Assessment Of Trabecular Bone Structure Research Articles

SAT-395 Correlations Between Biochemical Parameters and Trabecular Bone Score (TBS) in Primary Hyperparathyroidism (PHP) Patients

Background: Vitamin D deficiency is common among PHP patients. While data are limited, some studies suggest that vitamin D deficiency may exacerbates skeletal disease in PHP. TBS is a software-based method for assessment of trabecular bone structure of the spine, based on analysis of pixels obtained in dual energy x-ray absorptiometry (DXA) images. The aim of this study was to evaluate TBS, vitamin D status, clinical and laboratorial measurements in a PHP group of patients in a search for a more accurate bone fragility test for risk assessment in this group of patients.Methods: From June/2017 to January/2019, patients who met the criteria for PHP diagnosis were included in this study. Control group was composed by age and sex-matched healthy individuals. Overall, 64 PHP and 63 controls were enrolled. Bone mineral density (BMD) measured by DXA (Hologic QDR 4500) at the lumbar spine, total hip, femoral neck, and TBS values (InSight™) were determined in both groups. Total and ionized calcium, PTH, 25-hydroxyvitamin D (25(OH)D), creatinine, alkaline phosphatase, P1NP and CTX were measured. None were in use of Vitamin D supplementation.Results: As expected, PHP patients had lower BMD values than controls in all sites (p<0.0001). TBS measurements were also reduced in PHP patients compared to controls (1233 vs 1280, p=0.0444). TBS values were inversely correlated with total calcium (CaT) and phosphorus measurements were positively correlated in the PHP patients. 25(OH)D measurements didn’t differ between groups (PHP 22.5 vs. controls 19.8 ng/mL, p=0.1699). There was a positive correlation between 25(OH)D and TBS in both PHP and controls (r= 0,3088, p= 0,0138 and r= 0,3708, p= 0,003 respectively). Considering individuals with vitamin D deficiency (25(OH)D levels <=20 ng/mL), a negative correlation between TBS and CaT measurements among PHP patients (r= -0,4391, p=0,0172) was observeed, while in controls there was a positive correlation between TBS and 25(OH)D (r= 0,3504, p= 0,0362).Conclusion: Serum total calcium presents negative correlation and phosphorus a positive one with TBS in PHP patients. We also found a correlation between TBS and 25(OH)D, both in PHP and in controls. 25(OH)D <=20 ng/mL is an independent risk factor determining degraded TBS among PHP patients and controls.

Dental imaging of trabecular bone structure for systemic disorder screening: A systematic review.

The purpose of this systematic review was to evaluate the potential use of dental imaging assessment of trabecular bone structure in the maxillomandibular complex as an adjuvant screening tool to identify systemic disorders. Five electronic databases and grey literature were searched. Studies were included if they investigated subjects with altered trabecular bone determined by dental radiographs. The QUADAS-2 assessed the risk of bias (RoB) among the studies, while the GRADE determined the strength of evidence. A total of 14 studies that included 1,466 individuals were considered eligible for the qualitative analysis. All studies presented an overall low RoB and low concern regarding applicability. Systemic disorders such as osteoporosis, osteogenesis imperfecta, diabetes, and primary hyperparathyroidism, with their respective control groups, were analyzed among the included studies. Osteoporosis was the condition presenting the most significant results, and 72% of the studies detected changes in the maxillomandibular trabecular bone structure. Studies exploring diabetic edentulous patients found less dense trabecular bone pattern (p<0.05). In summary, periapical and panoramic radiographs, computed tomography, and cone beam computed tomography imaging could be considered useful for the assessment of the mandibular trabecular bone structure of patients affected by osteoporosis and patients with diabetes.

Associations between trabecular bone score and biochemistry in surgically vs conservatively treated outpatients with primary hyperparathyroidism: A retrospective cohort study

PurposeTrabecular Bone Score (TBS) is a software-based method for indirect assessment of trabecular bone structure of the spine, based on analysis of pixels in dual energy x-ray absorptiometry (DXA) images. Few studies describe the use of TBS in patients with primary hyperparathyroidism (PHPT). This study aimed at further describing this relationship, investigating possible correlations between biochemistry, body mass index (BMI), fracture incidence and TBS. MethodsCross-sectional study of 195 patients with verified PHPT, surgically (27) or conservatively (168) treated at the Department of Endocrinology, Aalborg University Hospital. TBS was acquired by reanalyzing DXA-images of the included subjects from the outpatient clinic. Biochemical variables were obtained from clinical routine blood samples taken in relation to the DXA-scans. History of fractures and medical history was obtained from radiology reports and medical charts. ResultsPatients with active PHPT had a TBS-score signifying a partly degraded bone structure, whereas surgically treated patients had a normal bone structure as judged by TBS, though the difference in TBS-score was not statistically significant. Use of antiresorptive treatment was negatively associated with BMD but not TBS. No correlations between the biochemical variables and TBS were found. A negative correlation between TBS and BMI in patients with PHPT was present. Patients experiencing a fragility fracture had a significantly lowered TBS, BMD and T-Score. ConclusionBiochemistry does not seem to predict bone status in terms of TBS in patients with PHPT. TBS is negatively correlated to BMI, which is also seen in patients not suffering from PHPT. The lack of a predictive value for antiresorptive treatment for TBS may raise concern. TBS appears to have a predictive value when assessing risk of fracture in patients with PHPT. Mini abstractThis cross-sectional study investigates possible correlations between biochemical variables, body mass index (BMI) and trabecular bone score (TBS) in 195 patients with primary hyperparathyroidism. It finds no correlation between biochemical variables and TBS, but finds a negative correlation between TBS and BMI and a clear association between fracture incidence and low TBS-score.

Is quantitative magnetic resonance imaging valuable in the assessment of trabecular bone structure in osteoporosis?

This study aims to evaluate the value of quantitative magnetic resonance imaging in the assessment of bone trabeculae in osteoporosis by comparing the results with dual-energy X-ray (DXA) absorptiometry. The study consisted of 85 postmenopausal women (mean age 57.2 years; range 43 to 83 years) underwent both DXA absorptiometry and lumbar quantitative magnetic resonance imaging. T2 and T2* values were calculated by magnetic resonance imaging and the results were compared with bone mineral density. According to bone mineral density t-scores; there were 32 normal, 30 osteopenic, and 23 osteoporotic patients. T2 values of L1- L4 were different in normal with osteoporotic, and the osteopenic with osteoporotic groups. There were increased T2 values with reducing t-scores. Comparing the normal and osteopenic groups, no statistical difference was found in T2 measurements of lumbar vertebrae, except L4. T2* values of L1-L4 vertebrae were not statistically different between the study groups. T2 measurements of lumbar vertebra on quantitative magnetic resonance imaging may be useful in evaluation of bone trabeculae in osteoporosis, and may also be helpful in differentiation of osteoporotic from normal, and osteopenic from osteoporotic patients.

Image-based assessment of trabecular bone structure and cortical bone geometry using Multi-Detector Computed Tomography

Image-based assessment of trabecular bone structure and cortical bone geometry using Multi-Detector Computed Tomography

Imaging of the Musculoskeletal System In Vivo Using Ultra-high Field Magnetic Resonance at 7 T

Recently, great progress has been made in particularly in the imaging of cartilage and bone structure. Increased interest has focused on high-field (3 Tesla) imaging and more recently on ultra-high field (UHF) magnetic resonance imaging (MRI) at 7 T for in vivo imaging. Because the signal-to-noise ratio (SNR) scales linearly with field strength, a substantial increase in SNR is expected compared with lower field strengths. This gain in SNR can be used to increase spatial resolution or reduce imaging time. The goal of this review was to highlight recent developments and challenges in in vivo musculoskeletal (MSK) imaging using UHF-MRI at 7 T. One focus of this review is on the emerging methodology of quantitative MRI for the assessment of trabecular bone structure at the tibia, wrist, and knee. In particular for this application, susceptibility effects between the bone and bone marrow transitions that scale with field strength have to be considered. Another important MSK application is the characterization of knee cartilage morphology. The higher SNR provided by UHF-MRI is a potential advantage for visualizing, segmenting, and analyzing cartilage. Standard clinical MSK imaging relies heavily on T1, T2, and proton density weighted fast spin echo sequences. However, fast spin echo imaging has proven to be very challenging at higher fields because of very high specific absorption rates, using multiple pulses in a short time frame; thus the imaging protocols have to be adapted and gradient echo sequences may be more beneficial. Imaging of more central body parts such as the spine at 7 T is still in its infancy and dedicated coils have to be developed.

Assessment of trabecular bone structure using MDCT: comparison of 64- and 320-slice CT using HR-pQCT as the reference standard

ObjectivesThe aim of our study was to perform trabecular bone structure analysis with images from 64- and 320-slice multidetector computed tomography (MDCT) and to compare these with high-resolution peripheral computed tomography (HR-pQCT).Materials and methodsTwenty human cadaver distal forearm specimens were imaged on a 64- and 320-slice MDCT system at 120 kVp, 200 mA and 135 kVp, 400 mA (in-plane pixel size 234 µm; slice thickness 500 µm). HR-pQCT imaging was performed at an isotropic voxel size of 41 µm. Bone volume fraction (BV/TV), trabecular number (Tb.N), thickness (Tb.Th) and separation (Tb.Sp) were computed.ResultsMDCT-derived BV/TV and Tb.Sp were highly correlated (r = 0.92–0.96, p < 0.0001) with the corresponding HR-pQCT parameters. Tb.Th was the only structure measure that did not yield any significant correlation.ConclusionThe 64- and 320-slice MDCT systems both perform equally well in depicting trabecular bone architecture. However, because of constrained resolutions accurate derivation of trabecular bone measures is limited to only a subset of microarchitectural parameters.

Assessment of trabecular bone structure of the calcaneus using multi-detector CT: Correlation with microCT and biomechanical testing

The prediction of bone strength can be improved when determining bone mineral density (BMD) in combination with measures of trabecular microarchitecture. The goal of this study was to assess parameters of trabecular bone structure and texture of the calcaneus by clinical multi-detector row computed tomography (MDCT) in an experimental in situ setup and to correlate these parameters with microCT (μCT) and biomechanical testing. Thirty calcanei in 15 intact cadavers were scanned using three different protocols on a 64-slice MDCT scanner with an in-plane pixel size of 208 μm and 500 μm slice thickness. Bone cores were harvested from each specimen and μCT images with a voxel size of 16 μm were obtained. After image coregistration, trabecular bone structure and texture were evaluated in identical regions on the MDCT images. After data acquisition, uniaxial compression testing was performed. Significant correlations between MDCT- and μCT-derived measures of bone volume fraction (BV/TV), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp) were found (range, R2=0.19–0.65, p<0.01 or 0.05). The MDCT-derived parameters of volumetric BMD, app. BV/TV, app. Tb.Th and app. Tb.Sp were capable of predicting 60%, 63%, 53% and 25% of the variation in bone strength (p<0.01). When combining those measures with one additional texture index (either GLCM, TOGLCM or MF.euler), prediction of mechanical competence was significantly improved to 86%, 85%, 71% and 63% (p<0.01). In conclusion, this study showed the feasibility of trabecular microarchitecture assessment using MDCT in an experimental setup simulating the clinical situation. Multivariate models of BMD or structural parameters combined with texture indices improved prediction of bone strength significantly and might provide more reliable estimates of fracture risk in patients.

Assessment of trabecular bone structure comparing magnetic resonance imaging at 3 Tesla with high-resolution peripheral quantitative computed tomography ex vivo and in vivo

In vivo high-resolution peripheral quantitative micro-CT (HR-pQCT) is a new modality for imaging peripheral sites like the distal tibia and the distal radius, providing structural bone parameters. Comparing HR-pQCT with MRI, we found that both modalities are capable of offering meaningful information on trabecular structure. Magnetic resonance imaging (MRI) has emerged as the leading in vivo method for measuring trabecular bone micro-architecture and providing structural information. Recently, an in vivo HR-pQCT modality was introduced for imaging peripheral sites like the distal tibia and the distal radius, providing structural bone parameters. The goal of this work was to compare and evaluate the performances and in vivo capabilities of HR-pQCT in comparison with MRI at 3 Tesla. To this end images of 8 human specimens (5 tibiae and 3 radii) and 11 participants (6 tibia and 5 radii) were acquired with both modalities. Additionally, the radius specimens were scanned with micro-CT (muCT), which was used as a standard of reference. Structural parameters calculated from MRI were compared with results from HR-pQCT images and additionally muCT for the radii specimens. High correlations (r > 0.7) were found for trabecular number and trabecular spacing between the two modalities in vivo and ex vivo. 2D and 3D analysis revealed high correlations (r > 0.8) in structural bone parameters for all measurements. Using micro-CT as standard of reference both results from QCT and MRI correlated well. Both imaging modalities were found to perform equally well regarding trabecular bone measurements.

Assessment of trabecular bone structure in postmenopausal and senile osteoporosis in women by image analysis

Objective: The aim of the study was to assess bone trabecular structure in postmenopausal and senile osteoporosis.Methods: The study was performed on transiliac specimens obtained from women with postmenopausal (n=10) and senile osteoporosis (n=10) and on normal autopsy bone (n=7). Digitalized microradiographs were analysed using dedicated software allowing for selection of longitudinal and transversal elements.Results: Significant differences between transversal and control, as well as between longitudinal and control trabecular areas were observed in senile osteoporosis (p<0.005). In postmenopausal osteoporosis, such differences were found for longitudinal trabeculae only (p<0.005). Mean longitudinal trabecular area loss in senile and postmenopausal osteoporosis as compared to control group was 57.2% and 25.7%, respectively. Respective values for transversal trabecular area were 35.0% and 59.4%.Conclusion: Structural anisotropy of trabecular bone is greater in postmenopausal than in senile osteoporosis and control group. The method developed allows the evaluation of bone structures in radiographs with uneven exposure.

Imaging of trabecular bone structure in osteoporosis.

Osteoporosis is a metabolic bone disorder that is characterized by reduced bone mass and a deterioration of bone structure which results in an increased fracture risk. Since the disease is preventable, diagnostic techniques are of major importance. Standard techniques determine bone mineral density, whereas some of the newer techniques focus on trabecular structure. This article reviews structure analysis techniques in the diagnosis of osteoporosis. Imaging techniques applied to the assessment of trabecular bone structure include conventional radiography, magnification radiography, high-resolution CT (HRCT) and high-resolution MR imaging (HRMRI). The best results were obtained using high-resolution tomographic techniques. The highest spatial resolutions in vivo were achieved using HRMRI. The most common texture analysis techniques that have been used are morphological parameters (analogous to bone histomorphometry). Fractal dimension, co-occurrence matrices, mathematical filter techniques and autocorrelation functions are more complex techniques. Most of the studies evaluating structure analysis show that texture parameters and bone mineral density both predict bone strength and osteoporotic fractures, and that combining both techniques yields the best results in the diagnosis of osteoporosis.

Fractal analysis of radiographs: assessment of trabecular bone structure and prediction of elastic modulus and strength.

The purpose of this study was to determine whether fractal dimension of radiographs provide measures of trabecular bone structure which correlate with bone mineral density (BMD) and bone biomechanics, and whether these relationships depend on the technique used to calculate the fractal dimension. Eighty seven cubic specimen of human trabecular bone were obtained from the vertebrae and femur. The cubes were radiographed along all three orientations--superior-inferior (SI), medial-lateral (ML), and anterior-posterior (AP), digitized, corrected for background variations, and fractal based techniques were applied to quantify trabecular structure. Three different techniques namely, semivariance, surface area, and power spectral methods were used. The specimens were tested in compression along three orientations and the Young's modulus (YM) was determined. Compressive strength was measured along the SI direction. Quantitative computed tomography was used to measure trabecular BMD. High-resolution magnetic-resonance images were used to obtain three-dimensional measures of trabecular architecture such as the apparent bone volume fraction, trabecular thickness, spacing, and number. The measures of trabecular structure computed in the different directions showed significant differences (p<0.05). The correlation between BMD, YM, strength, and the fractal dimension were direction and technique dependent. The trends of variation of the fractal dimension with BMD and biomechanical properties also depended on the technique and the range of resolutions over which the data was analyzed. The fractal dimension showed varying trends with bone mineral density changes, and these trends also depended on the range of frequencies over which the fractal dimension was measured. For example, using the power spectral method the fractal dimension increased with BMD when computed over a lower range of spatial frequencies and decreased for higher ranges. However, for the surface area technique the fractal dimension increased with increasing BMD. Fractal measures showed better correlation with trabecular spacing and number, compared to trabecular thickness. In a multivariate regression model inclusion of some of the fractal measures in addition to BMD improved the prediction of strength and elastic modulus. Thus, fractal based texture analysis of radiographs are technique dependent, but may be used to quantify trabecular structure and have a potentially valuable impact in the study of osteoporosis.

Comparison of Computer Simulated and Phantom Measured Phase Variance in the Study of Trabecular Bone

A new method using magnetic resonance phase images for the assessment of trabecular bone structure has recently been proposed. To test this method, a mathematical model is developed which calculates the phase distribution in gradient echo acquired phase images of a structure of Pyrex glass rods immersed in a copper sulfate solution. Several experiments were performed using a phantom built in the same way as the structure used in the mathematical model. The results from the model are compared with those from the phantom tests, and the influence of resolution and bone area fraction on the phase dispersion is studied. The good correlation between theoretical and experimental results shows that phase variance increases with increasing resolution and bone density. However, the dependence of variance on bone density is less prominent for large pixel sizes.

In vivo assessment of trabecular bone structure with 3D computed tomography and local reconstruction

In vivo assessment of trabecular bone structure with 3D computed tomography and local reconstruction

In vivo assessment of trabecular bone structure with 3D computed tomography and local reconstruction

In vivo assessment of trabecular bone structure with 3D computed tomography and local reconstruction

In vivo assessment of trabecular bone structure at the distal radius from high-resolution computed tomography images

A dedicated computed tomography system was used to acquire transaxial images of the distal radius to assess trabecular bone structure in vivo. We segmented trabecular bone from the marrow and soft tissue background by postprocessing the image with a region grow and skeletonization step. From the processed image we assessed the integrity of the bone by examining the continuity of its trabecular network and by determining the area of the holes comprising its marrow space. The continuity of the bone imaged was assessed by a proposed connectivity index (CI) and the size of the marrow spaces was assessed by calculating a mean hole area () in the bone cross-section. Repeat measurements revealed that the intra-subject variability in CI and was small (). Both CI and were sensitive enough to reflect differences in structure at the head of the radius and at several sites along its shaft. We tested the diagnostic value of assessing bone structure at the distal end of the radius by measuring trabecular bone density, CI and in a mixed group of 26 subjects, nine of whom had suffered a wrist fracture. We found that a trabecular bone density threshold of , corresponding to two standard deviations below the mean density in the 17 non-fractured subjects, separated fractured from non-fractured subjects with a sensitivity of 22% and a specificity of 100%. A CI threshold of -4.7 doubled the sensitivity (44%) and maintained the 100% specificity. An threshold of achieved a sensitivity of 89% and a specificity of 94%. This increased sensitivity achieved by our indices suggests that an in vivo assessment of trabecular bone structure can contribute significantly to the identification of persons at risk of fracture.