High-resolution cone-beam computed tomography is a fast and promising technique to quantify bone microstructure and mechanics of the distal radius

Mys, Karen; Varga, Peter; Stockmans, Filip; Gueorguiev, Boyko; Neumann, Verena; Vanovermeire, Olivier; Wyers, Caroline E.; van den Bergh, Joop P. W.; van Lenthe, G. Harry

Affiliations

¹Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium

²AO Research Institute Davos, Davos, Switzerland

³Muscles & Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium

⁴Department of Radiology, AZ Groeninge, Kortrijk, Belgium

⁵Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands

⁶NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands

⁷Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands

Abstract and keywords

Obtaining high-resolution scans of bones and joints for clinical applications is challenging. HR-pQCT is considered the best technology to acquire high-resolution images of the peripheral skeleton in vivo, but a breakthrough for widespread clinical applications is still lacking. Recently, we showed on trapezia that CBCT is a promising alternative providing a larger FOV at a shorter scanning time. The goals of this study were to evaluate the accuracy of CBCT in quantifying trabecular bone microstructural and predicted mechanical parameters of the distal radius, the most often investigated skeletal site with HR-pQCT, and to compare it with HR-pQCT. Nineteen radii were scanned with four scanners: (1) HR-pQCT (XtremeCT, Scanco Medical AG, @ (voxel size) 82 μm), (2) HR-pQCT (XtremeCT-II, Scanco, @60.7 μm), (3) CBCT (NewTom 5G, Cefla, @75 μm) reconstructed and segmented using in-house developed software and (4) microCT (VivaCT40, Scanco, @19 μm—gold standard). The following parameters were evaluated: predicted stiffness, strength, bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N). The overall accuracy of CBCT with in-house optimized algorithms in quantifying bone microstructural parameters was comparable (R² = 0.79) to XtremeCT (R² = 0.76) and slightly worse than XtremeCT-II (R² = 0.86) which were both processed with the standard manufacturer’s technique. CBCT had higher accuracy for BV/TV and Tb.Th but lower for Tb.Sp and Tb.N compared to XtremeCT. Regarding the mechanical parameters, all scanners had high accuracy (R² ≥ 0.96). While HR-pQCT is optimized for research, the fast scanning time and good accuracy renders CBCT a promising technique for high-resolution clinical scanning.

Keywords: CBCT; HR-pQCT; Bone parameters

Links

DOI: 10.1007/s00223-020-00773-5

PubMed: 33452889

WoS: 000608095000002

History

Received: 2020-05-05

Accepted: 2020-10-27

Online: 2021-01-16

Cited Works (12)

Year	Entry
2007	MacNeil JA, Boyd SK. Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys. December 2007;29(10):1096-1105.
2008	MacNeil JA, Boyd SK. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone. June 2008;42(6):1203-1213.
2002	Pistoia W, van Rietbergen B, Lochmüller E-M, Lill CA, Eckstein F, Rüegsegger P. Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone. June 2002;30(6):842-848.
2004	Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JPTM, Pols HAP. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. January 2004;34(1):195-202.
2008	Verhulp E, van Rietbergen B, Müller R, Huiskes R. Indirect determination of trabecular bone effective tissue failure properties using micro-finite element simulations. J Biomech. 2008;41(7):1479-1485.
1994	Müller R, Hildebrand T, Rüegsegger P. Non-invasive bone biopsy: a new method to analyse and display the three-dimensional structure of trabecular bone. Phys Med Biol. January 1994;39(1):145-164.
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. December 2013;8(1):136.
2019	Samelson EJ, Broe KE, Xu H, Yang L, Boyd S, Biver E, Szulc P, Adachi J, Amin S, Atkinson E, Berger C, Burt L, Chapurlat R, Chevalley T, Ferrari S, Goltzman D, Hanley DA, Hannan MT, Khosla S, Liu C-T, Lorentzon M, Mellstrom D, Merle B, Nethander M, Rizzoli R, Sornay-Rendu E, Van Rietbergen B, Sundh D, Wong AKO, Ohlsson C, Demissie S, Kiel DP, Bouxsein ML. Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study. Lancet Diabetes Endocrinol. January 2019;7(1):34-43.
2007	Buie HR, Campbell GM, Klinck RJ, MacNeil JA, Boyd SK. Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis. Bone. October 2007;41(4):505-515.
2007	Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J. August 2007;83(982):509-517.
2008	Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. April 2008;19(4):385-397.
1998	Kothari M, Keaveny TM, Lin JC, Newitt DC, Genant HK, Majumdar S. Impact of spatial resolution on the prediction of trabecular architecture parameters. Bone. May 1998;22(5):437-443.

Cited By (1)

Year	Entry
2022	Mys K, Stockmans F, Gueorguiev B, Wyers CE, van den Bergh JP, van Lenthe GH, Varga P. Adaptive local thresholding can enhance the accuracy of HR-pQCT-based trabecular bone morphology assessment. Bone. January 2022;154:116225.