Predicting Vertebral Bone Strength Using Finite Element Analysis for Opportunistic Osteoporosis Screening in Routine Multidetector Computed Tomography Scans-A Feasibility Study.

Nithin Manohar Rayudu,Michael Dieckmeyer,Peter B Noël,Thomas Baum,Maximilian T Löffler,Karupppasamy Subburaj,Jan S Kirschke

doi:10.3389/fendo.2020.526332

Abstract

PurposeTo investigate the feasibility of using routine clinical multidetector computed tomography (MDCT) scans for conducting finite element (FE) analysis to predict vertebral bone strength for opportunistic osteoporosis screening.MethodsRoutine abdominal MDCT with and without intravenous contrast medium (IVCM) of seven subjects (five male; two female; mean age: 71.86 ± 7.40 years) without any bone disease were used. FE analysis was performed on individual vertebrae (T11, T12, L1, and L2) including the posterior elements to investigate the effect of IVCM and slice thickness (1 and 3 mm) on vertebral bone strength. Another subset of data from subjects with vs. without osteoporotic vertebral fractures (n = 9 age and gender-matched pairs) was analyzed for investigating the ability of FE-analysis to differentiate the two cohorts. Bland-Altman plots, box plots, and coefficient of correlation (R2) were calculated to determine the variations in FE-predicted failure loads for different conditions.ResultsThe FE-predicted failure loads obtained from routine MDCT scans were strongly correlated with those from without IVCM (R2 = 0.91 for 1mm; R2 = 0.92 for 3mm slice thickness, respectively) and different slice thicknesses (R2 = 0.93 for 1mm vs. 3mm with IVCM). Furthermore, a good correlation was observed for 3mm slice thickness with IVCM vs. 1mm without IVCM (R2 = 0.87). Significant difference between FE-predicted failure loads of healthy and fractured patients was observed (4,705 ± 1,238 vs. 4,010 ± 1,297 N; p=0.026).ConclusionRoutine clinical MDCT scans could be reliably used for assessment of fracture risk based on FE analysis and may be beneficial for patients who are at increased risk for osteoporotic fractures.

Highlights

Osteoporosis is a skeletal disorder that occurs due to bone loss and deterioration of bone microarchitecture [1, 2]
Considering many of the finite element (FE) studies reported in the literature only included the vertebral body for the strength prediction of the vertebra, we analyzed a sub-cohort of seven subjects T11 vertebra with and without posterior elements to study its effect on the FE-predicted failure load
We evaluated the feasibility of using routine clinical Multidetector computed tomography (MDCT) data to generate finite element models for the opportunistic assessment of osteoporotic fracture risk based on FE-predicted vertebral strength

Summary

Introduction

Osteoporosis is a skeletal disorder that occurs due to bone loss and deterioration of bone microarchitecture [1, 2]. These changes remain undetected until a fragility fracture happens and it significantly affects the quality of life and is associated with increased morbidity and mortality [3,4,5,6]. Threedimensional patient-specific finite element (FE) models derived from medical images (realistic 3D anatomy, heterogeneous material properties mapping based on attenuation values, and loading and boundary conditions to predict response) have been increasingly used for solving biomechanical-related clinical problems, including bone strength predictions [16,17,18,19]

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