Pore‐Size Distribution and Frequency‐Dependent Attenuation in Human Cortical Tibia Bone Discriminate Fragility Fractures in Postmenopausal Women With Low Bone Mineral Density

Armbrecht, Gabriele; Minh, Huong Nguyen; J, Massmann; Raum, Kay

doi:10.1002/jbm4.10536

Cited by 12 publications

(7 citation statements)

References 54 publications

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“…Specifically, we have found that the presence of large pores is detrimental to image quality. Such large pores are characteristic of degraded bone and were associated with weak femoral strength ex vivo [35] and with fracture risk [41]. This may appear to be a major obstacle to bone imaging for some individuals with a high risk of fracture.…”

Section: Discussionmentioning

confidence: 99%

The influence of intra-cortical microstructure on the contrast in ultrasound images of the cortex of long bones: A 2D simulation study

et al. 2023

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Section: Discussionmentioning

confidence: 99%

The influence of intra-cortical microstructure on the contrast in ultrasound images of the cortex of long bones: A 2D simulation study

et al. 2023

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“…Following Armbrecht et al [17], the fragility fracture discrimination performance of BDAT and DXA was assessed by means of multivariate Partial Least Square discrimination analyses with Leave-One-Out Cross-Validation (PLS-LOOCV) using the libPLS library [44]. Significant parameters were used to build a first set of discrimination models used to predict vertebral, non-vertebral, and all fragility fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, cortical bone appears as a homogenized material, which elasticity can be parametrized with porosity [56]. Recently, it has been shown that cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck and can predict fragility fractures [10,17]. The second HR-pQCT generation, with a lower resolution, is able to resolve the larger pores, usually associated with resorption cavities [17].…”

Section: Plos Onementioning

confidence: 99%

“…Transverse transmission has also been applied at the one third distal [14] or distal [15] radius. A second configuration corresponds to back scattering or pulse-echo techniques, applied at the hip and spine [16], tibia [17] and radius [18,19]. Moreover, note that echography has been recently enhanced to quantitative cortical bone imaging [20,21].…”

Section: Introductionmentioning

confidence: 99%

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Bi-Directional Axial Transmission measurements applied in a clinical environment

Minonzio

Ramiandrisoa²,

Schneider

et al. 2022

PLoS ONE

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Accurate measurement of cortical bone parameters may improve fracture risk assessment and help clinicians on the best treatment strategy. Patients at risk of fracture are currently detected using the current X-Ray gold standard DXA (Dual XRay Absorptiometry). Different alternatives, such as 3D X-Rays, Magnetic Resonance Imaging or Quantitative Ultrasound (QUS) devices, have been proposed, the latter having advantages of being portable and sensitive to mechanical and geometrical properties. The objective of this cross-sectional study was to evaluate the performance of a Bi-Directional Axial Transmission (BDAT) device used by trained operators in a clinical environment with older subjects. The device, positioned at one-third distal radius, provides two velocities: VFAS (first arriving signal) and VA0 (first anti-symmetrical guided mode). Moreover, two parameters are obtained from an inverse approach: Ct.Th (cortical thickness) and Ct.Po (cortical porosity), along with their ratio Ct.Po/Ct.Th. The areal bone mineral density (aBMD) was obtained using DXA at the femur and spine. One hundred and six patients (81 women, 25 men) from Marien Hospital and St. Anna Hospital (Herne, Germany) were included in this study. Age ranged from 41 to 95 years, while body mass index (BMI) ranged from 16 to 47 kg.m−2. Three groups were considered: 79 non-fractured patients (NF, 75±13years), 27 with non-traumatic fractures (F, 80±9years) including 14 patients with non-vertebral fractures (NVF, 84±7years). Weak to moderate significant Spearman correlations (R ranging from 0.23 to 0.53, p < 0.05) were found between ultrasound parameters and age, BMI. Using multivariate Partial Least Square discrimination analyses with Leave-One-Out Cross-Validation (PLS-LOOCV), we found the combination of VFAS and the ratio Ct.Po/Ct.Th to be predictive for all non traumatic fractures (F) with the odds ratio (OR) equals to 2.5 [1.6-3.4] and the area under the ROC curve (AUC) equal to 0.63 [0.62-0.65]. For the group NVF, combination of four parameters VA0. Ct.Th, Ct.Po and Ct.Po/Ct.Po, along with age provides a discrimination model with OR and AUC equals to 7.5 [6.0-9.1] and 0.75 [0.73-0.76]. When restricted to a smaller population (87 patients) common to both BDAT and DXA, BDAT ORs and AUCs are comparable or slightly higher to values obtained with DXA. The fracture risk assessment by BDAT method in older patients, in a clinical setting, suggests the benefit of the affordable and transportable device for the routine use.

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“…Transducer characteristics, such as transducer aperture, may also affect the successful transmission of ultrasound through the bone and alter the amount of information available in the resulting pressure field. 35 Alternate methods for determining tissue properties in vivo, such as novel ultrasonic cortical backscatter methods or other quantitative ultrasound techniques for determining attenuation coefficients 38,39 and speed of sound in bone 40 may help supplement or compare with the strategies outlined in this work.…”

Section: Limitationsmentioning

confidence: 99%

The influence of bone model geometries on the determination of skull acoustic properties

Marchant,

Clinard,

Odéen

et al. 2023

Numer Methods Biomed Eng

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In this study, we investigated the impact of various simulated skull bone geometries on the determination of skull speed of sound and acoustic attenuation values via optimization using transmitted pressure amplitudes beyond the bone. Using the hybrid angular spectrum method (HAS), we simulated ultrasound transmission through four model sets of different geometries involving sandwiched layers of diploë and cortical bone in addition to three models generated from CT images of ex‐vivo human skull‐bones. We characterized cost‐function solution spaces for each model and, using optimization, found that when a model possessed appreciable variations in resolvable layer thickness, the predefined attenuation coefficients could be found with low error (RMSE < 0.01 Np/cm). However, we identified a spatial frequency cutoff in the models' geometry beyond which the accuracy of the property determination begins to fail, depending on the frequency of the ultrasound source. There was a large increase in error of the attenuation coefficients determined by the optimization when the variations in layer thickness were above the identified spatial frequency cutoffs, or when the lateral variations across the model were relatively low in amplitude. For our limited sample of three CT‐image derived bone models, the attenuation coefficients were determined successfully. The speed of sound values were determined with low error for all models (including the CT‐image derived models) that were tested (RMSE < 0.4 m/s). These results illustrate that it is possible to determine the acoustic properties of two‐component models when the internal bone structure is taken into account and the structure satisfies the spatial frequency constraints discussed.

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Pore‐Size Distribution and Frequency‐Dependent Attenuation in Human Cortical Tibia Bone Discriminate Fragility Fractures in Postmenopausal Women With Low Bone Mineral Density

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 12 publications

References 54 publications

The influence of intra-cortical microstructure on the contrast in ultrasound images of the cortex of long bones: A 2D simulation study

The influence of intra-cortical microstructure on the contrast in ultrasound images of the cortex of long bones: A 2D simulation study

Bi-Directional Axial Transmission measurements applied in a clinical environment

The influence of bone model geometries on the determination of skull acoustic properties

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