Quantitative in vivo assessment of bone microarchitecture in the human knee using HR-pQCT

Kroker, Andres; Zhu, Ying; Manske, Sarah L.; Barber, Rhamona; Mohtadi, Nicholas; Boyd, Steven K.

doi:10.1016/j.bone.2016.12.015

Cited by 63 publications

(39 citation statements)

References 25 publications

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“…First, this is a cross‐sectional study; because our femoral head specimens were collected from patients with advanced hip OA, the results might not be generalizable to patients with early‐stage OA. The second‐generation HR‐pQCT (Xtreme‐CT II; Scanco Medical AG) is a promising tool that can provide unprecedented visualization of bone microstructure and allows in vivo analysis . Xtreme‐CT II could be adopted as a tool for longitudinal studies of patients with OP‐OA.…”

Section: Discussionmentioning

confidence: 99%

“…The second-generation HR-pQCT (Xtreme-CT II; Scanco Medical AG) is a promising tool that can provide unprecedented visualization of bone microstructure and allows in vivo analysis. (52) Xtreme-CT II could be adopted as a tool for longitudinal studies of patients with OP-OA. In addition, because there were no specimens from patients with early-stage OA, we cannot determine the sequence of OP and OA diseases in our patients.…”

Section: Discussionmentioning

confidence: 99%

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Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Chu

Liu

et al. 2019

Journal of Bone and Mineral Research

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Osteoarthritis (OA) and osteoporosis (OP) are two skeletal disorders associated with joint structures. Occasionally, OA and OP occur in the same patient. However, the effect of OP changes on OA progression in patients with osteoporotic OA (OP‐OA) has not been reported, especially the potential association between subchondral bone and articular cartilage. Thus we investigated the alterations in the microstructure, biomechanical properties, and remodeling of subchondral bone as well as their association with cartilage damage in the hip joint of patients with OP‐OA. Thirty‐nine femoral head specimens were obtained from patients who underwent total hip arthroplasty (OA group, n = 19; OP‐OA group, n = 20), and healthy specimens from cadaver donors were used (control group, n = 10). The microstructure and biomechanical properties of subchondral bone were evaluated by micro–computed tomography and micro–finite‐element analysis. Histology, histomorphometric measurements, and immunohistochemistry were used to assess subchondral bone remodeling and cartilage damage. Linear regression analysis was performed to elucidate the relationship between subchondral bone and articular cartilage. In the subchondral bone of the OP‐OA group, compared with that of the OA group, aberrant bone remodeling leads to an inferior microstructure and worsening biomechanical properties, potentially affecting transmission of loading stress from the cartilage to the subchondral bone, and then resulting in accelerated OA progression in patients with OP‐OA. The results indicate that changes in subchondral bone could affect OA development and the improvement in subchondral bone with bone‐metabolism agents may help mitigate OA progression when OP and OA coexist in the same patients. © 2019 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Chu

Liu

et al. 2019

Journal of Bone and Mineral Research

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“…Third, the first generation HR-pQCT equipment used in this study can be used for in vitro but not in vivo scans of knees; therefore, for the purpose of this study we were restricted to a cadaver study. In vivo knee scans have been reported with the second-generation HR-pQCT equipment [34] but will be limited to younger people who can still bend one leg while the other remains stretched. Fourth, only five texture parameters were included in the study, although many more exist.…”

Section: Discussionmentioning

confidence: 99%

Advanced Knee Structure Analysis (AKSA): a comparison of bone mineral density and trabecular texture measurements using computed tomography and high-resolution peripheral quantitative computed tomography of human knee cadavers

et al. 2017

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BackgroundA change of loading conditions in the knee causes changes in the subchondral bone and may be a cause of osteoarthritis (OA). However, quantification of trabecular architecture in vivo is difficult due to the limiting spatial resolution of the imaging equipment; one approach is the use of texture parameters. In previous studies, we have used digital models to simulate changes of subchondral bone architecture under OA progression. One major result was that, using computed tomography (CT) images, subchondral bone mineral density (BMD) in combination with anisotropy and global homogeneity could characterize this progression.The primary goal of this study was a comparison of BMD, entropy, anisotropy, variogram slope, and local and global inhomogeneity measurements between high-resolution peripheral quantitative CT (HR-pQCT) and CT using human cadaveric knees. The secondary goal was the verification of the spatial resolution dependence of texture parameters observed in the earlier simulations, two important prerequisites for the interpretation of in vivo measurements in OA patients.MethodThe applicability of texture analysis to characterize bone architecture in clinical CT examinations was investigated and compared to results obtained from HR-pQCT. Fifty-seven human knee cadavers (OA status unknown) were examined with both imaging modalities. Three-dimensional (3D) segmentation and registration processes, together with automatic positioning of 3D analysis volumes of interest (VOIs), ensured the measurement of BMD and texture parameters at the same anatomical locations in CT and HR-pQCT datasets.ResultsAccording to the calculation of dice ratios (>0.978), the accuracy of VOI locations between methods was excellent. Entropy, anisotropy, and global inhomogeneity showed significant and high linear correlation between both methods (0.68 < R 2 < 1.00). The resolution dependence of these parameters simulated earlier was confirmed by the in vitro measurements.ConclusionThe high correlation of HR-pQCT- and CT-based measurements of entropy, global inhomogeneity, and anisotropy suggests interchangeability between devices regarding the quantification of texture. The agreement of the experimentally determined resolution dependence of global inhomogeneity and anisotropy with earlier simulations is an important milestone towards their use to quantify subchondral bone structure. However, an in vivo study is still required to establish their clinical relevance.

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“…Knees were imaged using an HR‐pQCT imaging protocol developed in our lab (XtremeCT II; SCANCO Medical AG, Switzerland, Brüttisellen, Switzerland) . In brief, participants placed their knee in full extension into the gantry.…”

Section: Methodsmentioning

confidence: 99%

Longitudinal Effects of Acute Anterior Cruciate Ligament Tears on Peri‐Articular Bone in Human Knees Within the First Year of Injury

Kroker

Besler

Bhatla

et al. 2019

Journal Orthopaedic Research

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Anterior cruciate ligament (ACL) tears are common sports‐related knee injuries that increase the risk of developing post‐traumatic osteoarthritis. ACL tears are rarely an isolated injury but are often associated with traumatic bone marrow lesions (BMLs). While early loss of bone mass following the ACL injury has been previously described, to date, microarchitectural information has not been reported due to the limited resolution of clinical imaging systems. In this study, we provide the first evidence of detailed bone mass and microarchitectural changes in the first 10 months following an acute ACL tear, and localized to traumatic BMLs. Fifteen participants with an acute unilateral ACL tear were assessed at four‐time points using dual‐energy X‐ray absorptiometry and high‐resolution peripheral quantitative computed tomography, and traumatic BMLs were identified with magnetic resonance imaging. Loss of bone mass was localized to the injured knee (−4.6% to −15.8%, depending on bone and depth) and was accelerated immediately following the injury before suggesting a recovery phase. This loss of bone was accelerated even greater in traumatic BMLs (−18.2% to −20.6%, depending on bone). Bone loss was accompanied by microstructural degeneration of trabecular bone. For example, in the lateral femur of the injured knee, the subchondral bone plate decreased in thickness (−9.0%). This study confirmed loss of bone mass in the months following ACL tears and described the underlying bone microstructural changes. The presented bone changes were accelerated in regions of traumatic BMLs. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2325–2336, 2019

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Quantitative in vivo assessment of bone microarchitecture in the human knee using HR-pQCT

Cited by 63 publications

References 25 publications

Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Advanced Knee Structure Analysis (AKSA): a comparison of bone mineral density and trabecular texture measurements using computed tomography and high-resolution peripheral quantitative computed tomography of human knee cadavers

Longitudinal Effects of Acute Anterior Cruciate Ligament Tears on Peri‐Articular Bone in Human Knees Within the First Year of Injury

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