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Automated finite element analysis of excised human femora based on precision -QCT.

The creation of 3-D finite element (FE) models of bone and implant-bone systems is a labor-intensive task due to the need to model different cases and variations, to perform patch tests and to account for the nonhomogeneous material properties with an acceptable amount of work. In this study, we developed an interface between a precision QCT and a FE system and applied it to a specimen bone. With the new method, the time necessary for model generation was reduced substantially. Furthermore, the elastic properties for each element were automatically derived from the corresponding CT-values. In order to demonstrate the importance of taking into account inhomogeneity, a comparison between the nonhomogeneous model and a homogeneous, "averaged" model was performed.

Biomechanical Phenomena↗

[A calibration phantom system for QCT bone mineral density determination].

This paper describes a calibration phantom system for QCT bone mineral density determination, which consists of 4-standard-solid-sample calibration phantom, a quality assurance (QA) phantom and the bone mineral density analysis software. The system adds to the new applications of CT systems, and provides a new method with a good accuracy and reliability for the examination, diagnosis, prevention, treatment of osteoporosis diseases and the observation of curative effect of drugs.

Absorptiometry, Photon↗

Correlation between the values of bone measurements using DXA, QCT and USD methods and the bone strength in calcanei in vitro.

In this study we used the calcanei from 32 female and 29 male cadavers, ages 58 to 100. The bone mineral density (BMD) and average bone density (ABD) were measured using dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) respectively, while speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI) were measured using ultrasound densitometry (USD). Thereafter, the bone strength was measured using a compressor to cause bone fracture, and evaluated in comparison with the values of the three measurement methods. The scatter diagrams of the values of the three different methods versus age displayed a negative linear regression in both sexes. Values for BMD and ABD were generally about 20% higher in males than in females, while SOS, BUA and SI were a few percents higher in males than in females. A significantly high correlation existed between BMD and ABD (r = 0.95), and a moderate correlation between BMD and either SOS, BUA or SI (r = 0.65; r = 0.39; r = 0.57, respectively). Thus, among the values measured using USD, SOS most closely corresponded to BMD of the calcanei. The bone strength of the calcanei indicated a moderate correlation with BMD, ABD and SOS (r = 0.38, P < 0.01; r = 0.43, P < 0.001; r = 0.45, P < 0.001, respectively). However, 42 calcanei fractured under pressures of less than 40 kgf, although the other 19 calcanei endured pressure of 40 kgf or more. Two calcanei with high BMD over 0.7 g/cm2 by DXA were very fragile, whereas a few with low BMD less than 0.4 g/cm2 were not very fragile. Similarly, high SOS, BUA and SI values by USD did not always correspond to high bone strength. Thus, some discrepancies among the bone strength and measurement values remained to be solved in the future.

Absorptiometry, Photon↗

Age-related changes assessed by peripheral QCT in healthy Italian women.

The purpose of this study was to describe the normal cross-sectional pattern of radial bone loss associated with aging in healthy women and to generate a normative database using peripheral quantitative computed tomography (pQCT). Subjects with suspected conditions affecting bone metabolism or receiving any drugs affecting bone mineralization were excluded. The trabecular bone mineral density (BMD) and the total bone density of the ultradistal radius at the nondominant forearm was measured using the Norland-Stratec XCT-960 pQCT scanner in 386 healthy pre-, peri-, and postmenopausal females aged 15-81 years. The long-term in vivo precision error was 1.6 % CV (coefficient of variation) for trabecular and 0.8% CV for total BMD measurements. The highest value of trabecular and total BMD measured was observed at the age group 15-39 years. Beyond these ages both trabecular and total BMD showed a linear decline with aging, decreasing by an overall slope of -1.28 and -0.55 mg/cm3 per year for total and trabecular BMD measurements, respectively. The test of parallelism between the regression slopes of the peri- and postmenopausal women showed a statistically significant difference for total BMD measurement (p = 0.003). Measurement of total and trabecular BMD was not influenced by weight, height or body mass index, but it was correlated with natural logarithm of years since menopause. We conclude that pQCT of the ultradistal radius is a precise method for measuring the true volumetric BMD and for detecting age-related bone loss in the trabecular and total bone of female subjects encompassing the adult age range and menopausal status.

Adolescent↗

DXA vs QCT: in vitro and in vivo studies.

The aim of this study was to evaluate the discrepancy between bone mineral density (BMD) results when using dual X-ray absorptiometry and quantitative computed tomography both in vitro and in vivo. Using these two techniques, we found that the T-score densitometric index values were discrepant in the BMD qualitative evaluation, which can affect the diagnosis of osteopenia or osteoporosis, thus we propose its modification.

Absorptiometry, Photon↗

Effect of nonweight bearing on tibial bone density measured by QCT in patients with hip surgery.

Tibial bone mineral density (BMD) was measured in 11 patients who had undergone hip joint surgery, including 10 women (22-61 years old; mean +/- SD = 42.6+/-10.3) and 1 man (61 years old). Four patients received total hip replacement (THR), while the others underwent rotational acetabular osteotomy (RAO). In one case, the start of rehabilitation was delayed until 4 months after the surgery because of infection at the surgical site. Nine patients underwent hip surgery for osteoarthritis and 2 patients for avascular necrosis. These 2 patients had a history of medication with corticosteroid. BMD of the tibia on the surgically treated side was measured by a peripheral quantitative CT (pQCT) system, which provided three different BMD values of trabecular BMD in the distal portion, total BMD in the distal portion, and total BMD in the diaphysis. The measurements were obtained preoperatively, and at several time points postoperatively, at 2, 4, 6, and 8 weeks and 3, 4, 5, 8, 12, 18, and 24 months after surgery. Brief periods of nonweightbearing lead to significant bone loss, and 1-1.5 years was required to recover to the baseline BMD. Accelerated bone loss was seen in patients in the perimenopausal state, with prolonged bed rest, and in patients receiving corticosteroid. Both trabecular and cortical components were influenced by nonweightbearing and restoration of weightbearing. The decrease in the cortical region occurs after the decrease in the trabecular and endosteal regions.

Adult↗

An anatomic coordinate system of the femoral neck for highly reproducible BMD measurements using 3D QCT.

In this paper, a procedure for the determination of an anatomically oriented coordinate system of the femoral neck (NCS) in 3D spiral CT datasets is described. The origin of the NCS is centered in the minimal cross-sectional area of the neck. Its three axes are defined as follows: the so called neck axis is perpendicular to this area and points towards the femoral head, the second axis is the principal axis of the minimal cross-sectional area and the third axis is perpendicular to the other two. After a semi-automatic 3D segmentation of the proximal femur the NCS is automatically determined in a two-step minimization procedure. Relative to the coordinate system volumes of interest (VOIs) are positioned in which bone mineral density (BMD) and cortical thickness are analyzed. We investigated intra- and inter-operator precision of the position of the NCS, the BMD in cortical and trabecular VOIs, and cortical thickness in nine pelvic CT datasets obtained from clinical routine examinations. We further investigated the effect of increased noise by adding Gaussian distributed noise to measured projections before tomographic reconstruction. The mean precision error (averaged form the results of the nine datasets) of the NCS position was less than 0.5 mm and smaller than 2.25 degrees . There were no significant differences between inter- and intra-operator analyses. Precision errors in trabecular BMD were smaller than 3% in a stack of five 1 mm thin slices cut perpendicularly to the neck axis and smaller than 1% in a spherical VOI encompassing the neck. Relative precision errors for cortical BMD were smaller than 3% for both VOIs. An increase of noise up to a factor of 5 caused a maximal displacement of the NCS origin position by less than 1mm and a rotation by less than 2 degrees .

Bone Density↗

A hierarchical 3D segmentation method and the definition of vertebral body coordinate systems for QCT of the lumbar spine.

We have developed a new hierarchical 3D technique to segment the vertebral bodies in order to measure bone mineral density (BMD) with high trueness and precision in volumetric CT datasets. The hierarchical approach starts with a coarse separation of the individual vertebrae, applies a variety of techniques to segment the vertebral bodies with increasing detail and ends with the definition of an anatomic coordinate system for each vertebral body, relative to which up to 41 trabecular and cortical volumes of interest are positioned. In a pre-segmentation step constraints consisting of Boolean combinations of simple geometric shapes are determined that enclose each individual vertebral body. Bound by these constraints viscous deformable models are used to segment the main shape of the vertebral bodies. Volume growing and morphological operations then capture the fine details of the bone-soft tissue interface. In the volumes of interest bone mineral density and content are determined. In addition, in the segmented vertebral bodies geometric parameters such as volume or the length of the main axes of inertia can be measured. Intra- and inter-operator precision errors of the segmentation procedure were analyzed using existing clinical patient datasets. Results for segmented volume, BMD, and coordinate system position were below 2.0%, 0.6%, and 0.7%, respectively. Trueness was analyzed using phantom scans. The bias of the segmented volume was below 4%; for BMD it was below 1.5%. The long-term goal of this work is improved fracture prediction and patient monitoring in the field of osteoporosis. A true 3D segmentation also enables an accurate measurement of geometrical parameters that may augment the clinical value of a pure BMD analysis.

Absorptiometry, Photon↗

Assessment of the effect of mesh density on the material property discretisation within QCT based FE models: a practical example using the implanted proximal tibia.

A three-dimensional, quantitative computed tomography based finite element model of a proximal implanted tibia was analysed in order to assess the effect of mesh density on material property discretisation and the resulting influence on the predicted stress distribution. The mesh was refined on the contact surfaces (matched meshes) with element sizes of 3, 2, 1.4, 1 and 0.8 mm. The same loading conditions were used in all models (bi-condylar load: 60% medial, 40% lateral). Significant variations were observed in the modulus distributions between the coarsest and finest mesh densities. Poor discretisation of the material properties also resulted in poor correlations of the stresses and risk ratios between the coarsest and finest meshes. Little difference in Young's modulus, von Mises stress and risk ratio distributions were observed between the three finest models; hence, it was concluded that for this particular case an element size of 1.4 mm on the contact surfaces was enough to properly describe the stiffness, stress and risk ratio distributions within the bone. Poor convergence of the material property distribution occurred when the element size was significantly larger than the pixel size of the source CT data. It was concluded that unless there is convergence in the Young's modulus distribution, convergence of the stress field or of other parameters of interest will not occur either.

Computer Simulation↗

Effects of physical training on cortical bone at midtibia assessed by peripheral QCT.

Effects of long-term exercise on volumetric bone mineral density (vBMD), bone mineral content, bone geometric properties, and the strength indexes of bone were examined in a cross-sectional study of athletes and controls. Tibias of 25 jumpers (13 women), 30 swimmers (15 women), and 25 controls (15 women), aged 18-23 yr, were scanned at midsite by using peripheral quantitative computed tomography. The cortical vBMD of female athletes was lower than that of the controls (2.00 +/- 0.05, 1.90 +/- 0.08, and 1.92 +/- 0.12 g/cm3, respectively, for controls, swimmers, and jumpers). On the other hand, periosteal areas of male jumpers and female athletes were greater than that of controls (460 +/- 50, 483 +/- 46, and 512 +/- 55 mm2, respectively, for male controls, swimmers, and jumpers, and 283 +/- 52, 341 +/- 73, and 378 +/- 75 mm2, respectively, for female controls, swimmers, and jumpers). The endocortical area of female swimmers was greater than that of controls (103 +/- 29, 148 +/- 52, and 135 +/- 54 mm2, respectively, for controls, swimmers, and jumpers). The polar moment of inertia and strength strain index of male jumpers and female athletes were significantly greater than those of controls, except for the difference in strength strain index between male jumpers and controls. We conclude that the improvement of mechanical properties of young adult bone in response to long-term exercise is related to geometric adaptation and not to vBMD.

Absorptiometry, Photon↗