinical practice today, this is done in the peripheral skeleton like the wrist and heel. In this cadaveric bone study, fourteen bone specimens from the wrist were imaged by two dental cone beam computed tomography (CBCT) devices and one HR-pQCT device as well as by dual energy X-ray absorptiometry (DXA). Histomorphometric measurements from micro-CT data were used as gold standard. The image processing was done with an in-house developed code based on the automated region growing (ARG) algorithm. Evaluation of how well stiffness (Young’s modulus E3) and minimum shear modulus from the 12, 13, or 23 could be predicted from the CBCT and HR-pQCT imaging data was studied and compared to FE analysis from the micro-CT imaging data. Strong correlations were found between the clinical machines and micro-CT regarding trabecular bone structure parameters, such as bone volume over total volume, trabecular thickness, trabecular number and trabecular nodes (varying from 0.79 to 0.96). The two CBCT devices as well as the HR-pQCT showed the ability to predict stiffness and shear, with adjusted R2-values between 0.78 and 0.92, based on data derived through our in-house developed code based on the ARG algorithm. These findings indicate that clinically used CBCT may be a feasible method for clinical studies of bone structure and mechanical properties in future osteoporosis research.
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Affiliation(s)
- Eva Klintström
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
- * E-mail:
| | - Benjamin Klintström
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Rodrigo Moreno
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
| | - Torkel B. Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Dieter H. Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Örjan Smedby
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
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20
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Hwang JJ, Park H, Jeong HG, Han SS. Change in Image Quality According to the 3D Locations of a CBCT Phantom. PLoS One 2016; 11:e0153884. [PMID: 27093639 PMCID: PMC4836729 DOI: 10.1371/journal.pone.0153884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/05/2016] [Indexed: 12/22/2022] Open
Abstract
A patient's position changes in every CBCT scan despite patient alignment protocols. However, there have been studies to determine image quality differences when an object is located at the center of the field of view (FOV). To evaluate changes in the image quality of the CBCT scan according to different object positions, the image quality indexes of the Alphard 3030 (Alphard Roentgen Ind., Ltd., Kyoto, Japan) and the Rayscan Symphony (RAY Ind., Ltd., Suwon, Korea) were measured using the Quart DVT_AP phantom at the center of the FOV and 6 peripheral positions under four types of exposure conditions. Anterior, posterior, right, left, upper, and lower positions 1 cm offset from the center of the FOV were used for the peripheral positions. We evaluated and compared the voxel size, homogeneity, contrast to noise ratio (CNR), and the 10% point of the modulation transfer function (MTF10%) of the center and periphery. Because the voxel size, which is determined by the Nyquist frequency, was within tolerance, other image quality indexes were not influenced by the voxel size. For the CNR, homogeneity, and MTF10%, there were peripheral positions which showed considerable differences with statistical significance. The average difference between the center and periphery was up to 31.27% (CNR), 70.49% (homogeneity), and 13.64% (MTF10%). Homogeneity was under tolerance at some of the peripheral locations. Because the CNR, homogeneity, and MTF10% were significantly affected by positional changes of the phantom, an object's position can influence the interpretation of follow up CBCT images. Therefore, efforts to locate the object in the same position are important.
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Affiliation(s)
- Jae Joon Hwang
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyok Park
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Yonsei University, Seoul, Korea
| | - Ho-Gul Jeong
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Yonsei University, Seoul, Korea
- * E-mail:
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Demirturk Kocasarac H, Helvacioglu Yigit D, Bechara B, Sinanoglu A, Noujeim M. Contrast-to-noise ratio with different settings in a CBCT machine in presence of different root-end filling materials: an in vitro study. Dentomaxillofac Radiol 2016; 45:20160012. [PMID: 26954290 DOI: 10.1259/dmfr.20160012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the contrast-to-noise ratio (CNR) of multiple acquisition settings for four types of retrograde filling materials in CBCT images taken for endodontic surgery follow-up. METHODS 20 maxillary central incisors were endodontically treated and obturated with 4 different root-end filling materials: amalgam, mineral trioxide aggregate, SuperEBA(™) (Harry J Bosworth Company, Skokie, IL) and Biodentine™ (Septodont, Saint-Maur-des-Faussés, France). Teeth were placed in a skull and scanned, one by one, with the Planmeca ProMax(®) 3D Max (Planmeca, Helsinki, Finland); at different voltages: 66, 76, 84 and 96 kVp; with low, normal and high resolution and high definition (HD); with and without metal artefact reduction (MAR). Images were analyzed using ImageJ software (National Institutes of Health, Bethesda, MD) to calculate the CNR. The dose-area product was registered, and the effective dose calculated. RESULTS No statistically significant difference was noted between the four materials. 84 and 96 kVp with low resolution and the use of MAR-generated images that have statistically better CNR than 66 and 76 kVp with HD, normal and high resolutions and without MAR. The use of low resolution also generated the smallest value of effective dose. CONCLUSIONS The best setting for radiographic follow-up in an endodontic surgery with retrograde filling on the Planmeca ProMax is 96 kVp with low resolution and high MAR; this setting produced one of the lowest effective doses.
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Affiliation(s)
- Husniye Demirturk Kocasarac
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Basiskele, Kocaeli, Turkey
| | - Dilek Helvacioglu Yigit
- 2 Department of Endodontics, Faculty of Dentistry, Kocaeli University, Basiskele, Kocaeli, Turkey
| | - Boulos Bechara
- 3 Department of Comprehensive Dentistry, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Alper Sinanoglu
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Basiskele, Kocaeli, Turkey
| | - Marcel Noujeim
- 3 Department of Comprehensive Dentistry, The University of Texas Health Science Center, San Antonio, TX, USA
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