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Subdar S, Hoens AM, White K, Hartfeld NMS, Dhiman K, Duffey K, Heath CE, Lamoureux G, Graveline C, Davidson E, Hazlewood G, Lacaille D, Lopatina E, Barber MRW, Then KL, Crump T, Zafar S, Manske SL, Charlton A, Osinski K, Fifi-Mah A, Mosher D, Barber CEH. An Environmental Scan and Appraisal of Patient Online Resources for Managing Rheumatoid Arthritis Flares. J Rheumatol 2024:jrheum.2023-1025. [PMID: 38490667 DOI: 10.3899/jrheum.2023-1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To conduct an environmental scan and appraisal of online patient resources to support rheumatoid arthritis (RA) flare self-management. METHODS We used the Google search engine (last search March 2023) using the terms "rheumatoid arthritis" and "flare management." Additional searches targeted major arthritis organizations, as well as regional, national, and international resources. Appraisal of the resources was conducted by 2 research team members and 1 patient partner to assess the understandability and actionability of the resource using the Patient Education Materials Assessment Tool (PEMAT). Resources rating ≥ 60% in both domains by either the research team or the patient partner were further considered for content review. During content review, resources were excluded if they contained product advertisements, inaccurate information, or use of noninclusive language. If content review criteria were met, resources were designated as "highly recommended" if both patient partners and researchers' PEMAT ratings were ≥ 60%. If PEMAT ratings were divergent and had a rating ≥ 60% from only 1 group of reviewers, the resource was designated "acceptable." RESULTS We identified 44 resources; 12 were excluded as they did not pass the PEMAT assessment. Fourteen resources received ratings ≥ 60% on understandability and actionability from both researchers and patient partners; 10 of these were retained following content review as "highly recommended" flare resources. Of the 18 divergent PEMAT ratings, 8 resources were retained as "acceptable" following content review. CONCLUSION There is high variability in the actionability and understandability of online RA flare materials; only 23% of resources were highly recommended by researchers and patient partners.
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Affiliation(s)
- Shakeel Subdar
- S. Subdar, HBSc, University of Toronto, Toronto, Ontario
| | - Alison M Hoens
- A.M. Hoens, PT, MSc, Arthritis Research Canada, and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia
| | - Krista White
- K. White, MA, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Nicole M S Hartfeld
- N.M.S. Hartfeld, MSc, MC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Kiran Dhiman
- K. Dhiman, MPH, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Keeva Duffey
- K. Duffey, MPH, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Claire E Heath
- C.E. Heath, MN, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Gisele Lamoureux
- G. Lamoureux, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Christine Graveline
- C. Graveline, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Eileen Davidson
- E. Davidson, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Glen Hazlewood
- G. Hazlewood, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Diane Lacaille
- D. Lacaille, MDCM, MHSc, Arthritis Research Canada, and Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Elena Lopatina
- E. Lopatina, MD, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta
| | - Megan R W Barber
- M.R.W. Barber, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Karen L Then
- K.L. Then, ACNP, PhD, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Trafford Crump
- T. Crump, PhD, Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec
| | - Saania Zafar
- S. Zafar, BCR, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sarah L Manske
- S.L. Manske, PhD, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Alexandra Charlton
- A. Charlton, BScPharm, PharmD, Alberta Health Services, Calgary, Alberta
| | - Kelly Osinski
- K. Osinski, RN, BN, Alberta Health Services, Calgary, Alberta
| | - Aurore Fifi-Mah
- A. Fifi-Mah, MD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Dianne Mosher
- D. Mosher, MD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Boyd SK, Manske SL, Matheson B, Smith A, Bott K. Letter to the Editor regarding "Opportunistic screening with CT: comparison of phantomless BMD calibration methods". J Bone Miner Res 2024; 39:76-77. [PMID: 38630884 DOI: 10.1093/jbmr/zjad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 04/19/2024]
Affiliation(s)
- Steven K Boyd
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary T1N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary T1N 4Z6, Canada
| | - Sarah L Manske
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary T1N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary T1N 4Z6, Canada
| | - Bryn Matheson
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary T1N 4Z6, Canada
| | - Ainsley Smith
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary T1N 4Z6, Canada
| | - Kirsten Bott
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary T1N 4Z6, Canada
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Subdar S, Dhiman K, Hartfeld NMS, Hoens AM, White K, Manske SL, Hazlewood G, Lacaille D, Lopatina E, Barber MRW, Mosher D, Fifi-Mah A, Twilt M, Luca N, Then KL, Crump T, Zafar S, Osinski K, Barber CEH. Investigating the influence of patient eligibility characteristics on the number of deferrable rheumatologist visits: planning for a patient-initiated follow-up (PIFU) strategy. J Rheumatol 2024:jrheum.2023-0891. [PMID: 38302163 DOI: 10.3899/jrheum.2023-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Patient-initiated follow-up (PIFU) for rheumatoid arthritis (RA) is a model of care delivery wherein patients contact the clinic when needed instead of regularly scheduled followups. Our objective was to investigate the influence of different patient eligibility characteristics on the number of potentially deferred visits to inform future implementation of a PIFU strategy. METHODS We conducted a retrospective chart review of seven rheumatologists' practices at two university-based clinics between 01/03/2021-28/02/2022. Data extracted included the type and frequency of visits, disease management, comorbidities, and care complexities. Stable disease was defined as remission or low-disease activity with no medication changes at all visits. The influence of patient characteristics on the number of deferrable visits in patients with stable disease was explored in four criteria sets that were based on: early disease duration, medication prescribed, presence of care complexity elements, and comorbidity burden. RESULTS Records from 770 visits were reviewed from 365 RA patients (71.5% female, 70.0% seropositive). Among all criteria sets, the proportion of visits that could be redirected varied between 2.5%-20.9%. The highest proportion of deferrable visits was achieved when eligibility criteria included only stable disease activity and RA patients on conventional synthetic disease modifying drugs or no medications (n=161, 20.9%). CONCLUSION PIFU may result in a more efficient use of specialist healthcare resources. However, the applicability of such models of care and the number of deferred visits is highly dependent on patient characteristics used to establish eligibility criteria for that model. These findings should be considered when planning implementation trials.
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Affiliation(s)
- Shakeel Subdar
- Shakeel Subdar HBSc, University of Toronto, Toronto, Ontario, Canada
| | - Kiran Dhiman
- Kiran Dhiman MPH, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole M S Hartfeld
- Nicole M.S. Hartfeld MSc MC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Alison M. Hoens PT MSc, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krista White
- Krista White MA, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah L Manske
- Sarah L. Manske PhD, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Glen Hazlewood MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Diane Lacaille MDCM MHSc FRCPC, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Elena Lopatina
- Elena Lopatina MD PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Megan R W Barber
- Megan R.W. Barber MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Mosher
- Dianne Mosher MD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aurore Fifi-Mah
- Aurore Fifi-Mah MD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- Marinka Twilt MD MSCE PhD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nadia Luca
- Nadia Luca MD FRCPC MSc, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Then
- Karen L. Then ACNP PhD, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Trafford Crump
- Trafford Crump PhD, Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Saania Zafar
- Saania Zafar BCR, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Osinski
- Kelly Osinski, Alberta Health Services, Calgary, Alberta, Canada
| | - Claire E H Barber
- Claire E.H. Barber MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Schadow JE, Maxey D, Smith TO, Finnilä MAJ, Manske SL, Segal NA, Wong AKO, Davey RA, Turmezei T, Stok KS. Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis. Bone 2024; 178:116948. [PMID: 37926204 DOI: 10.1016/j.bone.2023.116948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards. DESIGN A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis. RESULTS This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties. CONCLUSIONS Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.
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Affiliation(s)
- Jemima E Schadow
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
| | - David Maxey
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
| | - Toby O Smith
- Warwick Medical School, University of Warwick, United Kingdom.
| | - Mikko A J Finnilä
- Research Unit of Health Science and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Sarah L Manske
- Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, United States.
| | - Andy Kin On Wong
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Schroeder's Arthritis Institute, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
| | - Rachel A Davey
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
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Al-Khoury Y, Finzel S, Figueiredo C, Burghardt AJ, Stok KS, Tam LS, Cheng I, Tse JJ, Manske SL. Erosion Identification in Metacarpophalangeal Joints in Rheumatoid Arthritis using High-Resolution Peripheral Quantitative Computed Tomography. J Vis Exp 2023. [PMID: 37870316 DOI: 10.3791/65802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Bone erosions are a pathological feature of several forms of inflammatory arthritis including rheumatoid arthritis (RA). The increased presence and size of erosions are associated with poor outcomes, joint function, and disease progression. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides unparalleled in vivo visualization of bone erosions. However, at this resolution, discontinuities in the cortical shell (cortical breaks) that are associated with normal physiological processes and pathology are also visible. The Study grouP for xtrEme Computed Tomography in Rheumatoid Arthritis previously used a consensus process to develop a definition of pathological erosion in HR-pQCT: a cortical break detected in at least two consecutive slices, in at least two perpendicular planes, non-linear in shape, with underlying trabecular bone loss. However, despite the availability of a consensus definition, erosion identification is a demanding task with challenges in inter-rater variability. The purpose of this work is to introduce a training tool to provide users with guidance on identifying pathological cortical breaks on HR-pQCT images for erosion analysis. The protocol presented here uses a custom-built module (Bone Analysis Module (BAM) - Training), implemented as an extension to an open-source image processing software (3D Slicer). Using this module, users can practice identifying erosions and compare their results to erosions annotated by expert rheumatologists.
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Affiliation(s)
- Yousif Al-Khoury
- Department of Radiology, McCaig Institute for Bone and Joint Health, University of Calgary; Department of Biomedical Engineering, University of Calgary
| | | | | | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Kathryn S Stok
- Department of Biomedical Engineering, University of Melbourne
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Isaac Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Justin J Tse
- Department of Radiology, McCaig Institute for Bone and Joint Health, University of Calgary
| | - Sarah L Manske
- Department of Radiology, McCaig Institute for Bone and Joint Health, University of Calgary;
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Bott KN, Matheson BE, Smith ACJ, Tse JJ, Boyd SK, Manske SL. Addressing Challenges of Opportunistic Computed Tomography Bone Mineral Density Analysis. Diagnostics (Basel) 2023; 13:2572. [PMID: 37568935 PMCID: PMC10416827 DOI: 10.3390/diagnostics13152572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Computed tomography (CT) offers advanced biomedical imaging of the body and is broadly utilized for clinical diagnosis. Traditionally, clinical CT scans have not been used for volumetric bone mineral density (vBMD) assessment; however, computational advances can now leverage clinically obtained CT data for the secondary analysis of bone, known as opportunistic CT analysis. Initial applications focused on using clinically acquired CT scans for secondary osteoporosis screening, but opportunistic CT analysis can also be applied to answer research questions related to vBMD changes in response to various disease states. There are several considerations for opportunistic CT analysis, including scan acquisition, contrast enhancement, the internal calibration technique, and bone segmentation, but there remains no consensus on applying these methods. These factors may influence vBMD measures and therefore the robustness of the opportunistic CT analysis. Further research and standardization efforts are needed to establish a consensus and optimize the application of opportunistic CT analysis for accurate and reliable assessment of vBMD in clinical and research settings. This review summarizes the current state of opportunistic CT analysis, highlighting its potential and addressing the associated challenges.
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Affiliation(s)
- Kirsten N. Bott
- Department of Radiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.N.B.); (S.K.B.)
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Bryn E. Matheson
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Ainsley C. J. Smith
- Department of Radiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.N.B.); (S.K.B.)
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Justin J. Tse
- Department of Radiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.N.B.); (S.K.B.)
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Steven K. Boyd
- Department of Radiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.N.B.); (S.K.B.)
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Sarah L. Manske
- Department of Radiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.N.B.); (S.K.B.)
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kuczynski MT, Wang K, Tse JJ, Bugajski T, Manske SL. Reproducibility and repeatability of a semi-automated pipeline to quantify trapeziometacarpal joint angles using dynamic computed tomography. BMC Med Imaging 2022; 22:192. [DOI: 10.1186/s12880-022-00922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
The trapeziometacarpal (TMC) joint is a mechanically complex joint and is commonly affected by musculoskeletal diseases such as osteoarthritis. Quantifying in vivo TMC joint biomechanics, such as joint angles, with traditional reflective marker-based methods can be difficult due to the joint’s location in the hand. Dynamic computed tomography (CT) can facilitate the quantification of TMC joint motion by continuously capturing three-dimensional volumes over time. However, post-processing of dynamic CT datasets can be time intensive and automated methods are needed to reduce processing times to allow for application to larger clinical studies. The purpose of this work is to introduce a fast, semi-automated pipeline to quantify joint angles from dynamic CT scans of the TMC joint and evaluate the associated error in joint angle and translation computation by means of a reproducibility and repeatability study.
Methods
Ten cadaveric hands were scanned with dynamic CT using a passive motion device to move thumbs in a radial abduction–adduction motion. Static CT scans and high-resolution peripheral quantitative CT scans were also acquired to generate high-resolution bone meshes. Abduction–adduction, flexion–extension, and axial rotation angles were computed using a joint coordinate system. Reproducibility and repeatability were assessed using intraclass correlation coefficients, Bland–Altman analysis, and root mean square errors. Target registration errors were computed to evaluate errors associated with image registration.
Results
We found good repeatability for flexion–extension, abduction–adduction, and axial rotation angles. Reproducibility was moderate for all three angles. Joint translations exhibited greater repeatability than reproducibility. Specimens with greater joint degeneration had lower repeatability and reproducibility. We found that the difference in resulting joint angles and translations were likely due to differences in segment coordinate system definition between multiple raters, rather than due to registration errors.
Conclusions
The proposed semi-automatic processing pipeline was fast, repeatable, and moderately reproducible when quantifying TMC joint angles and translations. This work provides a range of errors for TMC joint angles from dynamic CT scans using manually selected anatomical landmarks.
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Smith ACJ, Tse JJ, Waungana TH, Bott KN, Kuczynski MT, Michalski AS, Boyd SK, Manske SL. Internal calibration for opportunistic computed tomography muscle density analysis. PLoS One 2022; 17:e0273203. [PMID: 36251648 PMCID: PMC9576101 DOI: 10.1371/journal.pone.0273203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Muscle weakness can lead to reduced physical function and quality of life. Computed tomography (CT) can be used to assess muscle health through measures of muscle cross-sectional area and density loss associated with fat infiltration. However, there are limited opportunities to measure muscle density in clinically acquired CT scans because a density calibration phantom, allowing for the conversion of CT Hounsfield units into density, is typically not included within the field-of-view. For bone density analysis, internal density calibration methods use regions of interest within the scan field-of-view to derive the relationship between Hounsfield units and bone density, but these methods have yet to be adapted for muscle density analysis. The objective of this study was to design and validate a CT internal calibration method for muscle density analysis. METHODOLOGY We CT scanned 10 bovine muscle samples using two scan protocols and five scan positions within the scanner bore. The scans were calibrated using internal calibration and a reference phantom. We tested combinations of internal calibration regions of interest (e.g., air, blood, bone, muscle, adipose). RESULTS We found that the internal calibration method using two regions of interest, air and adipose or blood, yielded accurate muscle density values (< 1% error) when compared with the reference phantom. The muscle density values derived from the internal and reference phantom calibration methods were highly correlated (R2 > 0.99). The coefficient of variation for muscle density across two scan protocols and five scan positions was significantly lower for internal calibration (mean = 0.33%) than for Hounsfield units (mean = 6.52%). There was no difference between coefficient of variation for the internal calibration and reference phantom methods. CONCLUSIONS We have developed an internal calibration method to produce accurate and reliable muscle density measures from opportunistic computed tomography images without the need for calibration phantoms.
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Affiliation(s)
- Ainsley C. J. Smith
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Justin J. Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Tadiwa H. Waungana
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Kirsten N. Bott
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Michael T. Kuczynski
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Andrew S. Michalski
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Steven K. Boyd
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Sarah L. Manske
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
- * E-mail:
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10
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Whittier DE, Manske SL, Billington E, Walker RE, Schneider PS, Burt LA, Hanley DA, Boyd SK. Hip Fractures in Older Adults Are Associated With the Low Density Bone Phenotype and Heterogeneous Deterioration of Bone Microarchitecture. J Bone Miner Res 2022; 37:1963-1972. [PMID: 35895080 PMCID: PMC9804299 DOI: 10.1002/jbmr.4663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 01/05/2023]
Abstract
Femoral neck areal bone mineral density (FN aBMD) is a key determinant of fracture risk in older adults; however, the majority of individuals who have a hip fracture are not considered osteoporotic according to their FN aBMD. This study uses novel tools to investigate the characteristics of bone microarchitecture that underpin bone fragility. Recent hip fracture patients (n = 108, 77% female) were compared with sex- and age-matched controls (n = 216) using high-resolution peripheral quantitative computed tomography (HR-pQCT) imaging of the distal radius and tibia. Standard morphological analysis of bone microarchitecture, micro-finite element analysis, and recently developed techniques to identify void spaces in bone microarchitecture were performed to evaluate differences between hip fracture patients and controls. In addition, a new approach for phenotyping bone microarchitecture was implemented to evaluate whether hip fractures in males and females occur more often in certain bone phenotypes. Overall, hip fracture patients had notable deterioration of bone microarchitecture and reduced bone mineral density compared with controls, especially at weight-bearing sites (tibia and femoral neck). Hip fracture patients were more likely to have void spaces present at either site and had void spaces that were two to four times larger on average when compared with non-fractured controls (p < 0.01). Finally, bone phenotyping revealed that hip fractures were significantly associated with the low density phenotype (p < 0.01), with the majority of patients classified in this phenotype (69%). However, female and male hip fracture populations were distributed differently across the bone phenotype continuum. These findings highlight how HR-pQCT can provide insight into the underlying mechanisms of bone fragility by using information about bone phenotypes and identification of microarchitectural defects (void spaces). The added information suggests that HR-pQCT can have a beneficial role in assessing the severity of structural deterioration in bone that is associated with osteoporotic hip fractures. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Danielle E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Emma Billington
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Richard Ea Walker
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Prism S Schneider
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauren A Burt
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David A Hanley
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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11
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de Bakker CM, Knowles NK, Walker RE, Manske SL, Boyd SK. Independent changes in bone mineralized and marrow soft tissues following acute knee injury require dual-energy or high-resolution computed tomography for accurate assessment of bone mineral density and stiffness. J Mech Behav Biomed Mater 2022; 127:105091. [DOI: 10.1016/j.jmbbm.2022.105091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/12/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
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12
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Owoeye OBA, Whittaker JL, Toomey CM, Räisänen AM, Jaremko JL, Carlesso LC, Manske SL, Emery CA. Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold? Foot Ankle Int 2022; 43:21-31. [PMID: 34353138 DOI: 10.1177/10711007211033543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study examined the association between youth sport-related ankle sprain injury and health-related outcomes, 3-15 years postinjury. METHODS A historical cohort study in which uninjured controls were cluster-matched with injured cases. The primary outcome was self-reported Foot and Ankle Outcome Score (FAOS). Secondary outcomes included measures of adiposity, validated questionnaires for physical activity, athletic identity, fear of pain, and tests of strength, balance, and function. RESULTS We recruited 86 participants (median age of 23 years; 77% female); 50 with a time-loss ankle sprain, median of 8 years postinjury, and 36 uninjured controls cluster-matched by sex and sport. Based on mixed effects multivariable regression models, previously injured participants demonstrated poorer outcomes than controls on all 5 FAOS subscales regardless of sex and time since injury, with the largest differences observed in symptoms (-20.9, 99% CI: -29.5 to -12.3) and ankle-related quality of life (-25.3, 99% CI: -34.7 to -15.9) subscales. Injured participants also had poorer unipedal dynamic balance (-1.9, 99% CI: 3.5 to -0.2) and greater fear of pain (7.2, 99% CI: 0.9-13.4) compared with controls. No statistically significant differences were found for other secondary outcomes. CONCLUSION At 3-15 years following time-loss ankle sprain injury in youth sport, previously injured participants had more pain and symptoms, poorer self-reported function, ankle-related quality of life, reduced sport participation, balance, and greater fear of pain than controls. This underlines the need to promote the primary prevention of ankle sprains and secondary prevention of potential health consequences, including posttraumatic osteoarthritis. LEVEL OF EVIDENCE Level III, historical cohort study.
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Affiliation(s)
- Oluwatoyosi B A Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St Louis, MO, USA.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Clodagh M Toomey
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| | - Anu M Räisänen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Therapy Education, College of Health Sciences, Western University of Health Sciences, Lebanon, OR, USA
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa C Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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13
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Abstract
PURPOSE OF REVIEW The purpose of this review is to inform researchers and clinicians with the most recent imaging techniques that are employed (1) to opportunistically screen for osteoporosis and (2) to provide a better understanding into the disease etiology of osteoporosis. RECENT FINDINGS Phantomless calibration techniques for computed tomography (CT) may pave the way for better opportunistic osteoporosis screening and the retroactive analysis of imaging data. Additionally, hardware advances are enabling new applications of dual-energy CT and cone-beam CT to the study of bone. Advances in MRI sequences are also improving imaging evaluation of bone properties. Finally, the application of image registration techniques is enabling new uses of imaging to investigate soft tissue-bone interactions as well as bone turnover. While DXA remains the most prominent imaging tool for osteoporosis diagnosis, new imaging techniques are becoming more widely available and providing additional information to inform clinical decision-making.
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Affiliation(s)
- Justin J Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ainsley C J Smith
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Michael T Kuczynski
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Daphne A Kaketsis
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.
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14
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Lennie KI, Manske SL, Mansky CF, Anderson JS. Locomotory behaviour of early tetrapods from Blue Beach, Nova Scotia, revealed by novel microanatomical analysis. R Soc Open Sci 2021; 8:210281. [PMID: 34084552 PMCID: PMC8150034 DOI: 10.1098/rsos.210281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 05/07/2023]
Abstract
Evidence for terrestriality in early tetrapods is fundamentally contradictory. Fossil trackways attributed to early terrestrial tetrapods long predate the first body fossils from the Late Devonian. However, the Devonian body fossils demonstrate an obligatorily aquatic lifestyle. Complicating our understanding of the transition from water to land is a pronounced gap in the fossil record between the aquatic Devonian taxa and presumably terrestrial tetrapods from the later Early Carboniferous. Recent work suggests that an obligatorily aquatic habit persists much higher in the tetrapod tree than previously recognized. Here, we present independent microanatomical data of locomotor capability from the earliest Carboniferous of Blue Beach, Nova Scotia. The site preserves limb bones from taxa representative of Late Devonian to mid-Carboniferous faunas as well as a rich trackway record. Given that bone remodels in response to functional stresses including gravity and ground reaction forces, we analysed both the midshaft compactness profiles and trabecular anisotropy, the latter using a new whole bone approach. Our findings suggest that early tetrapods retained an aquatic lifestyle despite varied limb morphologies, prior to their emergence onto land. These results suggest that trackways attributed to early tetrapods be closely scrutinized for additional information regarding their creation conditions, and demand an expansion of sampling to better identify the first terrestrial tetrapods.
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Affiliation(s)
- Kendra I. Lennie
- Biological Sciences, University of Calgary, 507 Campus Drive NW, Calgary, Alberta, Canada T2N 1N4
- McCaig Institute for Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
| | - Sarah L. Manske
- McCaig Institute for Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
- Radiology, Foothills Medical Centre, University of Calgary, 1403-29th Street NW, Calgary, Alberta, Canada T2N 2T9
| | - Chris F. Mansky
- Blue Beach Fossil Museum, 127 Blue Beach Road, Hantsport, Nova Scotia, Canada B0P 1P0
| | - Jason S. Anderson
- McCaig Institute for Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
- Comparative Biology and Experimental Medicine, Foothills Campus, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
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15
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Brunet SC, Tse JJ, Kuczynski MT, Engelke K, Boyd SK, Barnabe C, Manske SL. Heterogenous bone response to biologic DMARD therapies in rheumatoid arthritis patients and their relationship to functional indices. Scand J Rheumatol 2021; 50:417-426. [PMID: 33775211 DOI: 10.1080/03009742.2020.1869303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Previous studies of high-resolution peripheral quantitative computed tomography (HR-pQCT) imaging of hand joints in patients with rheumatoid arthritis (RA) have suggested that erosion healing may occur. Our objective was to examine changes in erosion volume, joint space width (JSW), bone mineral density (BMD), and bone remodelling, and their association with clinical outcomes and measures of patient hand function.Method: We examined 48 patients who achieved a good response to a newly initiated biologic therapy. HR-pQCT images of the dominant hands' second and third metacarpophalangeal joints were obtained 3 and 12 months after therapy initiation. Bone erosion volume, JSW, BMD, and bone remodelling were quantified from HR-pQCT images, with improvement, no change (unchanged), or progression in these measures determined by least significant change. Disease activity and hand function measures were collected.Results: There were no significant group changes in HR-pQCT outcomes over the 9 month period. Twenty-two patients had total erosion volumes that remained unchanged, nine showed improvement, and two progressed. The majority of JSW and BMD measures remained unchanged. There was a significant association between the baseline Health Assessment Questionnaire score and the change in minimum JSW, but no other significant associations between HR-pQCT outcomes and function were observed.Conclusions: The vast majority of patients maintained unchanged JSW and BMD over the course of follow-up. Significant improvements in total erosion volume occurred in 27% of patients, suggesting that biologic therapies may lead to erosion healing in some patients, although this did not have an impact on self-reported and demonstrated hand function.
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Affiliation(s)
- S C Brunet
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, 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
| | - J J Tse
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M T Kuczynski
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, 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
| | - K Engelke
- Department of Medicine, FAU University Erlangen-Nürnberg and University Clinic Erlangen, Erlangen, Germany
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, 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
| | - C 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
| | - S L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, 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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16
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de Bakker CMJ, Walker REA, Besler BA, Tse JJ, Manske SL, Martin CR, French SJ, Dodd AE, Boyd SK. A quantitative assessment of dual energy computed tomography-based material decomposition for imaging bone marrow edema associated with acute knee injury. Med Phys 2021; 48:1792-1803. [PMID: 33606278 DOI: 10.1002/mp.14791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study developed methods to quantify and improve the accuracy of dual-energy CT (DECT)-based bone marrow edema imaging using a clinical CT system. Objectives were: (a) to quantitatively compare DECT with gold-standard, fluid-sensitive MRI for imaging of edema-like marrow signal intensity (EMSI) and (b) to identify image analysis parameters that improve delineation of EMSI associated with acute knee injury on DECT images. METHODS DECT images from ten participants with acute knee injury were decomposed into estimated fractions of bone, healthy marrow, and edema based on energy-dependent differences in tissue attenuation. Fluid-sensitive MR images were registered to DECT for quantitative, voxel-by-voxel comparison between the two modalities. An optimization scheme was developed to find attenuation coefficients for healthy marrow and edema that improved EMSI delineation, compared to MRI. DECT method accuracy was evaluated by measuring dice coefficients, mutual information, and normalized cross correlation between the DECT result and registered MRI. RESULTS When applying the optimized three-material decomposition method, dice coefficients for EMSI identified through DECT vs MRI were 0.32 at the tibia and 0.13 at the femur. Optimization of attenuation coefficients improved dice coefficient, mutual information, and cross-correlation between DECT and gold-standard MRI by 48%-107% compared to three-material decomposition using non-optimized parameters, and improved mutual information and cross-correlation by 39%-58% compared to the manufacturer-provided two-material decomposition. CONCLUSIONS This study quantitatively evaluated the performance of DECT in imaging knee injury-associated EMSI and identified a method to optimize DECT-based visualization of complex tissues (marrow and edema) whose attenuation parameters cannot be easily characterized. Further studies are needed to improve DECT-based EMSI imaging at the femur.
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Affiliation(s)
- Chantal M J de Bakker
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Richard E A Walker
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Bryce A Besler
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Justin J Tse
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - C Ryan Martin
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Stephen J French
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Andrew E Dodd
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
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17
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Tse JJ, Brunet SC, Salat P, Hazlewood GS, Barnabe C, Manske SL. Multi-Modal Imaging to Assess the Interaction Between Inflammation and Bone Damage Progression in Inflammatory Arthritis. Front Med (Lausanne) 2020; 7:545097. [PMID: 33102498 PMCID: PMC7544988 DOI: 10.3389/fmed.2020.545097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
Combining results from multiple imaging techniques (i.e., multi-modal imaging) through image registration can result in the better characterization of joint tissue characteristics. In the context of inflammatory arthritis conditions, high-resolution peripheral quantitative computed tomography (HR-pQCT) provides excellent bone contrast while magnetic resonance imaging (MRI) provides superior contrast and resolution of soft tissue and inflammatory characteristics. Superimposing these imaging results upon each other provides a robust characterization of the joint. In a preliminary study of nine rheumatoid arthritis (RA) participants in clinical remission, we acquired HR-pQCT and MR images of their 2nd and 3rd metacarpophalangeal (MCP) joints at two timepoints 6 months apart. We present the benefits of a multi-modal imaging approach, in which we demonstrate the ability to localize regions of inflammation with subtle changes in bone erosion volume. Using HR-pQCT and MRI to visualize bone damage and inflammation, respectively, will improve our understanding of the impact that subclinical inflammation has on bone damage progression, and demonstrating if bone repair occurs where inflammation is resolved. The presented multi-modal imaging technique has the potential to study the progression of bone damage in relation to inflammation that otherwise would not be possible with either imaging technique alone. The multi-modal image registration technique will be helpful to understanding the development and pathogenesis of RA-associated bone erosions. Additionally, multi-modal imaging may provide a technique to probe the tissue-level changes that occur as a result of treatment regimes.
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Affiliation(s)
- Justin J Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Scott C Brunet
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Peter Salat
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Glen S Hazlewood
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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18
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Finzel S, Manske SL, Barnabe CCM, Burghardt AJ, Marotte H, Scharmga A, Hauge EM, Chapurlat R, Engelke K, Li X, van Teeffelen BCJ, Conaghan PG, Stok KS. Reliability and Change in Erosion Measurements by High-resolution Peripheral Quantitative Computed Tomography in a Longitudinal Dataset of Rheumatoid Arthritis Patients. J Rheumatol 2020; 48:348-351. [PMID: 32934121 DOI: 10.3899/jrheum.191391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this multireader exercise was to assess the reliability and change over time of erosion measurements in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS HR-pQCT scans of 23 patients with RA were assessed at baseline and 12 months. Four experienced readers examined the dorsal, palmar, radial, and ulnar surfaces of the metacarpal head (MH) and phalangeal base (PB) of the second and third digits, blinded to time order. In total, 368 surfaces (23 patients´ 16 surfaces) were evaluated per timepoint to characterize cortical breaks as pathological (erosion) or physiological, and to quantify erosion width and depth. Reliability was evaluated by intraclass correlation coefficients (ICC), percentage agreement, and Light k; change over time was defined by means ± SD of erosion numbers and dimensions. RESULTS ICC for the mean measurements of width and depth of the pathological breaks ranged between 0.819-0.883, and 0.771-0.907, respectively. Most physiological cortical breaks were found at the palmar PB, whereas most pathological cortical breaks were located at the radial MH. There was a significant increase in both the numbers and the dimensions of erosions between baseline and follow-up (P = 0.0001 for erosion numbers, width, and depth in axial plane; P = 0.001 for depth in perpendicular plane). CONCLUSION This exercise confirmed good reliability of HR-pQCT erosion measurements and their ability to detect change over time.
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Affiliation(s)
- Stephanie Finzel
- S. Finzel, MD, Senior Attending Physician, Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany;
| | - Sarah L Manske
- S.L. Manske, PhD, Assistant Professor, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl C M Barnabe
- C.C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Andrew J Burghardt
- A.J. Burghardt, BS, Research Specialist, Department of Radiology and Biomedical Imaging, University of California San Francisco, California, USA
| | - Hubert Marotte
- H. Marotte, MD, PhD, Professor, INSERM 1059, Université de Lyon, and Service de Rhumatologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Andrea Scharmga
- A. Scharmga, PhD, Maastricht University, Maastricht, the Netherlands
| | - Ellen-Margrethe Hauge
- E.M. Hauge, MD, PhD, Professor, Department of Rheumatology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Roland Chapurlat
- R. Chapurlat, MD, PhD, Professor, INSERM 1033, Hôpital Edouard Herriot, Lyon, France
| | - Klaus Engelke
- K. Engelke, PhD, Professor, Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Xiaojuan Li
- X. Li, PhD, Professor, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bente C J van Teeffelen
- B.C. van Teeffelen, Department of Biomedical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia
| | - Philip G Conaghan
- P.G. Conaghan, MD, PhD, Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Kathryn S Stok
- K.S. Stok, PhD, Senior Lecturer, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland, and Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
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Klose-Jensen R, Tse JJ, Keller KK, Barnabe C, Burghardt AJ, Finzel S, Tam LS, Hauge EM, Stok KS, Manske SL. High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease. Front Med (Lausanne) 2020; 7:337. [PMID: 32766262 PMCID: PMC7381125 DOI: 10.3389/fmed.2020.00337] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022] Open
Abstract
High resolution peripheral quantitative computed tomography (HR-pQCT) is a 3-dimensional imaging modality with superior sensitivity for bone changes and abnormalities. Recent advances have led to increased use of HR-pQCT in inflammatory arthritis to report quantitative volumetric measures of bone density, microstructure, local anabolic (e.g., osteophytes, enthesiophytes) and catabolic (e.g., erosions) bone changes and joint space width. These features may be useful for monitoring disease progression, response to therapy, and are responsive to differentiating between those with inflammatory arthritis conditions and healthy controls. We reviewed 69 publications utilizing HR-pQCT imaging of the metacarpophalangeal (MCP) and/or wrist joints to investigate arthritis conditions. Erosions are a marker of early inflammatory arthritis progression, and recent work has focused on improvement and application of techniques to sensitively identify erosions, as well as quantifying erosion volume changes longitudinally using manual, semi-automated and automated methods. As a research tool, HR-pQCT may be used to detect treatment effects through changes in erosion volume in as little as 3 months. Studies with 1-year follow-up have demonstrated progression or repair of erosions depending on the treatment strategy applied. HR-pQCT presents several advantages. Combined with advances in image processing and image registration, individual changes can be monitored with high sensitivity and reliability. Thus, a major strength of HR-pQCT is its applicability in instances where subtle changes are anticipated, such as early erosive progression in the presence of subclinical inflammation. HR-pQCT imaging results could ultimately impact decision making to uptake aggressive treatment strategies and prevent progression of joint damage. There are several potential areas where HR-pQCT evaluation of inflammatory arthritis still requires development. As a highly sensitive imaging technique, one of the major challenges has been motion artifacts; motion compensation algorithms should be implemented for HR-pQCT. New research developments will improve the current disadvantages including, wider availability of scanners, the field of view, as well as the versatility for measuring tissues other than only bone. The challenge remains to disseminate these analysis approaches for broader clinical use and in research.
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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Justin J Tse
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Cheryl Barnabe
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Medical Centre - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah L Manske
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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20
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Brunet SC, Kuczynski MT, Bhatla JL, Lemay S, Pauchard Y, Salat P, Barnabe C, Manske SL. The utility of multi-stack alignment and 3D longitudinal image registration to assess bone remodeling in rheumatoid arthritis patients from second generation HR-pQCT scans. BMC Med Imaging 2020; 20:36. [PMID: 32264872 PMCID: PMC7140503 DOI: 10.1186/s12880-020-00437-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Medical imaging plays an important role in determining the progression of joint damage in rheumatoid arthritis (RA). High resolution peripheral quantitative computed tomography (HR-pQCT) is a sensitive tool capable of evaluating bone microarchitecture and erosions, and 3D rigid image registration can be used to visualize and quantify bone remodeling over time. However, patient motion during image acquisition can cause a "stack shift" artifact resulting in loss of information and reducing the number of erosions that can be analyzed using HR-pQCT. The purpose of this study was to use image registration to improve the number of useable HR-pQCT scans and to apply image-based bone remodeling assessment to the metacarpophalangeal (MCP) joints of RA patients. METHODS Ten participants with RA completed HR-pQCT scans of the 2nd and 3rd MCP joints at enrolment to the study and at a 6-month follow-up interval. At 6-months, an additional repeat scan was acquired to evaluate reliability. HR-pQCT images were acquired in three individual 1 cm acquisitions (stacks) with a 25% overlap. We completed analysis first using standard evaluation methods, and second with multi-stack registration. We assessed whether additional erosions could be evaluated after multi-stack registration. Bone remodeling analysis was completed using registration and transformation of baseline and follow-up images. We calculated the bone formation and resorption volume fractions with 6-month follow-up, and same-day repositioning as a negative control. RESULTS 13/57 (23%) of erosions could not be analyzed from raw images due to a stack shift artifact. All erosions could be volumetrically assessed after multi-stack registration. We observed that there was a median bone formation fraction of 2.1% and resorption fraction of 3.8% in RA patients over the course of 6 months. In contrast to the same-day rescan negative control, we observed median bone formation and resorption fractions of 0%. CONCLUSIONS Multi-stack image registration is a useful tool to improve the number of useable scans when analyzing erosions using HR-pQCT. Further, image registration can be used to longitudinally assess bone remodeling. These methods could be implemented in future studies to provide important pathophysiological information on the progression of bone damage.
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Affiliation(s)
- Scott C Brunet
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada.,Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael T Kuczynski
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada.,Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer L Bhatla
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sophie Lemay
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yves Pauchard
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Peter Salat
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada. .,Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada. .,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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21
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Stok KS, Burghardt AJ, Boutroy S, Peters MPH, Manske SL, Stadelmann V, Vilayphiou N, van den Bergh JP, Geusens P, Li X, Marotte H, van Rietbergen B, Boyd SK, Barnabe C. Consensus approach for 3D joint space width of metacarpophalangeal joints of rheumatoid arthritis patients using high-resolution peripheral quantitative computed tomography. Quant Imaging Med Surg 2020; 10:314-325. [PMID: 32190559 DOI: 10.21037/qims.2019.12.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Joint space assessment for rheumatoid arthritis (RA) by ordinal conventional radiographic scales is susceptible to floor and ceiling effects. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides superior resolution, and may detect earlier changes. The goal of this work was to compare existing 3D methods to calculate joint space width (JSW) metrics in human metacarpophalangeal (MCP) joints with HR-pQCT and reach consensus for future studies. Using the consensus method, we established reproducibility with repositioning as well as feasibility for use in second-generation HR-pQCT scanners. Methods Three published JSW methods were compared using datasets from individuals with RA from three research centers. A SPECTRA consensus method was developed to take advantage of strengths of the individual methods. Using the SPECTRA method, reproducibility after repositioning was tested and agreement between scanner generations was also established. Results When comparing existing JSW methods, excellent agreement was shown for JSW minimum and mean (ICC 0.987-0.996) but not maximum and volume (ICC 0.000-0.897). Differences were identified as variations in volume definitions and algorithmic differences that generated high sensitivity to boundary conditions. The SPECTRA consensus method reduced this sensitivity, demonstrating good scan-rescan reliability (ICC >0.911) except for minimum JSW (ICC 0.656). There was strong agreement between results from first- and second-generation HR-pQCT (ICC >0.833). Conclusions The SPECTRA consensus method combines unique strengths of three independently-developed algorithms and leverages underlying software updates to provide a mature analysis to measure 3D JSW. This method is robust with respect to repositioning and scanner generations, suggesting its suitability for detecting change.
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Affiliation(s)
- Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia.,SCANCO Medical AG, Brüttisellen, Switzerland
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | | | - Michiel P H Peters
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands.,NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vincent Stadelmann
- SCANCO Medical AG, Brüttisellen, Switzerland.,Department of Research and Development, Schulthess Klinik, Zürich, Switzerland
| | | | - Joop P van den Bergh
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,VieCuri Medical Centre, Venlo, The Netherlands
| | - Piet Geusens
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands.,Department of Research and Development, Schulthess Klinik, Zürich, Switzerland
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
| | - Hubert Marotte
- SAINBIOSE, INSERM U1059, University of Lyon, Saint-Etienne, France.,Department of Rheumatology, University Hospital of Saint-Etienne, Saint-Etienne, France.,INSERM CIE3 1408, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.,Department of Medicine and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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22
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Kroker A, Besler BA, Bhatla JL, Shtil M, Salat P, Mohtadi N, Walker RE, Manske SL, Boyd SK. Longitudinal Effects of Acute Anterior Cruciate Ligament Tears on Peri-Articular Bone in Human Knees Within the First Year of Injury. J Orthop Res 2019; 37:2325-2336. [PMID: 31283044 DOI: 10.1002/jor.24410] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) tears are common sports-related knee injuries that increase the risk of developing post-traumatic osteoarthritis. ACL tears are rarely an isolated injury but are often associated with traumatic bone marrow lesions (BMLs). While early loss of bone mass following the ACL injury has been previously described, to date, microarchitectural information has not been reported due to the limited resolution of clinical imaging systems. In this study, we provide the first evidence of detailed bone mass and microarchitectural changes in the first 10 months following an acute ACL tear, and localized to traumatic BMLs. Fifteen participants with an acute unilateral ACL tear were assessed at four-time points using dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography, and traumatic BMLs were identified with magnetic resonance imaging. Loss of bone mass was localized to the injured knee (-4.6% to -15.8%, depending on bone and depth) and was accelerated immediately following the injury before suggesting a recovery phase. This loss of bone was accelerated even greater in traumatic BMLs (-18.2% to -20.6%, depending on bone). Bone loss was accompanied by microstructural degeneration of trabecular bone. For example, in the lateral femur of the injured knee, the subchondral bone plate decreased in thickness (-9.0%). This study confirmed loss of bone mass in the months following ACL tears and described the underlying bone microstructural changes. The presented bone changes were accelerated in regions of traumatic BMLs. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2325-2336, 2019.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Bryce A Besler
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Jennifer L Bhatla
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Mariya Shtil
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Peter Salat
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Nicholas Mohtadi
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Richard E Walker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, 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, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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23
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Silva AMH, Boyd SK, Manske SL, Alves JM, de Carvalho J. Assessment of the elastic properties of human vertebral trabecular bone using computational mechanical tests and x-ray microtomography—a subvolume analysis. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab2c70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Whittier DE, Manske SL, Boyd SK, Schneider PS. The Correction of Systematic Error due to Plaster and Fiberglass Casts on HR-pQCT Bone Parameters Measured In Vivo at the Distal Radius. J Clin Densitom 2019; 22:401-408. [PMID: 30658879 DOI: 10.1016/j.jocd.2018.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
Due to difficulty assessing healing of distal radius fractures using conventional radiography, there is interest in using high resolution peripheral quantitative computed tomography (HR-pQCT) to track healing at the microarchitectural level. Unfortunately, the plaster-of-Paris and fiberglass casts used to immobilize fractures affect HR-pQCT measurements due to beam hardening, and increased noise. The challenge is compounded because casts have variable thickness, and an individual patient will often have their cast changed 2-3 times during the course of treatment. This study quantifies the effect of casts within a clinically relevant range of thicknesses on measured bone parameters at the distal radius, and establishes conversion equations to correct for systematic error in due to cast presence. Eighteen nonfractured participants were scanned by HR-pQCT in three conditions: no cast, plaster-of-Paris cast, and fiberglass cast. Measured parameters were compared between the baseline scan (no cast) and each cast scan to evaluate if systematic error exists due to cast presence. A linear regression model was used to determine an appropriate conversion for parameters that were found to have systematic error. Plaster-of-Paris casts had a greater range of thicknesses (3.2-9.5 mm) than the fiberglass casts (3.0-5.4 mm), and induced a greater magnitude of systematic error overall. Key parameters of interest were bone mineral density (total, cortical, and trabecular) and trabecular bone volume fraction, all of which were found to have systematic error due to presence of either cast type. Linear correlations between baseline and cast scans for these parameters were excellent (R2 > 0.98), and appropriate conversions could be determined within a margin of error less than a ±6% for the plaster-of-Paris cast, and ±4% for the fiberglass cast. We have demonstrated the effects of cast presence on bone microarchitecture measurements, and presented a method to correct for systematic error, in support of future use of HR-pQCT to study fracture healing.
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Affiliation(s)
- Danielle E Whittier
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Prism S Schneider
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.
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25
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Manske SL, Brunet SC, Finzel S, Stok KS, Conaghan PG, Boyd SK, Barnabe C. The SPECTRA Collaboration OMERACT Working Group: Construct Validity of Joint Space Outcomes with High-resolution Peripheral Quantitative Computed Tomography. J Rheumatol 2019; 46:1369-1373. [PMID: 30647172 DOI: 10.3899/jrheum.180870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We assessed construct validity of high-resolution peripheral quantitative computed tomography (HR-pQCT) joint space outcomes by comparison with radiographs in patients with rheumatoid arthritis. METHODS In 43 patients, quantitative, volumetric, HR-pQCT measurements were compared with ordinal Sharp/van der Heijde scoring (SvdH) in the 2nd and 3rd metacarpophalangeal joints. RESULTS Generalized estimating equations showed that joint space minimum, SD, and asymmetry by HR-pQCT were associated with SvdH scores (p < 0.05). There was a considerable range in HR-pQCT measurements at SvdH equal to 0. CONCLUSION HR-pQCT demonstrated construct validity outcomes and provides improved 3-D visualization of joint space.
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Affiliation(s)
- Sarah L Manske
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK. .,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.
| | - Scott C Brunet
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Stephanie Finzel
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Kathryn S Stok
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Philip G Conaghan
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Steven K Boyd
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Cheryl Barnabe
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
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Kroker A, Manske SL, Mohtadi N, Boyd SK. A study of the relationship between meniscal injury and bone microarchitecture in ACL reconstructed knees. Knee 2018; 25:746-756. [PMID: 30115589 DOI: 10.1016/j.knee.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/03/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears increase the risk of developing knee osteoarthritis. This risk increases further with concurrent meniscus injury. The role of bone changes during knee osteoarthritis development are not well-understood, but may be important to its etiology. PURPOSE To explore the effects of ACL tears on bone mineral density (BMD) and bone microarchitecture at five years post-op and their relationship to meniscal pathology, using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Twenty-eight participants with unilateral ACL reconstructions five years prior and no evidence of clinical or radiographic osteoarthritis were recruited. All participants represented one of three meniscus statuses: meniscus intact, meniscus repair, or meniscectomy. BMD and bone microarchitecture of the subchondral bone plate and adjacent trabecular bone were assessed using HR-pQCT, and percent-differences between the injured and contralateral knee were determined. RESULTS Subchondral bone plate thickness in the lateral femoral condyle was higher in the reconstructed knee (9.0%, p = 0.002), driven by the meniscus repair and meniscectomy groups (15.2% to 15.4%, p < 0.05). Trabecular BMD was lower in the reconstructed knee in the medial femoral condyle (-4.8% to -7.6%, p < 0.05), driven by all meniscus statuses. In the lateral compartments, few differences in trabecular bone were found. However, accounting for meniscus status, the meniscus intact group had lower trabecular BMD throughout both femur and tibia. CONCLUSIONS Five years post-op, reconstructed knees demonstrated detectable differences in BMD and bone microarchitecture, despite having normal radiographs. Meniscus damage affected primarily the lateral compartment, warranting further investigation to determine if these changes relate to osteoarthritis development.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Nicholas Mohtadi
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
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Whittier DE, Manske SL, Kiel DP, Bouxsein M, Boyd SK. Harmonizing finite element modelling for non-invasive strength estimation by high-resolution peripheral quantitative computed tomography. J Biomech 2018; 80:63-71. [PMID: 30201250 DOI: 10.1016/j.jbiomech.2018.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
The finite element (FE) method based on high-resolution peripheral quantitative computed tomography (HR-pQCT) use a variety of tissue constitutive properties and boundary conditions at different laboratories making comparison of mechanical properties difficult. Furthermore, the advent of a second-generation HR-pQCT poses challenges due to improved resolution and a larger region of interest (ROI). This study addresses the need to harmonize results across FE models. The aims are to establish the relationship between FE results as a function of boundary conditions and a range of tissue properties for the first-generation HR-pQCT system, and to determine appropriate model parameters for the second-generation HR-pQCT system. We implemented common boundary conditions and tissue properties on a large cohort (N = 1371), and showed the relationships were highly linear (R2 > 0.99) for yield strength and reaction force between FE models. Cadaver radii measured on both generation HR-pQCT with matched ROIs were used to back-calculate a tissue modulus that accounts for the increased resolution (61 µm versus 82 µm), resulting in a modulus of 8748 MPa for second-generation HR-pQCT to produce bone yield strength and reaction force equivalent to using 6829 MPa for first-generation HR-pQCT. Finally, in vivo scans (N = 61) conducted on both generations demonstrated that the larger ROI in the second-generation system results in stronger bone outcome measures, suggesting it is not advisable to convert FE results across HR-pQCT generations without matching ROIs. Together, these findings harmonize FE results by providing a means to compare findings with different boundary conditions and tissue properties, and across scanner generations.
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Affiliation(s)
- Danielle E Whittier
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mary Bouxsein
- Beth Israel Deaconess Medical Center, Center for Advanced Orthopedic Studies, Boston, MA, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Bhatla JL, Kroker A, Manske SL, Emery CA, Boyd SK. Differences in subchondral bone plate and cartilage thickness between women with anterior cruciate ligament reconstructions and uninjured controls. Osteoarthritis Cartilage 2018; 26:929-939. [PMID: 29678623 DOI: 10.1016/j.joca.2018.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/30/2018] [Accepted: 04/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Anterior cruciate ligament (ACL) tears increase early onset osteoarthritis (OA) risk leading to cartilage and bone degradation. While the contribution of bone in OA development is unclear, evidence suggests that bone changes accompany cartilage degradation. This study aims to assess if regions with differences in subchondral bone plate thickness have differences in cartilage thickness when comparing ACL reconstructed (ACLR) knees of women ≥5 years post-injury to contralateral and controls with uninjured knees. DESIGN Magnetic resonance imaging (MRI) assessed cartilage and high resolution peripheral quantitative computed tomography (HR-pQCT) assessed subchondral bone in both knees. Multimodal 3D image registration aligned anatomy. Maps of the spatial distribution of thickness on the articular surfaces were generated to compare women with ACL reconstructions to contralateral and controls with uninjured knees. RESULTS ACLR knees had a thicker subchondral bone plate in the posterior and central lateral femur compared to contralateral knees (10.4% and 4.2% thicker, P = 0.032 and 0.032, W = 108 and 107, respectively) and in the posterior lateral femur compared to control knees (17.1% thicker, P = 0.014, W = 177). Cartilage differences were not detected (P > 0.05) in these regions. CONCLUSIONS This study demonstrates that subchondral bone plate thickness differences are prominent following knee injury, as measured by HR-pQCT, but no statistically significant differences in cartilage morphology, measured by MRI, were found between ACLR knees compared to contralateral and control knees. These data provide novel insight into post-traumatic knee injuries that may be signs of early OA pathogenesis.
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Affiliation(s)
- J L Bhatla
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - A Kroker
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - S L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - C A Emery
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Abstract
Anterior cruciate ligament (ACL) tears are a common sports-related knee injury that increases the risk of developing post-traumatic osteoarthritis (OA). During OA progression bone microarchitecture changes in the affected knee, however, little is known about bone microarchitecture in knees with early stage OA. The purpose of this study is to investigate in a cohort of females predisposed to develop OA how bone microarchitecture in ACL reconstructed knees differs from uninjured contralateral knees as well as healthy control knees and how this relates to early changes in OA. Bone microarchitecture was directly assessed in ACL reconstructed knees of injured female participants (n=15) with a median age of 25.4years (age range: 22.5-28.5) and compared to their uninjured contralateral knees, as well as to a healthy age-matched female control sample (n=14) with a median age of 25.2years (age range: 22.2-27.1). ACL reconstructed knees had lower trabecular bone mineral density (compared to contralateral: -7.7% to -10.4%, p<0.05; control knees: -7.1% to -13.9%, p<0.05) and altered trabecular bone microarchitecture in the medial femur compared to contralateral and control knees. The subchondral bone plate in the lateral femur was thicker in ACL reconstructed knees compared to contralateral (29.6%, p=0.009) and control knees (47.9% to 53.7%, p<0.05). Contralateral knees did not differ from control knees. Loss of trabecular bone and increased subchondral bone plate thickness in the ACL-reconstructed knees are consistent with changes associated with OA progression. Most differences in bone microarchitecture were found in the femur, with few differences in the tibia. The bone microarchitecture of contralateral knees did not differ from control knees in our participants, suggesting the potential to use them as control references in future longitudinal studies.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Jennifer L Bhatla
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
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Burt LA, Manske SL, Hanley DA, Boyd SK. Lower Bone Density, Impaired Microarchitecture, and Strength Predict Future Fragility Fracture in Postmenopausal Women: 5-Year Follow-up of the Calgary CaMos Cohort. J Bone Miner Res 2018; 33:589-597. [PMID: 29363165 DOI: 10.1002/jbmr.3347] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/25/2017] [Accepted: 11/19/2017] [Indexed: 01/13/2023]
Abstract
The aim of this prospective study was to use high-resolution peripheral quantitative computed tomography (HR-pQCT) to determine if baseline skeletal parameters can predict incident fragility fracture in women and, secondly, to establish if women that fracture lose bone at a faster rate than those who do not fracture. Women older than 60 years who experienced a fragility fracture during the 5-year follow-up period (incident fracture group, n = 22) were compared with those who did not experience a fragility fracture during the study (n = 127). After image registration between baseline and follow-up measures, standard and cortical morphological analyses were conducted. Odds ratios were calculated for baseline values and annualized percent change of HR-pQCT and finite element variables. At the radius, baseline HR-pQCT results show women who fractured had lower total bone mineral density (Tt.BMD; 19%), trabecular bone mineral density (Tb.BMD; 25%), and trabecular number (Tb.N; 14%), with higher trabecular separation (Tb.Sp; 19%) than women who did not fracture. At the tibia, women with incident fracture had lower Tt.BMD (15%), Tb.BMD (12%), cortical thickness (Ct.Th; 14%), cortical area (Ct.Ar; 12%), and failure load (10%) with higher total area (Tt.Ar; 7%) and trabecular area (Tb.Ar; 10%) than women who did not fracture. Odds ratios (ORs) at the radius revealed every SD decrease of Tt.BMD (OR = 2.1), Tb.BMD (OR = 2.0), and Tb.N (OR = 1.7) was associated with a significantly increased likelihood of fragility fracture. At the tibia, every SD decrease in Tt.BMD (OR = 2.1), Tb.BMD (OR = 1.7), Ct.Th (OR = 2.2), Ct.Ar (OR = 1.9), and failure load (OR = 1.7) were associated with a significantly increased likelihood of fragility fracture. Irrespective of scanning modality, the annualized percent rate of bone loss was not different between fracture groups. The results suggest baseline bone density, microarchitecture, and strength rather than change in these variables are associated with incident fragility fractures in women older than 60 years. Furthermore, irrespective of fragility fracture status, women experienced changes in skeletal health at a similar rate. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Lauren A Burt
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, 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, University of Calgary, Calgary, Canada
| | - David A Hanley
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.,Departments of Medicine, Community Health Sciences, and Oncology, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
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Manske SL, Davison EM, Burt LA, Raymond DA, Boyd SK. The Estimation of Second-Generation HR-pQCT From First-Generation HR-pQCT Using In Vivo Cross-Calibration. J Bone Miner Res 2017; 32:1514-1524. [PMID: 28294415 DOI: 10.1002/jbmr.3128] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/07/2022]
Abstract
Second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT) provides the highest resolution in vivo to assess bone density and microarchitecture in 3D. Although strong agreement of most outcomes measured with first- (XCTI) and second- (XCTII) generation HR-pQCT has been demonstrated, the ability to use the two systems interchangeably is unknown. From in vivo measurements, we determined the limits of estimating XCTII data from XCTI scans conducted in vivo and whether that estimation can be improved by linear cross-calibration equations. These data are crucial as the research field transitions to the new technology. Our study design established cross-calibration equations by scanning 62 individuals on both systems on the same day and then tested those cross-calibrations on the same cohort 6 months later so that estimated (denoted as XCTII*) and "true" XCTII parameters could be compared. We calculated the generalized least-significant change (GLSC) for those predictions. There was strong agreement between both systems for density (R2 > 0.94), macroarchitecture (R2 > 0.95), and most microarchitecture outcomes with the exception of trabecular thickness (Tb.Th, R2 = 0.51 to 0.67). Linear regression equations largely eliminated the systematic error between XCTII and XCTII* and produced a good estimation of most outcomes, with individual error estimates between 0.2% and 3.4%, with the exception of Tt.BMD. Between-system GLSC was similar to within-XCTI LSC (eg, 8.3 to 41.9 mg HA/cm3 for density outcomes). We found that differences between outcomes assessed with XCTI and XCTII can be largely eliminated by cross-calibration. Tb.Th is poorly estimated because it is measured more accurately by XCTII than XCTI. It may be possible to use cross-calibration for most outcomes when both scanner generations are used for multicenter and longitudinal studies. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Erin M Davison
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauren A Burt
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Duncan A Raymond
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Kroker A, Zhu Y, Manske SL, Barber R, Mohtadi N, Boyd SK. Quantitative in vivo assessment of bone microarchitecture in the human knee using HR-pQCT. Bone 2017; 97:43-48. [PMID: 28039095 DOI: 10.1016/j.bone.2016.12.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/10/2016] [Accepted: 12/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE High-resolution peripheral quantitative computed tomography (HR-pQCT) is a novel imaging modality capable of visualizing bone microarchitecture in vivo at human peripheral sites such as the distal radius and distal tibia. This research has extended the technology to provide a non-invasive assessment of bone microarchitecture at the human knee by establishing new hardware, imaging protocols and data analysis. DESIGN A custom leg holder was developed to stabilize a human knee centrally within a second generation HR-pQCT field of view. Five participants with anterior cruciate ligament reconstructions had their knee joint imaged in a continuous scan of 6cm axially. The nominal isotropic voxel size was 60.7μm. Bone mineral density and microarchitecture were assessed within the weight-bearing regions of medial and lateral compartments of the knee at three depths from the weight-bearing articular bone surface, including both the cortical and trabecular bone regions. RESULTS Scan duration was approximately 18min per knee and produced 5GB of projection data and 10GB of reconstructed image data (2304×2304 image matrix, 1008 slices). Motion during the scan was minimized by the leg holder and was similar in magnitude as a scan of the distal tibia. Bone mineral density and microarchitectural parameters were assessed for 16 volumes of interest in the tibiofemoral joint. CONCLUSIONS This is a new non-invasive in vivo assessment tool for bone microarchitecture in the human knee that provides an opportunity to gain insight into normal, injured and surgically reconstructed human knee bone architecture in cross-sectional or longitudinal studies.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Ying Zhu
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Rhamona Barber
- University of Calgary Sport Medicine Centre, University of Calgary, Canada.
| | - Nicholas Mohtadi
- University of Calgary Sport Medicine Centre, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
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Tom S, Frayne M, Manske SL, Burghardt AJ, Stok KS, Boyd SK, Barnabe C. Determining Metacarpophalangeal Flexion Angle Tolerance for Reliable Volumetric Joint Space Measurements by High-resolution Peripheral Quantitative Computed Tomography. J Rheumatol 2016; 43:1941-1944. [DOI: 10.3899/jrheum.160649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective.The position-dependence of a method to measure the joint space of metacarpophalangeal (MCP) joints using high-resolution peripheral quantitative computed tomography (HR-pQCT) was studied.Methods.Cadaveric MCP were imaged at 7 flexion angles between 0 and 30 degrees. The variability in reproducibility for mean, minimum, and maximum joint space widths and volume measurements was calculated for increasing degrees of flexion.Results.Root mean square coefficient of variance values were < 5% under 20 degrees of flexion for mean, maximum, and volumetric joint spaces. Values for minimum joint space width were optimized under 10 degrees of flexion.Conclusion.MCP joint space measurements should be acquired at < 10 degrees of flexion in longitudinal studies.
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Hildebrandt EM, Manske SL, Hanley DA, Boyd SK. Bilateral Asymmetry of Radius and Tibia Bone Macroarchitecture and Microarchitecture: A High-Resolution Peripheral Quantitative Computed Tomography Study. J Clin Densitom 2016; 19:250-4. [PMID: 25863722 DOI: 10.1016/j.jocd.2015.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/07/2015] [Accepted: 02/11/2015] [Indexed: 11/18/2022]
Abstract
Studies assessing bone health often select the dominant or nondominant limb to scan, but not both, for efficiency reasons. New scanning technology allows 3-dimensional (3D) visualization of the microarchitecture in bone, but it is not well understood whether there are differences between the dominant and nondominant limbs. Using 3D high-resolution peripheral quantitative computed tomography (HR-pQCT), the aim of this study is to investigate the effect of limb dominance on bone macroarchitecture and microarchitecture. Healthy male and female participants (N=100; 59 female, 41 male), mean age 30.7±12.1 years, were scanned at both radii and tibiae using HR-pQCT. Hand and foot dominance were determined by the participant's self-report. Most participants were right hand dominant (94.0%) and right foot dominant (91.0%). In the pooled cohort, the dominant radius had significantly greater cortical area (2.11%; p=0.002) and failure load (3.00%; p=0.001). At the tibia, the dominant foot had significantly lower bone mineral density (-0.77%; p=0.042), cortical area (-1.05%; p=0.031), and thickness (-1.51%; p=0.017). For females, there were no differences at the radius, but at the tibia, the dominant side had greater cross-sectional area (1.03%; p=0.044). Our data suggest that dominance has a small yet significant effect on macroarchitecture at both the ultradistal radius and tibia but not microarchitecture. This work emphasizes that it is important to be consistent in the selection of either dominant or nondominant limbs for HR-pQCT cohort studies; however, in the case where the opposite limb needs to be scanned, there would be small differences in macroarchitecture and no significant differences in microarchitecture anticipated.
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Affiliation(s)
- Erin M Hildebrandt
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, 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, University of Calgary, Calgary, Canada
| | - David A Hanley
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.
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Manske SL, Zhu Y, Sandino C, Boyd SK. Human trabecular bone microarchitecture can be assessed independently of density with second generation HR-pQCT. Bone 2015; 79:213-21. [PMID: 26079995 DOI: 10.1016/j.bone.2015.06.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 05/16/2015] [Accepted: 06/09/2015] [Indexed: 12/18/2022]
Abstract
The second generation HR-pQCT scanner (XtremeCTII, Scanco Medical) can assess human bone microarchitecture of peripheral limbs with a 61 μm nominal isotropic voxel size. This is a marked improvement from the first generation HR-pQCT that had a nominal isotropic voxel size of 82 μm, which is at the limit to accurately determine the thickness of individual human trabeculae. We sought to determine the accuracy of a direct morphometric approach to measure trabecular bone microarchitecture with three-dimensional morphological techniques using second generation HR-pQCT, and to compare this with the approach currently applied by the first generation HR-pQCT scanner based on derived indices using ex vivo scans of human cadaveric radii. We also compared images acquired and resampled to mimic the first generation HR-pQCT with those obtained directly from the first generation HR-pQCT. We evaluated 20 human cadaveric radii and a micro-CT performance phantom using the first (XtremeCT, Scanco Medical) and second generation HR-pQCT scanner (XtremeCTII) and compared a patient evaluation (XCTII, 61 μm) with a high resolution ex vivo protocol (HR, 30μm). We generated 82 μm scans of the same specimens to mimic a first-generation HR-pQCT evaluation (XCTIM, 82 μm) and compared these with a first-generation patient evaluation (XCTI, 82 μm). A standard structural extraction approach was applied to both XCTII and HR evaluations for assessment of bone volume fraction (BV/TV), and a distance transform was used to assess trabecular number (Tb.N), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). For XCTI and XCTIM evaluations we followed the manufacturer's standard procedure and assessed bone mineral density (BMD), Tb.N with a distance transform, and then derived bone volume ratio (BV/TV(d)), trabecular thickness (Tb.Th(d)) and separation (Tb.Sp(d)). The spatial resolution (10% MTF) was 142.2 μm for XCTI, 108.9 μm for XCTIM, 95.2μm for XCTII, and 55.9 μm for HR. XCTI and XCTIM provided strongly associated measurements of BMD and microarchitectural outcomes (R(2)>0.97), however there were systematic differences in all outcomes. The Tb.N was highly associated with HR by both XCTII (R(2)=0.93, mean error=-0.12 mm(-1)) and XCTIM (R(2)=0.98, mean error=0.25 mm(-1)). Also, both XCTII (R(2)=0.99, mean error=0.20mm) and XCTIM (R(2)=0.99, mean error=-0.18 mm) had Tb.Sp that were strongly related to HR. For Tb.Th, the XCTII was more closely related to HR (R(2)=0.94, mean error=0.04 mm) than the relatively weak XCTIM (R(2)=0.16, mean error=- 0.076 mm). We found that trabecular microarchitecture assessment following the XCTII direct morphometric approach accurately represented the HR data. In particular, the measure of Tb.Th was markedly improved for XCTII compared with the derived approach of XCTIM. These data support the application of analysis techniques in HR-pQCT that are analogous to those traditionally used for micro-CT to assess trabecular microarchitecture. The decreased dependence of structural outcomes on density provides a new, important opportunity to monitor human in vivo bone microarchitecture.
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Affiliation(s)
- Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Ying Zhu
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Clara Sandino
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.
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Zhu Y, Manske SL, Boyd SK. Cartilage imaging of a rabbit knee using dual-energy X-ray microscopy and 1.0 T and 9.4 T magnetic resonance imaging. J Orthop Translat 2015; 3:212-218. [PMID: 30035060 PMCID: PMC5986986 DOI: 10.1016/j.jot.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/08/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background/Objective Osteoarthritis is a common chronic disease of the joints characterised by the degeneration of articular cartilages and subchondral bone. The most common diagnostic imaging used clinically is X-ray; however, it cannot directly image cartilage. Magnetic resonance imaging (MRI) is well suited for cartilage imaging, but it requires costly and lengthy scans. For preclinical work, microcomputed tomography provides high spatial resolution and contrast for bone, however, its standard application is not well suited for cartilage imaging. Methods We performed a preliminary investigation into the use of dual-energy X-ray microscopy (XRM) for cartilage imaging and analysis of a rabbit knee, and compared it to the MRI results from 9.4 T and 1.0 T small-animal scanners. Results The XRM images offer a higher image resolution (∼25 μm nominal isotropic resolution) compared with the MRI (50-86 μm in plane, and 250 μm slice thickness). The cartilage-thickness measurements using the dual-energy XRM are on average 3.8% (femur) and 5.1% (tibia) thicker estimates than the 9.4 T MRI results. The cartilage-thickness measurements using the 1.0 T MRI are on average 10.9% (femur) and 2.3% (tibia) thinner estimates than the 9.4 T MRI results. Conclusion Our results suggest that the dual-energy XRM for articular-cartilage analysis is feasible and comparable to the MRI. This technology will provide good support for high-resolution animal-osteoarthritis studies, and in the future, it may be possible to apply dual energy in a clinical setting.
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Affiliation(s)
- Ying Zhu
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Taiani JT, Buie HR, Campbell GM, Manske SL, Krawetz RJ, Rancourt DE, Boyd SK, Matyas JR. Embryonic stem cell therapy improves bone quality in a model of impaired fracture healing in the mouse; tracked temporally using in vivo micro-CT. Bone 2014; 64:263-72. [PMID: 24780879 DOI: 10.1016/j.bone.2014.04.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/25/2014] [Accepted: 04/17/2014] [Indexed: 01/08/2023]
Abstract
In the current study, we used an estrogen-deficient mouse model of osteoporosis to test the efficacy of a cell-generated bone tissue construct for bone augmentation of an impaired healing fracture. A reduction in new bone formation at the defect site was observed in ovariectomized fractures compared to the control group using repeated measures in vivo micro-computed tomography (μCT) imaging over 4 weeks. A significant increase in the bone mineral density (BMD), trabecular bone volume ratio, and trabecular number, thickness and connectivity were associated with fracture repair in the control group, whereas the fractured bones of the ovariectomized mice exhibited a loss in all of these parameters (p<0.001). In a separate group, ovariectomized fractures were treated with murine embryonic stem (ES) cell-derived osteoblasts loaded in a three-dimensional collagen I gel and recovery of the bone at the defect site was observed. A significant increase in the trabecular bone volume ratio (p<0.001) and trabecular number (p<0.01) was observed by 4 weeks in the fractures treated with cell-loaded collagen matrix compared to those treated with collagen I alone. The stem cell-derived osteoblasts were identified at the fracture site at 4 weeks post-implantation through in situ hybridization histochemistry. Although this cell tracking method was effective, the formation of an ectopic cellular nodule adjacent to the knee joints of two mice suggested that alternative in vivo cell tracking methods should be employed in order to definitively assess migration of the implanted cells. To our knowledge, this study is the first of its kind to examine the efficacy of stem cell therapy for fracture repair in an osteoporosis-related fracture model in vivo. The findings presented provide novel insight into the use of stem cell therapies for bone injuries.
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Affiliation(s)
- J T Taiani
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada; Biomedical Engineering Program, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - H R Buie
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada; Schulich School of Engineering, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - G M Campbell
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada; Schulich School of Engineering, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - S L Manske
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - R J Krawetz
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada; Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, T2N 1N4, Canada.
| | - D E Rancourt
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada; Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada; Schulich School of Engineering, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - J R Matyas
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada; Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
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Gupta S, Manske SL, Judex S. Increasing the Number of Unloading/Reambulation Cycles does not Adversely Impact Body Composition and Lumbar Bone Mineral Density but Reduces Tissue Sensitivity. Acta Astronaut 2013; 92:89-96. [PMID: 23976804 PMCID: PMC3747666 DOI: 10.1016/j.actaastro.2012.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A single exposure to hindlimb unloading leads to changes in body mass, body composition and bone, but the consequences of multiple exposures are not yet understood. Within a 18wk period, adult C57BL/6 male mice were exposed to one (1x-HLU), two (2x-HLU) or three (3x-HLU) cycles of 2 wk of hindlimb unloading (HLU) followed by 4 wk of reambulation (RA), or served as ambulatory age-matched controls. In vivo µCT longitudinally tracked changes in abdominal adipose and lean tissues, lumbar vertebral apparent volumetric bone mineral density (vBMD) and upper hindlimb muscle cross-sectional area before and after the final HLU and RA cycle. Significant decreases in total adipose tissue and vertebral vBMD were observed such that all unloaded animals reached similar values after the final unloading cycle. However, the magnitude of these losses diminished in mice undergoing their 2nd or 3rd HLU cycle. Irrespective of the number of HLU/RA cycles, total adipose tissue and vertebral vBMD recovered and were no different from age-matched controls after the final RA period. In contrast, upper hindlimb muscle cross-sectional area was significantly lower than controls in all unloaded groups after the final RA period. These results suggest that tissues in the abdominal region are more resilient to multiple bouts of unloading and more amenable to recovery during reambulation than the peripheral musculoskeletal system.
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Affiliation(s)
- Shikha Gupta
- Integrative Skeletal Adaptation & Genetics Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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Taha MA, Manske SL, Kristensen E, Taiani JT, Krawetz R, Wu Y, Ponjevic D, Matyas JR, Boyd SK, Rancourt DE, Dunn JF. Assessment of the efficacy of MRI for detection of changes in bone morphology in a mouse model of bone injury. J Magn Reson Imaging 2012; 38:231-7. [PMID: 23125100 DOI: 10.1002/jmri.23876] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 09/12/2012] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine whether magnetic resonance imaging (MRI) could be used to track changes in skeletal morphology during bone healing using high-resolution micro-computed tomography (μCT) as a standard. We used a mouse model of bone injury to compare μCT with MRI. MATERIALS AND METHODS Surgery was performed to induce a burr hole fracture in the mouse tibia. A selection of biomaterials was immediately implanted into the fractures. First we optimized the imaging sequences by testing different MRI pulse sequences. Then changes in bone morphology over the course of fracture repair were assessed using in vivo MRI and μCT. Histology was performed to validate the imaging outcomes. RESULTS The rapid acquisition with relaxation enhancement (RARE) sequence provided sufficient contrast between bone and the surrounding tissues to clearly reveal the fracture. It allowed detection of the fracture clearly 1 and 14 days postsurgery and revealed soft tissue changes that were not clear on μCT. In MRI and μCT the fracture was seen at day 1 and partial healing was detected at day 14. CONCLUSION The RARE sequence was the most suitable for MRI bone imaging. It enabled the detection of hard and even soft tissue changes. These findings suggest that MRI could be an effective imaging modality for assessing changes in bone morphology and pathobiology.
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Affiliation(s)
- May A Taha
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Abstract
Mechanical loading is a crucial factor for maintaining skeletal health. Physical activities, exercise, and sports provide a wealth and variety of mechanical loads to bones, through muscle forces, ground reaction forces, and other contact or impact forces. Weightbearing activities can be effective exercises to enhance bone health-particularly, those that involve jumping and impact loads (with greater strain magnitudes, rates, and frequencies). Physical activity appears to be acutely beneficial for enhancing bone health in the early pubertal period and in older age, such as in postmenopausal women. In preparing this article, PubMed, Web of Science, and relevant edited books (English language) were reviewed from 1961 to present.
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Affiliation(s)
- Sarah L Manske
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Abstract
Nutrition, in sufficient amount and substance, is crucial for healthy growth and development of the skeleton and surrounding tissues, especially in physically active populations. Inadequate nutrition has been linked to maladies such as the female athlete triad, as well as poor training or competitive performance and increased risk of injury. Dietary choices favoring items high in quality protein of animal or plant origin, polyunsaturated fatty acids, fruits and vegetables high in potassium and fiber, and dairy products or other beverages fortified with calcium and vitamin D are essential to athletes to ensure adequate vitamin and mineral availability to the skeleton, which in turn can affect peak physical performance.
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Affiliation(s)
- Caeley Lorincz
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Manske SL, Good CA, Zernicke RF, Boyd SK. High-frequency, low-magnitude vibration does not prevent bone loss resulting from muscle disuse in mice following botulinum toxin injection. PLoS One 2012; 7:e36486. [PMID: 22590551 PMCID: PMC3349718 DOI: 10.1371/journal.pone.0036486] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/09/2012] [Indexed: 11/18/2022] Open
Abstract
High-frequency, low-magnitude vibration enhances bone formation ostensibly by mimicking normal postural muscle activity. We tested this hypothesis by examining whether daily exposure to low-magnitude vibration (VIB) would maintain bone in a muscle disuse model with botulinum toxin type A (BTX). Female 16–18 wk old BALB/c mice (N = 36) were assigned to BTX-VIB, BTX-SHAM, VIB, or SHAM. BTX mice were injected with BTX (20 µL; 1 U/100 g body mass) into the left hindlimb posterior musculature. All mice were anaesthetized for 20 min/d, 5 d/wk, for 3 wk, and the left leg mounted to a holder. Through the holder, VIB mice received 45 Hz, ±0.6 g sinusoidal acceleration without weight bearing. SHAM mice received no vibration. At baseline and 3 wk, muscle cross-sectional area (MCSA) and tibial bone properties (epiphysis, metaphysis and diaphysis) were assessed by in vivo micro-CT. Bone volume fraction in the metaphysis decreased 12±9% and 7±6% in BTX-VIB and BTX-SHAM, but increased in the VIB and SHAM. There were no differences in dynamic histomorphometry outcomes between BTX-VIB and BTX nor between VIB and SHAM. Thus, vibration did not prevent bone loss induced by a rapid decline in muscle activity nor produce an anabolic effect in normal mice. The daily loading duration was shorter than would be expected from postural muscle activity, and may have been insufficient to prevent bone loss. Based on the approach used in this study, vibration does not prevent bone loss in the absence of muscle activity induced by BTX.
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MESH Headings
- Animals
- Bone Diseases, Metabolic/chemically induced
- Bone Diseases, Metabolic/pathology
- Bone Diseases, Metabolic/physiopathology
- Bone Diseases, Metabolic/therapy
- Botulinum Toxins, Type A/adverse effects
- Botulinum Toxins, Type A/pharmacology
- Female
- Mice
- Mice, Inbred BALB C
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Muscle, Skeletal/physiopathology
- Muscular Disorders, Atrophic/chemically induced
- Muscular Disorders, Atrophic/pathology
- Muscular Disorders, Atrophic/physiopathology
- Muscular Disorders, Atrophic/therapy
- Neurotoxins/adverse effects
- Neurotoxins/pharmacology
- Physical Therapy Modalities
- Tibia/pathology
- Tibia/physiopathology
- Vibration
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Affiliation(s)
- Sarah L. Manske
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Craig A. Good
- Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Ronald F. Zernicke
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Faculty of Medicine, University of Calgary, Calgary, Canada
- Departments of Orthopaedic Surgery and Biomedical Engineering and School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Steven K. Boyd
- Schulich School of Engineering, University of Calgary, Calgary, Canada
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Uzer G, Manske SL, Chan ME, Chiang FP, Rubin CT, Frame MD, Judex S. Separating Fluid Shear Stress from Acceleration during Vibrations in Vitro: Identification of Mechanical Signals Modulating the Cellular Response. Cell Mol Bioeng 2012; 5:266-276. [PMID: 23074384 DOI: 10.1007/s12195-012-0231-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The identification of the physical mechanism(s) by which cells can sense vibrations requires the determination of the cellular mechanical environment. Here, we quantified vibration-induced fluid shear stresses in vitro and tested whether this system allows for the separation of two mechanical parameters previously proposed to drive the cellular response to vibration - fluid shear and peak accelerations. When peak accelerations of the oscillatory horizontal motions were set at 1g and 60Hz, peak fluid shear stresses acting on the cell layer reached 0.5Pa. A 3.5-fold increase in fluid viscosity increased peak fluid shear stresses 2.6-fold while doubling fluid volume in the well caused a 2-fold decrease in fluid shear. Fluid shear was positively related to peak acceleration magnitude and inversely related to vibration frequency. These data demonstrated that peak shear stress can be effectively separated from peak acceleration by controlling specific levels of vibration frequency, acceleration, and/or fluid viscosity. As an example for exploiting these relations, we tested the relevance of shear stress in promoting COX-2 expression in osteoblast like cells. Across different vibration frequencies and fluid viscosities, neither the level of generated fluid shear nor the frequency of the signal were able to consistently account for differences in the relative increase in COX-2 expression between groups, emphasizing that the eventual identification of the physical mechanism(s) requires a detailed quantification of the cellular mechanical environment.
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Affiliation(s)
- Gunes Uzer
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794
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Fried A, Manske SL, Eller LK, Lorincz C, Reimer RA, Zernicke RF. Skim milk powder enhances trabecular bone architecture compared with casein or whey in diet-induced obese rats. Nutrition 2011; 28:331-5. [PMID: 22119485 DOI: 10.1016/j.nut.2011.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 05/02/2011] [Accepted: 07/29/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We previously showed that skim milk powder (SMP) prevents weight gain more so than casein or whey alone. Dairy foods and changes in body mass can affect bone architecture; therefore, our objective was to examine the effect of dairy proteins on bone structure in the tibia of dietary-induced obese rats. METHODS Twelve-week-old diet-induced obese Sprague-Dawley rats were randomized to one of six diets that varied in protein source (casein, whey, or SMP), Ca level (0.67% or 2.4%), and energy density (high-fat/high-sucrose [HFHS], or normal energy density [NE]). After 8 wk, body composition was assessed via dual energy x-ray absorptiometry and trabecular and cortical bone parameters of the tibia were assessed using micro-computed tomography and mixed model analysis. RESULTS Rats fed SMP with 2.4% calcium had significantly lower body mass and fat mass than all other groups. The ratio of bone volume to total volume (BV/TV) was significantly higher when the HFHS diet was supplemented with SMP and 2.4% calcium compared with whey (+66.7%) or casein (+32.6%). The HFHS diet group had 49.3% greater BV/TV compared with the NE groups. Increasing the amount of calcium resulted in a significant increase in BV/TV (188.9%) in the HFHS diet groups but not in the NE groups. CONCLUSION The intake of skim milk powder supplemented with calcium enhances trabecular bone architecture in obese rats consuming HFHS diet to a greater extent than with either casein or whey protein alone. Bioactive ingredients in complete dairy may contribute to these effects.
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Affiliation(s)
- Aviv Fried
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Alberta, Canada
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Manske SL, Boyd SK, Zernicke RF. Vertical ground reaction forces diminish in mice after botulinum toxin injection. J Biomech 2011; 44:637-43. [DOI: 10.1016/j.jbiomech.2010.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 11/28/2022]
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Abstract
Studies to date have assumed that botulinum toxin type A (BTX) affects bone indirectly, through its action on muscle. We hypothesized that BTX has no discernable effect on bone morphometry, independent of its effect on muscle. Therefore, we investigated whether BTX had an additional effect on bone when combined with tenotomy compared to tenotomy in isolation. Female BALB/c mice (n = 73) underwent one of the following procedures in the left leg: BTX injection and Achilles tenotomy (BTX-TEN), BTX injection and sham surgery (BTX-sham), Achilles tenotomy (TEN), or sham surgery (sham). BTX groups were injected with 20 μL of BTX (1 U/100 g) in the posterior lower hindlimb. At 4 weeks, muscle cross-sectional area (MCSA) and tibial bone morphometry were assessed using micro-CT. Each treatment, other than sham, resulted in significant muscle and bone loss (P < 0.05). BTX-TEN experienced the greatest muscle loss (23-45% lower than other groups) and bone loss (20-30% lower bone volume fraction than other groups). BTX-sham had significantly lower MCSA and bone volume fraction than TEN and sham. After adjusting for differences in MCSA, there were no significant between-group differences in bone properties. We found that BTX injection resulted in more adverse muscle and bone effects than tenotomy and that effects were amplified when the procedures were combined. However, between-group differences in bone could be accounted for by MCSA. We conclude that any independent effect of BTX on bone morphometry is likely small or negligible compared with the effect on muscle.
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Affiliation(s)
- Sarah L Manske
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Manske SL, Boyd SK, Zernicke RF. Muscle and bone follow similar temporal patterns of recovery from muscle-induced disuse due to botulinum toxin injection. Bone 2010; 46:24-31. [PMID: 19853070 DOI: 10.1016/j.bone.2009.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 09/18/2009] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Abstract
If muscle force is a primary source for triggering bone adaptation, with disuse and reloading, bone changes should follow muscle changes. We examined the timing and magnitude of changes in muscle cross-sectional area (MCSA) and bone architecture in response to muscle inactivity following botulinum toxin (BTX) injection. We hypothesized that MCSA would return to baseline levels sooner than bone properties following BTX injection. Female BALB mice (15 weeks old) were injected with 20 muL of BTX (1 U/100 g body mass, n=18) or saline (SAL, n=18) into the posterior calf musculature of one limb. The contralateral limb (CON) served as an internal control. MCSA and bone properties were assessed at baseline, 2, 4, 8, 12, and 16 weeks post-injection using in vivo micro-CT at the tibia proximal metaphysis (bone only) and diaphysis. Muscles were dissected and weighed after sacrifice. Significant GroupxLegxTime interactions indicated that the maximal decrease in MCSA (56%), proximal metaphyseal BV/TV (38%) and proximal diaphyseal Ct.Ar (7%) occurred 4 weeks after injection. There was no delay prior to bone recovery as both muscle and bone properties began to recover after this time, but MCSA and BV/TV remained 15% and 20% lower, respectively, in the BTX-injected leg than the BTX-CON leg 16 weeks post-injection. Gastrocnemius mass (primarily fast-twitch) was 14% lower in the BTX-injected leg than the SAL-injected leg, while soleus mass (primarily slow-twitch) was 15% greater in the BTX group than the SAL group. Our finding that muscle size and bone began to recover at similar times after BTX injection was unexpected. This suggested that partial weight-bearing and/or return of slow-twitch muscle activity in the BTX leg may have been sufficient to stimulate bone recovery. Alternatively, muscle function may have recovered sooner than MCSA. Our results indicated that muscle cross-sectional area, while important, may not be the primary factor associated with bone loss and recovery when muscle atrophy is induced through BTX injection. To understand the nature of the interaction between muscle and bone, future work should focus on the functional recovery of individual muscles in relation to bone.
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Affiliation(s)
- Sarah L Manske
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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de Bakker PM, Manske SL, Ebacher V, Oxland TR, Cripton PA, Guy P. During sideways falls proximal femur fractures initiate in the superolateral cortex: Evidence from high-speed video of simulated fractures. J Biomech 2009; 42:1917-25. [DOI: 10.1016/j.jbiomech.2009.05.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/04/2009] [Accepted: 05/08/2009] [Indexed: 11/24/2022]
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Manske SL, Liu-Ambrose T, Cooper DML, Kontulainen S, Guy P, Forster BB, McKay HA. Cortical and trabecular bone in the femoral neck both contribute to proximal femur failure load prediction. Osteoporos Int 2009; 20:445-53. [PMID: 18661091 DOI: 10.1007/s00198-008-0675-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 05/29/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED We examined the contributions of femoral neck cortical and trabecular bone to proximal femur failure load. We found that trabecular bone mineral density explained a significant proportion of variance in failure load after accounting for total bone size and cortical bone mineral content or cortical area. INTRODUCTION The relative contribution of femoral neck trabecular and cortical bone to proximal femur failure load is unclear. OBJECTIVES Our primary objective was to determine whether trabecular bone mineral density (TbBMD) contributes to proximal femur failure load after accounting for total bone size and cortical bone content. Our secondary objective was to describe regional differences in the relationship among cortical bone, trabecular bone, and failure load within a cross-section of the femoral neck. MATERIALS AND METHODS We imaged 36 human cadaveric proximal femora using quantitative computed tomography (QCT). We report total bone area (ToA), cortical area (CoA), cortical bone mineral content (CoBMC), and TbBMD measured in the femoral neck cross-section and eight 45 degrees regions. The femora were loaded to failure. RESULTS AND OBSERVATIONS Trabecular bone mineral density explained a significant proportion of variance in failure load after accounting for ToA and then either CoBMC or CoA respectively. CoBMC contributed significantly to failure load in all regions of the femoral neck except the posterior region. TbBMD contributed significantly to failure load in all regions of the femoral neck except the inferoanterior, superoposterior, and the posterior regions. CONCLUSION Both cortical and trabecular bone make significant contributions to failure load in ex vivo measures of bone strength.
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Affiliation(s)
- S L Manske
- UBC Department of Orthopaedics, Centre for Hip Health and Musculoskeletal Research, Vancouver Coastal Health Research Institute, 302-2647 Willow Street, Vancouver, BC V5Z3P1, Canada
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Liu D, Manske SL, Kontulainen SA, Tang C, Guy P, Oxland TR, McKay HA. Tibial geometry is associated with failure load ex vivo: a MRI, pQCT and DXA study. Osteoporos Int 2007; 18:991-7. [PMID: 17268944 DOI: 10.1007/s00198-007-0325-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 01/03/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED We studied the relations between bone geometry and density and the mechanical properties of human cadaveric tibiae. Bone geometry, assessed by MRI and pQCT, and bone density, assessed by DXA, were significantly associated with bone's mechanical properties. However, cortical density assessed by pQCT was not associated with mechanical properties. INTRODUCTION The primary objective of this study was to determine the contribution of cross-sectional geometry (by MRI and pQCT) and density (by pQCT and DXA) to mechanical properties of the human cadaveric tibia. METHODS We assessed 20 human cadaveric tibiae. Bone cross-sectional geometry variables (total area, cortical area, and section modulus) were measured with MRI and pQCT. Cortical density and areal BMD were measured with pQCT and DXA, respectively. The specimens were tested to failure in a four-point bending apparatus. Coefficients of determination between imaging variables of interest and mechanical properties were determined. RESULTS Cross-sectional geometry measurements from MRI and pQCT were strongly correlated with bone mechanical properties (r(2) range from 0.55 to 0.85). Bone cross-sectional geometry measured by MRI explained a proportion of variance in mechanical properties similar to that explained by pQCT bone cross-sectional geometry measurements and DXA measurements. CONCLUSIONS We found that there was a close association between geometry and mechanical properties regardless of the imaging modality (MRI or pQCT) used.
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Affiliation(s)
- D Liu
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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