The Feasibility of High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Patients with Suspected Scaphoid Fractures

Bevers, Melissa S. A. M.; Daniels, Anne; Wyers, Caroline E.; Rietbergen, Bert van; Geusens, Piet; Kaarsemaker, Sjoerd; Janzing, H; Hannemann, P. F. W.; Poeze, Martijn; Bergh, Joop van den

doi:10.1016/j.jocd.2019.08.003

Cited by 9 publications

(21 citation statements)

References 36 publications

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“…Due to its thin cortex and the fine trabecular network motion might have a different impact on image quality. Moreover, the subjectivity when classifying the bone into grade 1 to grade 5 seems higher for the scaphoid than for the radius and tibia (7).…”

Section: Introductionmentioning

confidence: 96%

“…The CT also has a high specificity but a lower sensitivity; however, it is often preferred to the MRI as it is cheaper and more readily available (1,4,5). High-resolution peripheral quantitative computed tomography (HR-pQCT) represents an innovative option in detecting scaphoid fractures (6)(7)(8). Since the first results have only recently been published, its use is not yet widely established in this field.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the high resolution, small fissures in the scaphoid bone can be detected more sensitively than with the conventional CT (6,22). Furthermore, the analysis of the bone mineral density and micro-architecture could help to provide insights into fracture mechanisms, the non-union etiology (7), and its biology (23) and quantify the healing process of scaphoid fractures (16).…”

Section: Introductionmentioning

confidence: 99%

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The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Benedikt¹,

Horling²,

Stock³

et al. 2023

Quant Imaging Med Surg

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Background: In-vivo high-resolution peripheral quantitative computed tomography (HR-pQCT) has high potential in scaphoid bone pathologies' scientific and clinical fields. The manufacturer's visual grading scale (VGS) classifies motion artifacts and divides scans into five quality grades ranging from grade 1 (good quality) to grade 5 (poor quality). This prospective study aimed to investigate the feasibility of the VGS and the influence of image quality on bone density and microarchitecture parameters for the scaphoid bone.Methods: Within one year, twenty-two patients with scaphoid fractures received up to six scans of their fractured and contralateral wrist (each consisting of three stacks) using second-generation HR-pQCT (total 256 scans). Three experienced observers graded each stack following the visual grading system, and interand intraobserver variability were assessed. The contralateral uninjured scaphoids were then compared pairwise within each patient to high-quality grade 1 scans to determine the influence of image quality on density and microarchitecture parameters.Results: Inter-and intraobserver variability among the three observers significantly revealed fair to moderate agreement, P<0.001 and P<0.05, respectively. Bone volume (BV) fraction tended to increase with poorer image quality but did not exceed four percent. Trabecular bone mineral density (Tb.BMD) decreased with poorer image quality but did not exceed five percent. Trabecular number and trabecular thickness significantly increased by 15.5% and 6.8% at grade five (P<0.001), respectively, and trabecular separation significantly decreased by 13.7% at grade five (P<0.001).Conclusions: This study revealed a considerable influence of motion on bone morphometry parameters of the scaphoid. Therefore, high image quality must be a central point in studies focusing on the histomorphometry of small objects. The high inter-and intraobserver variability limit the VGS. Future research may focus on other grading systems or automated techniques leading to more consistent and reproducible results. Currently, the use of microarchitectural analysis should be limited to cases without motion artefacts or, at most low graded motion artefacts.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Benedikt¹,

Horling²,

Stock³

et al. 2023

Quant Imaging Med Surg

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“…In previous studies, we found that HR-pQCT is a feasible and reliable technique for scaphoid fracture diagnosis 29 , with "almost perfect" interobserver agreement (Fleiss kappa, 0.91) according to the guidelines by Landis and Koch 35 . In the present Fig.…”

Section: Discussionmentioning

confidence: 89%

“…The development of high-resolution peripheral quantitative CT (HR-pQCT), a novel high-resolution and lowradiation-dose technique, allows for the assessment of cortical and trabecular bone microarchitecture at the distal parts of the radius and tibia 25,26 . Recent research has shown that studying the fracture-healing process of stable distal radial fractures 27,28 and scanning the scaphoid bone in patients with a clinically suspected scaphoid fracture are feasible with HR-pQCT 29 . We hypothesized that the use of HR-pQCT for patients with a clinically suspected scaphoid fracture would improve scaphoid fracture detection when compared with conventional CT in the clinical setting.…”

mentioning

confidence: 99%

Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT

Daniels

Bevers

Sassen

et al. 2020

Journal of Bone and Joint Surgery

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Influence of demographic factors on the occurrence of motion artefacts in HR-pQCT

Benedikt,

Rieser,

Schmidle

et al. 2023

Arch Osteoporos

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Summary The study shows a high incidence of motion artefacts in a central European population and a significant increase of those artefacts with higher age. These findings may impact on the design and conduct of future in vivo HR-pQCT studies or at least help to estimate the potential number of drop outs due to unusable image quality. Purpose Motion artefacts in high-resolution peripheral quantitative computed tomography (HR-pQCT) are challenging, as they introduce error into the resulting measurement data. The aim of this study was to assess the general occurrence of motion artefacts in healthy distal radius and to evaluate the influence of demographic factors. Methods The retrospective study is based on 525 distal radius second-generation HR-pQCT scans of 95 patients. All stacks were evaluated by two experienced observers and graded according to the visual grading scale recommended by the manufacturer, ranging from grade 1 (no visible motion artefacts) to grade 5 (severe motion artefacts). Correlations between demographic factors and image quality were evaluated using a linear mixed effects model analysis. Results The average visual grading was 2.7 (SD ± 0.7). Age and severity of motion artefacts significantly correlated (p = 0.026). Patients aged 65 years or above had an average image quality between grades 1 and 3 in 72.7% of cases, while patients younger than 65 had an average image quality between grades 1 and 3 in 91.9% of cases. Gender, smoking behaviour, and handedness had no significant influence on motion artefacts. Conclusion This study showed a high incidence of motion artefacts in a representative central European population, but also a significant increase of motion artefacts with higher age. This could impact further study designs by planning for a sufficiently large and if possible a more selective study population to gain a representative amount of high-quality image data.

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The Feasibility of High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Patients with Suspected Scaphoid Fractures

Cited by 9 publications

References 36 publications

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT

Influence of demographic factors on the occurrence of motion artefacts in HR-pQCT

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