Analysis of bone architecture using fractal-based TX-Analyzer™ in adult patients with osteogenesis imperfecta

Schanda, Jakob E.; Huber, Stephanie; Behanova, Martina; Haschka, Judith; Kraus, Daniel A.; Meier, Philip; Bahrami, Arian; Zandieh, Shahin; Muschitz, Christian; Resch, Heinrich; Mähr, Matthias; Rötzer, Katharina; Uyanik, Göykan; Zwerina, Jochen; Kocijan, Roland

Affiliations

¹AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria

²Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria

³Austrian Cluster for Tissue Regeneration, Vienna, Austria

⁴Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria

⁵St. Vincent Hospital Vienna, II Medical Department, Vienna, Austria

⁶Hanusch Hospital Vienna, I Medical Department, Vienna, Austria

⁷Image Biopsy Lab, Vienna, Austria

⁸Hanusch Hospital Vienna, Department of Radiology and Nuclear Medicine, Vienna, Austria

⁹Sigmund Freud University Vienna, Medical Faculty of Bone Diseases, Vienna, Austria

¹⁰Hanusch Hospital Vienna, Department of Medical Genetics, Vienna, Austria

¹¹Sigmund Freud University, Medical Faculty of Genetics, Vienna, Austria

Abstract and keywords

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by impaired bone quality and quantity. Established imaging techniques have limited reliability in OI. The TX-Analyzer™ is a new, fractal-based software allowing a non-invasive assessment of bone structure based on conventional radiographs. We explored whether the TX-Analyzer™ can discriminate OI patients and healthy controls. Furthermore, we investigated the correlation between TX-Analyzer™ parameters and (i) bone mineral density (BMD) by Dual Energy X-ray Absorptiometry (DXA), (ii) trabecular bone score (TBS), and (iii) bone microstructure by high-resolution peripheral quantitative computed tomography (HR-pQCT).

Material and methods: Data of 29 adult OI patients were retrospectively analyzed. Standard radiographs of the thoracic and lumbar spine were evaluated using the TX-Analyzer™. Bone Structure Value (BSV), Bone Variance Value (BVV), and Bone Entropy Value (BEV) were measured at the vertebral bodies T7 to L5. Data were compared to a healthy, age- and gender-matched control group (n = 58). BMD by DXA, TBS, and trabecular bone microstructure by means of HR-pQCT were correlated to TX-Analyzer™ parameters in OI patients. The accuracy of the TX-Analyzer™ parameters in detecting OI was assessed with area under curve (AUC) analysis of receiver operating characteristic (ROC).

Results: BEV of the thoracic and the lumbar spine were significantly lower in OI patients compared to controls (both p < 0.001). BEV of the thoracic spine was significantly correlated to TBS (ρ = 0.427, p = 0.042) as well as trabecular number (Tb.N) at the radius (ρ = 0.603, p = 0.029) and inhomogeneity of the trabecular network (Tb.1/N.SD) at the radius (ρ = −0.610, p = 0.027), when assessed by HR-pQCT. No correlations were found between BEV and BMD by DXA. BEV of the thoracic and the lumbar spine had an AUC of 0.81 (95% confidence interval [CI] 0.67–0.94, p < 0.001) and 0.73 (95% CI 0.56–0.89, p = 0.008), respectively. BSV and BVV did not differ between OI patients and controls.

Conclusion: The software TX-Analyzer™ is able to discriminate patients with OI from healthy controls. ROC curves of BEV values suggest a suitable clinical applicability. Low to no correlations with conventional methods suggest, that the TX-Analyzer™ may indicate a new and independent examination tool in OI.

Keywords: Osteogenesis imperfecta; Bone microstructure; TX-Analyzer™; Trabecular bone score; High-resolution peripheral quantitative computed tomography

Links

DOI: 10.1016/j.bone.2021.115915

PubMed: 33722771

WoS: 000643707100008

History

Received: 2020-11-10

Revised: 2021-03-10

Accepted: 2021-03-10

Online: 2021-03-13

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