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High-Resolution Cone-Beam Computed Tomography is a Fast and Promising Technique to Quantify Bone Microstructure and Mechanics of the Distal Radius

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Abstract

Obtaining high-resolution scans of bones and joints for clinical applications is challenging. HR-pQCT is considered the best technology to acquire high-resolution images of the peripheral skeleton in vivo, but a breakthrough for widespread clinical applications is still lacking. Recently, we showed on trapezia that CBCT is a promising alternative providing a larger FOV at a shorter scanning time. The goals of this study were to evaluate the accuracy of CBCT in quantifying trabecular bone microstructural and predicted mechanical parameters of the distal radius, the most often investigated skeletal site with HR-pQCT, and to compare it with HR-pQCT. Nineteen radii were scanned with four scanners: (1) HR-pQCT (XtremeCT, Scanco Medical AG, @ (voxel size) 82 μm), (2) HR-pQCT (XtremeCT-II, Scanco, @60.7 μm), (3) CBCT (NewTom 5G, Cefla, @75 μm) reconstructed and segmented using in-house developed software and (4) microCT (VivaCT40, Scanco, @19 μm—gold standard). The following parameters were evaluated: predicted stiffness, strength, bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N). The overall accuracy of CBCT with in-house optimized algorithms in quantifying bone microstructural parameters was comparable (R2 = 0.79) to XtremeCT (R2 = 0.76) and slightly worse than XtremeCT-II (R2 = 0.86) which were both processed with the standard manufacturer’s technique. CBCT had higher accuracy for BV/TV and Tb.Th but lower for Tb.Sp and Tb.N compared to XtremeCT. Regarding the mechanical parameters, all scanners had high accuracy (R2 \(\ge\) 0.96). While HR-pQCT is optimized for research, the fast scanning time and good accuracy renders CBCT a promising technique for high-resolution clinical scanning.

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Acknowledgements

The authors are not compensated and there are no other institutional subsidies, corporate affiliations, or funding sources supporting this study unless clearly documented and disclosed. This research was supported by a FWO travel grant (Grant No. V438418N), KU Leuven Internal Funding (Grant No. C24/16/027) and the Swiss National Supercomputing Centre under Project ID 891. The authors would like to thank Ursula Eberli (AO Research Institute Davos, Davos, Switzerland) for assistance with the IPL software and Dieter Wahl (AO Research Institute Davos, Davos, Switzerland) for assistance with the development of scanning techniques and the development of scanner-specific holders.

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Authors and Affiliations

  1. Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium

    Karen Mys & G. Harry van Lenthe

  2. AO Research Institute Davos, Davos, Switzerland

    Karen Mys, Peter Varga, Boyko Gueorguiev & Verena Neumann

  3. Muscles & Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium

    Filip Stockmans

  4. Department of Radiology, AZ Groeninge, Kortrijk, Belgium

    Olivier Vanovermeire

  5. Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands

    Caroline E. Wyers & Joop P. W. van den Bergh

  6. NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands

    Caroline E. Wyers & Joop P. W. van den Bergh

  7. Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands

    Joop P. W. van den Bergh

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  1. Karen Mys
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Contributions

Study design: KM, PV, FS, BG and HVL. Data collection: KM, VN, OV, CW and JVB. Data analysis: KM and PV. Data interpretation: KM, PV, FS, BG and HVL. Drafting manuscript: KM. Revising manuscript content: PV, FS, BG, VN, OV, CW, JVB and HVL. Approving final version of manuscript: KM, PV, FS, BG, VN, OV, CW, JPV and HVL. KM takes responsibility for the integrity of the data analysis.

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Correspondence to Karen Mys.

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Conflict of interest

Karen Mys, Peter Varga, Filip Stockmans, Boyko Gueorguiev, Verena Neumann, Olivier Vanovermeire, Caroline E. Wyers, Joop P.W. van den Bergh and G. Harry van Lenthe declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

Nineteen human cadaveric radii (11 right, 8 left) of 14 female and 5 male donors aged between 25 to 93 years (mean ± standard deviation (SD): 67.9 ± 16.2 years) were used. The specimens were obtained from Science Care (Phoenix, AZ, USA) following study approval by the institutional internal review board, based on the approval of the specimens’ delivery by Science Care Ethics Committee. All donors gave their informed consent inherent within the donation of the anatomical gift statement during their lifetime.

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Mys, K., Varga, P., Stockmans, F. et al. High-Resolution Cone-Beam Computed Tomography is a Fast and Promising Technique to Quantify Bone Microstructure and Mechanics of the Distal Radius. Calcif Tissue Int 108, 314–323 (2021). https://doi.org/10.1007/s00223-020-00773-5

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