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Gazzotti S, Aparisi Gómez MP, Schileo E, Taddei F, Sangiorgi L, Fusaro M, Miceli M, Guglielmi G, Bazzocchi A. High-resolution peripheral quantitative computed tomography: research or clinical practice? Br J Radiol 2023; 96:20221016. [PMID: 37195008 PMCID: PMC10546468 DOI: 10.1259/bjr.20221016] [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: 10/31/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
High-resolution peripheral quantitative CT (HR-pQCT) is a low-dose three-dimensional imaging technique, originally developed for in vivo assessment of bone microarchitecture at the distal radius and tibia in osteoporosis. HR-pQCT has the ability to discriminate trabecular and cortical bone compartments, providing densitometric and structural parameters. At present, HR-pQCT is mostly used in research settings, despite evidence showing that it may be a valuable tool in osteoporosis and other diseases. This review summarizes the main applications of HR-pQCT and addresses the limitations that currently prevent its integration into routine clinical practice. In particular, the focus is on the use of HR-pQCT in primary and secondary osteoporosis, chronic kidney disease (CKD), endocrine disorders affecting bone, and rare diseases. A section on novel potential applications of HR-pQCT is also present, including assessment of rheumatic diseases, knee osteoarthritis, distal radius/scaphoid fractures, vascular calcifications, effect of medications, and skeletal muscle. The reviewed literature seems to suggest that a more widespread implementation of HR-pQCT in clinical practice would offer notable opportunities. For instance, HR-pQCT can improve the prediction of incident fractures beyond areal bone mineral density provided by dual-energy X-ray absorptiometry. In addition, HR-pQCT may be used for the monitoring of anti-osteoporotic therapy or for the assessment of mineral and bone disorder associated with CKD. Nevertheless, several obstacles currently prevent a broader use of HR-pQCT and would need to be targeted, such as the small number of installed machines worldwide, the uncertain cost-effectiveness, the need for improved reproducibility, and the limited availability of reference normative data sets.
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Affiliation(s)
- Silvia Gazzotti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Sangiorgi
- Department of Medical Genetics and Rare Orthopaedic Diseases, and CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Zhao M, Tse JJ, Kuczynski MT, Brunet SC, Yan R, Engelke K, Peters M, van den Bergh JP, van Rietbergen B, Stok KS, Barnabe C, Pauchard Y, Manske SL. Open-source image analysis tool for the identification and quantification of cortical interruptions and bone erosions in high-resolution peripheral quantitative computed tomography images of patients with rheumatoid arthritis. Bone 2022; 165:116571. [PMID: 36174928 DOI: 10.1016/j.bone.2022.116571] [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: 07/19/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
Identification of bone erosions and quantification of erosion volume is important for rheumatoid arthritis diagnosis, and can add important information to evaluate disease progression and treatment effects. High-resolution peripheral quantitative computed tomography (HR-pQCT) is well suited for this purpose, however analysis methods are not widely available. The purpose of this study was to develop an open-source software tool for the identification and quantification of bone erosions using images acquired by HR-pQCT. The collection of modules, Bone Analysis Modules (BAM) - Erosion, implements previously published erosion analysis techniques as modules in 3D Slicer, an open-source image processing and visualization tool. BAM includes a module to automatically identify cortical interruptions, from which erosions are manually selected, and a hybrid module that combines morphological and level set operations to quantify the volume of bone erosions. HR-pQCT images of the second and third metacarpophalangeal (MCP) joints were acquired in patients with RA (XtremeCT, n = 14, XtremeCTII, n = 22). The number of cortical interruptions detected by BAM-Erosion agreed strongly with the previously published cortical interruption detection algorithm for both XtremeCT (r2 = 0.85) and XtremeCTII (r2 = 0.87). Erosion volume assessment by BAM-Erosion agreed strongly (r2 = 0.95) with the Medical Image Analysis Framework. BAM-Erosion provides an open-source erosion analysis tool that produces comparable results to previously published algorithms, with improved options for visualization. The strength of the tool is that it implements multiple image processing algorithms for erosion analysis on a single, widely available, open-source platform that can accommodate future updates.
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Affiliation(s)
- Mingjie Zhao
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Justin J Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael T Kuczynski
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott C Brunet
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ryan Yan
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michiel Peters
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia
| | - Cheryl Barnabe
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yves Pauchard
- Department of Electrical and Software Engineering, University of Calgary, Calgary, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Gandikota G, Fakuda T, Finzel S. Computed tomography in rheumatology - From DECT to high-resolution peripheral quantitative CT. Best Pract Res Clin Rheumatol 2020; 34:101641. [PMID: 33281053 DOI: 10.1016/j.berh.2020.101641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this chapter, we discuss current updates and applications of Dual Energy Computed Tomography (DECT), iodine-DECT mapping, and high-resolution peripheral quantitative CT (HR-pQCT) in rheumatology. DECT provides a noninvasive diagnosis of gout and can help to differentiate gout from CPPD. Accuracy of DECT varies in various stages of gout. DECT needs specialized hardware, software, and skilled post-processing and interpretation. Sensitivity reduces significantly with deeper tissues such as hip and shoulder. Iodine map enables to delineate inflammatory lesions such as capsulitis and tenosynovitis by improving iodine contrast. Iodine quantification with an iodine map is a promising objective method to evaluate therapeutic effect of inflammatory arthritis. HR-pQCT allows for highly sensitive and specific measures of bone erosions and osteophytes in inflammatory joint diseases, documenting change over time, e.g. in cohorts undergoing immunosuppressive treatments. However, assessing the images requires trained readers, and (semi)-automated scripts to detect bone damage are still undergoing validation and further development.
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Affiliation(s)
- Girish Gandikota
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Takeshi Fakuda
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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