Digital Tomosynthesis and Fractal Analysis Predict Prevalent Vertebral Fractures in Patients With Multiple Myeloma: A Preliminary In Vivo Study

Oravec, D; Yaldo, Omar; Bolton, Carrie; Flynn, Michael J.; Holsbeeck, Marnix van; Yeni, Yener N.

doi:10.2214/ajr.18.20700

Cited by 7 publications

(5 citation statements)

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“…[27][28][29] These parameters were shown to increase the explained variability in multiple regression models of vertebral stiffness and strength beyond that explained by bone density alone. In a recent work done by our group 30 and others, 31 DTS-derived image texture parameters have been shown to be associated with the presence of vertebral fracture in vivo. Tomosynthesis has also been demonstrated to provide reliable quantitative results for geometric and texture analysis in other thoracic and orthopedic applications.…”

Section: Introductionmentioning

confidence: 95%

“…Collectively, previous work supports the notion that DTS has sufficient resolution to measure quantitative information from vertebral bone. DTS has been shown to meet at least three key requirements for clinical use of the DVC method: (a) As mentioned above, it has sufficient resolution (150–300 μm) to resolve cancellous bone texture at a depth of interest, (b) it is able to acquire images of a patient in nonloaded (patient lying) and loaded (patient standing with body weight) conditions in a safe and comfortable manner within seconds, and (c) acquisition of images is performed with an acceptable radiation dose to the patient (0.5–1.1 mSv effective dose) …”

Section: Introductionmentioning

confidence: 99%

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Digital tomosynthesis based digital volume correlation: A clinically viable noninvasive method for direct measurement of intravertebral displacements using images of the human spine under physiological load

et al. 2019

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Purpose We have developed a clinically viable method for measurement of direct, patient‐specific intravertebral displacements using a novel digital tomosynthesis based digital volume correlation technique. These displacements may be used to calculate vertebral stiffness under loads induced by a patient's body weight; this is particularly significant because, among biomechanical variables, stiffness is the strongest correlate of bone strength. In this proof of concept study, we assessed the feasibility of the method through a preliminary evaluation of the accuracy and precision of the method, identification of a range of physiological load levels for which displacements are measurable, assessment of the relationship of measured displacements with microcomputed tomography based standards, and demonstration of the in vivo application of the technique. Methods Five cadaveric T11 vertebrae were allocated to three groups in order to study (a) the optimization of digital volume correlation algorithm input parameters, (b) accuracy and precision of the method and the ability to measure displacements at a range of physiological load levels, and (c) the correlation between displacements measured using tomosynthesis based digital volume correlation vs. high resolution microcomputed tomography based digital volume correlation and large scale finite element models. Tomosynthesis images of one patient (Female, 60 yr old) were used to calculate displacement maps, and in turn stiffness, using images acquired in both standing and standing‐with‐weight (8 kg) configurations. Results We found that displacements were accurate (2.28 µm total error) and measurable at physiological load levels (above 267 N) with a linear response to applied load. Calculated stiffness among three tested vertebral bodies was within an acceptable range relative to reported values for vertebral stiffness (5651‐13260 N/mm). Displacements were in good qualitative and quantitative agreement with both microcomputed tomography based finite element (r2 = 0.762, P < 0.001) and digital volume correlation (r2 = 0.799, P < 0.001) solutions. For one patient tested twice, once standing and once holding weights, results demonstrated excellent qualitative reproducibility of displacement distributions with superior endplate displacements increasing by 22% with added weight. Conclusions The results of this work collectively suggest the feasibility of the method for in vivo measurement of intravertebral displacements and stiffness in humans. These findings suggest that digital volume correlation using digital tomosynthesis imaging may be useful in understanding the mechanical response of bone to disease and may further enhance our ability to assess fracture risk and treatment efficacy for the spine.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Digital tomosynthesis based digital volume correlation: A clinically viable noninvasive method for direct measurement of intravertebral displacements using images of the human spine under physiological load

et al. 2019

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“… 18 Conversely, increased FD values were observed in the periapical tissues after successful cases of endodontic treatment 23 and found to be associated with a lower probability of thoracic and lumbar vertebral fracture in MM patients. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, a previous study found that the FD was significantly associated with the presence of vertebral fractures in MM patients; however, only thoracic and lumbar spine images were used. 14 Thus, the aim of this study was 1) to objectively evaluate the structural complexity of the craniofacial trabecular bone in MM by fractal analysis of panoramic and lateral skull radiography, and 2) to compare the FD values of patients before and during treatment with intravenous bisphosphonates.…”

Section: Introductionmentioning

confidence: 99%

Structural complexity of the craniofacial trabecular bone in multiple myeloma assessed by fractal analysis

et al. 2022

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Purpose This study aimed to evaluate the structural complexity of craniofacial trabecular bone in multiple myeloma by fractal analysis of panoramic and lateral skull radiography, and to compare the fractal dimension values of healthy patients (HPs), pre-treatment patients (PTPs), and patients during bisphosphonate treatment (DTPs). Materials and Methods Pairs of digital panoramic and lateral skull radiographs of 84 PTPs and 72 DTPs were selected. After application of exclusion criteria, 43 panoramic and 84 lateral skull radiographs of PTPs, 56 panoramic and 72 lateral skull radiographs of DTPs, and 99 panoramic radiographs of age- and sex-matched HPs were selected. The fractal dimension values from panoramic radiographs were compared among HPs, PTPs, and DTPs and between anatomical locations within patient groups using analysis of variance with the Tukey test. Fractal dimension values from lateral skull radiographs were compared between PTPs and DTPs using the Student t-test. Pearson correlation coefficients were used to assess the relationship between the mandible from panoramic radiographs and the skull from lateral skull radiographs. Intra-examiner agreement was assessed using intraclass correlation coefficients (α=0.05). Results The fractal dimension values were not significantly different among HPs, PTPs, and DTPs on panoramic radiographs or between PTPs and DTPs on lateral skull radiographs ( P >0.05). The mandibular body presented the highest fractal dimension values ( P ≤0.05). The fractal dimension values of the mandible and skull in PTPs and DTPs were not correlated. Conclusion Fractal analysis was not sensitive for distinguishing craniofacial trabecular bone complexity in multiple myeloma patients using panoramic and lateral skull radiography.

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“…It was also found to be a useful tool for the evaluation of the spine, particularly the thoracolumbar area, where the overlaying anatomy is accentuated. Studies investigating the utility of tomosynthesis in assessing spinal injury in ankylosing spondylitis (8) and for predicting prevalent VCFs in multiple myeloma (9) have shown promising results. The Taiwan TomoDR tomosynthesis imaging system is a new X-ray imaging modality developed by the Institute of Nuclear Energy Research (10).…”

Section: Introductionmentioning

confidence: 99%

Application of tomosynthesis for vertebral compression fracture diagnosis and bone healing assessment in fracture liaison services

Chen

Tseng

et al. 2022

Front. Med.

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Digital Tomosynthesis and Fractal Analysis Predict Prevalent Vertebral Fractures in Patients With Multiple Myeloma: A Preliminary In Vivo Study

Cited by 7 publications

References 45 publications

Digital tomosynthesis based digital volume correlation: A clinically viable noninvasive method for direct measurement of intravertebral displacements using images of the human spine under physiological load

Digital tomosynthesis based digital volume correlation: A clinically viable noninvasive method for direct measurement of intravertebral displacements using images of the human spine under physiological load

Structural complexity of the craniofacial trabecular bone in multiple myeloma assessed by fractal analysis

Application of tomosynthesis for vertebral compression fracture diagnosis and bone healing assessment in fracture liaison services

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