Bone Structure Determined by HR-MDCT Does Not Correlate with Micro-CT of Lumbar Vertebral Biopsies: a Prospective Cross-sectional Human in Vivo Study

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2020 Sep 11

PMID 32912263

Citations 4

Authors

Matthias Pumberger

Ahi Sema Issever

Torsten Diekhoff

Christin Schwemmer

Susanne Berg

Yannick Palmowski

Michael Putzier

Affiliations

Soon will be listed here.

Abstract

Background: Osteoporosis is characterized by a deterioration of bone structure and quantity that leads to an increased risk of fractures. The primary diagnostic tool for the assessment of the bone quality is currently the dual-energy X-ray absorptiometry (DXA), which however only measures bone quantity. High-resolution multidetector computed tomography (HR-MDCT) offers an alternative approach to assess bone structure, but still lacks evidence for its validity in vivo. The objective of this study was to assess the validity of HR-MDCT for the evaluation of bone architecture in the lumbar spine.

Methods: We conducted a prospective cross-sectional study to compare the results of preoperative lumbar HR-MDCT scans with those from microcomputed tomography (μCT) analysis of transpedicular vertebral body biopsies. For this purpose, we included patients undergoing spinal surgery in our orthopedic department. Each patient underwent preoperative HR-MDCT scanning (L1-L4). Intraoperatively, transpedicular biopsies were obtained from intact vertebrae. Micro-CT analysis of these biopsies was used as a reference method to assess the actual bone architecture. HR-MDCT results were statistically analyzed regarding the correlation with results from μCT.

Results: Thirty-four patients with a mean age of 69.09 years (± 10.07) were included in the study. There was no significant correlation for any of the parameters (bone volume/total volume, trabecular separation, trabecular thickness) between μCT and HR-MDCT (bone volume/total volume: r = - 0.026 and p = 0.872; trabecular thickness: r = 0.074 and r = 6.42; and trabecular separation: r = - 0.18 and p = 0.254).

Conclusion: To our knowledge, this is the first study comparing in vivo HR-MDCT with μCT analysis of vertebral biopsies in human patients. Our findings suggest that lumbar HR-MDCT is not valid for the in vivo evaluation of bone architecture in the lumbar spine. New diagnostic tools for the evaluation of osteoporosis and preoperative orthopedic planning are urgently needed.

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References

Steiger P, Cummings S, Black D, Spencer N, Genant H . Age-related decrements in bone mineral density in women over 65. J Bone Miner Res. 1992; 7(6):625-32. DOI: 10.1002/jbmr.5650070606. View

Goldstein C, Brodke D, Choma T . Surgical Management of Spinal Conditions in the Elderly Osteoporotic Spine. Neurosurgery. 2015; 77 Suppl 4:S98-107. DOI: 10.1227/NEU.0000000000000948. View

Bauer J, Link T, Burghardt A, Henning T, Mueller D, Majumdar S . Analysis of trabecular bone structure with multidetector spiral computed tomography in a simulated soft-tissue environment. Calcif Tissue Int. 2007; 80(6):366-73. DOI: 10.1007/s00223-007-9021-5. View

Burke C, Didolkar M, Barnhart H, Vinson E . The use of routine non density calibrated clinical computed tomography data as a potentially useful screening tool for identifying patients with osteoporosis. Clin Cases Miner Bone Metab. 2016; 13(2):135-140. PMC: 5119712. DOI: 10.11138/ccmbm/2016.13.2.135. View

Gruber M, Bauer J, Dobritz M, Beer A, Wolf P, Woertler K . Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry. Eur Radiol. 2012; 23(2):505-12. DOI: 10.1007/s00330-012-2629-5. View

Jiang Y, Zhao J, Liao E, Dai R, Wu X, Genant H . Application of micro-CT assessment of 3-D bone microstructure in preclinical and clinical studies. J Bone Miner Metab. 2005; 23 Suppl:122-31. DOI: 10.1007/BF03026336. View

Kanis J, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B . Assessment of fracture risk. Osteoporos Int. 2004; 16(6):581-9. DOI: 10.1007/s00198-004-1780-5. View

Cummings S, Bates D, Black D . Clinical use of bone densitometry: scientific review. JAMA. 2002; 288(15):1889-97. DOI: 10.1001/jama.288.15.1889. View

Johanson N, Litrenta J, Zampini J, Kleinbart F, Goldman H . Surgical treatment options in patients with impaired bone quality. Clin Orthop Relat Res. 2011; 469(8):2237-47. PMC: 3126955. DOI: 10.1007/s11999-011-1838-6. View

10.

Mittra E, Rubin C, Gruber B, Qin Y . Evaluation of trabecular mechanical and microstructural properties in human calcaneal bone of advanced age using mechanical testing, microCT, and DXA. J Biomech. 2007; 41(2):368-75. DOI: 10.1016/j.jbiomech.2007.09.003. View

11.

Dodwad S, Khan S . Surgical stabilization of the spine in the osteoporotic patient. Orthop Clin North Am. 2013; 44(2):243-9. DOI: 10.1016/j.ocl.2013.01.008. View

12.

Cosman F, de Beur S, LeBoff M, Lewiecki E, Tanner B, Randall S . Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014; 25(10):2359-81. PMC: 4176573. DOI: 10.1007/s00198-014-2794-2. View

13.

Lehman Jr R, Kang D, Wagner S . Management of osteoporosis in spine surgery. J Am Acad Orthop Surg. 2015; 23(4):253-63. DOI: 10.5435/JAAOS-D-14-00042. View

14.

Damilakis J, Adams J, Guglielmi G, Link T . Radiation exposure in X-ray-based imaging techniques used in osteoporosis. Eur Radiol. 2010; 20(11):2707-14. PMC: 2948153. DOI: 10.1007/s00330-010-1845-0. View

15.

Diederichs G, Link T, Marie K, Huber M, Rogalla P, Burghardt A . Feasibility of measuring trabecular bone structure of the proximal femur using 64-slice multidetector computed tomography in a clinical setting. Calcif Tissue Int. 2008; 83(5):332-41. DOI: 10.1007/s00223-008-9181-y. View

16.

Wegrzyn J, Roux J, Arlot M, Boutroy S, Vilayphiou N, Guyen O . Determinants of the mechanical behavior of human lumbar vertebrae after simulated mild fracture. J Bone Miner Res. 2010; 26(4):739-46. PMC: 3179325. DOI: 10.1002/jbmr.264. View

17.

Ammann P, Rizzoli R . Bone strength and its determinants. Osteoporos Int. 2003; 14 Suppl 3:S13-8. DOI: 10.1007/s00198-002-1345-4. View

18.

Lodder M, Lems W, Ader H, Marthinsen A, van Coeverden S, Lips P . Reproducibility of bone mineral density measurement in daily practice. Ann Rheum Dis. 2004; 63(3):285-9. PMC: 1754906. DOI: 10.1136/ard.2002.005678. View

19.

Baum T, Muller D, Dobritz M, Wolf P, Rummeny E, Link T . Converted lumbar BMD values derived from sagittal reformations of contrast-enhanced MDCT predict incidental osteoporotic vertebral fractures. Calcif Tissue Int. 2012; 90(6):481-7. DOI: 10.1007/s00223-012-9596-3. View

20.

Diederichs G, Link T, Kentenich M, Schwieger K, Huber M, Burghardt A . Assessment of trabecular bone structure of the calcaneus using multi-detector CT: correlation with microCT and biomechanical testing. Bone. 2009; 44(5):976-83. DOI: 10.1016/j.bone.2009.01.372. View