Quantitative Computed Tomography-Based Predictions of Vertebral Strength in Anterior Bending

Buckley, Jenni M.; Cheng, Liu; Loo, Kenneth; Slyfield, Craig R.; Xu, Zheng

doi:10.1097/01.brs.0000260979.98101.9c

Cited by 52 publications

(50 citation statements)

References 33 publications

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“…Many studies have been performed on vertebra, femora, and other bones using QCT/FEA [3,12,14,17,[23][24][25][26][27][28]. Gray values of the CT images were converted to vBMD using a calibration phantom to develop patient specific models and assign material properties to the bone.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Quantitative Computed Tomography Acquisition Protocols on Bone Mineral Density Estimation

Giambini

Dragomir-Daescu

Huddleston

et al. 2015

Journal of Biomechanical Engineering

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Osteoporosis is characterized by bony material loss and decreased bone strength leading to a significant increase in fracture risk. Patient-specific quantitative computed tomography (QCT) finite element (FE) models may be used to predict fracture under physiological loading. Material properties for the FE models used to predict fracture are obtained by converting grayscale values from the CT into volumetric bone mineral density (vBMD) using calibration phantoms. If there are any variations arising from the CT acquisition protocol, vBMD estimation and material property assignment could be affected, thus, affecting fracture risk prediction. We hypothesized that material property assignments may be dependent on scanning and postprocessing settings including voltage, current, and reconstruction kernel, thus potentially having an effect in fracture risk prediction. A rabbit femur and a standard calibration phantom were imaged by QCT using different protocols. Cortical and cancellous regions were segmented, their average Hounsfield unit (HU) values obtained and converted to vBMD. Estimated vBMD for the cortical and cancellous regions were affected by voltage and kernel but not by current. Our study demonstrated that there exists a significant variation in the estimated vBMD values obtained with different scanning acquisitions. In addition, the large noise differences observed utilizing different scanning parameters could have an important negative effect on small subregions containing fewer voxels.

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Section: Discussionmentioning

confidence: 99%

The Effect of Quantitative Computed Tomography Acquisition Protocols on Bone Mineral Density Estimation

Giambini

Dragomir-Daescu

Huddleston

et al. 2015

Journal of Biomechanical Engineering

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“…They did not attempt to compute the ultimate force, keystone of fracture risk prediction from FE , Buckley et al 2007, Chevalier et al 2008, nor did they quantify damage in the bone. In this study, we use the state-of-the-art intervertebral disc and bone models to measure the effect of fully degenerated (PMMA) and healthy (IVD) boundary conditions on ultimate force and damage localisation.…”

Section: Discussionmentioning

confidence: 99%

Embedding of human vertebral bodies leads to higher ultimate load and altered damage localisation under axial compression

Maquer

Schwiedrzik

Zysset

2012

Computer Methods in Biomechanics and Biomedical Engineering

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Embedding of human vertebral bodies leads to higher ultimate load and altered damage localisation under axial compressionComputer tomography (CT-) based finite element (FE) models of vertebral bodies assess fracture load in vitro better than DXA, but boundary conditions affect stress distribution under the endplates that may influence ultimate load and damage localization under postyield strains. Therefore, HRpQCT-based homogenized FE models of 12 vertebral bodies were subjected to axial compression with two distinct boundary conditions: embedding in polymethylmethalcrylate (PMMA) and bonding to a healthy intervertebral disc (IVD) with distinct hyperelastic properties for nucleus and annulus. Bone volume fraction and fabric assessed from HRpQCT data were used to determine the elastic, plastic and damage behaviour of bone. Ultimate forces obtained with PMMA were 22% higher than with IVD but correlated highly (R 2 =0.99). At ultimate force, distinct fractions of damage were computed in the endplates (PMMA: 6%, IVD: 70%), cortex and trabecular subregions, which confirms previous observations that in contrast to PMMA embedding, failure initiated underneath the nuclei in healthy IVDs. In conclusion, axial loading of vertebral bodies via PMMA embedding versus healthy IVD overestimates ultimate load and leads to distinct damage localization and failure pattern.

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“…Finite element analysis (FEA) by QCT is a method of converting each voxel of the CT scan to an element in a finite element model. FEA can predict bone strength in the spine [56,57] and hip [58,59], but has not been validated as an outcome measure in clinical trials that is associated with treatment effect. High resolution magnetic resonance imaging (HR-MRI) and high resolution peripheral QCT (HR-pQCT) at peripheral skeletal sites measure trabecular microarchitecture; these technologies can distinguish between patients who have fractured and those who have not [60,61], but are not validated tools for measuring treatment effect.…”

Section: Potential Methods For Evaluating Treatment Effectmentioning

confidence: 98%

Monitoring pharmacological therapy for osteoporosis

Lewiecki

2010

Rev Endocr Metab Disord

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Osteoporosis is a common disease characterized by low bone strength that increases the risk of fractures. The consequences of fractures include increases in morbidity, mortality, and healthcare costs. Randomized clinical trials have shown that pharmacological therapy can reduce the risk of fractures. In clinical practice, however, failure to achieve optimal therapeutic benefit is common for reasons that include taking medication incorrectly, stopping it prematurely, malabsorption, and the presence of unrecognized diseases or conditions with adverse skeletal effects. Monitoring for anti-fracture effectiveness in individual patients is limited by the absence of clinical tools to directly measure bone strength. It is therefore necessary to monitor therapy with biomarkers such as bone mineral density and bone turnover markers. This is a review of the utility of these tools in the care of individual patients.

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Quantitative Computed Tomography-Based Predictions of Vertebral Strength in Anterior Bending

Cited by 52 publications

References 33 publications

The Effect of Quantitative Computed Tomography Acquisition Protocols on Bone Mineral Density Estimation

The Effect of Quantitative Computed Tomography Acquisition Protocols on Bone Mineral Density Estimation

Embedding of human vertebral bodies leads to higher ultimate load and altered damage localisation under axial compression

Monitoring pharmacological therapy for osteoporosis

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