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The Effect of Region of Interest on Measurement of Bone Mineral Density of the Proximal Femur: Simulation Analysis Using CT Images

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Abstract

While accurate measurement of bone mineral density (BMD) is essential in the diagnosis of osteoporosis and in evaluating the treatment of osteoporosis, it is unclear how region of interest (ROI) settings affect measurement of BMD at the total proximal femur region. In this study, we performed a simulation analysis to clarify the effect on BMD measurement of changing the ROI using hip computed tomography (CT) images of 75 females (mean age, 62.4 years). Digitally reconstructed radiographs of the proximal femur region were generated from CT images to calculate the change in BMD when the proximal boundary of the ROI was altered by 0–10 mm, and when the distal boundary of the ROI was altered by 0–30 mm. Further, changes in BMD were compared across BMD classification groups. A mean BMD increase of 0.62% was found for each 1-mm extension of the distal boundary. A mean BMD decrease of 0.18% was found for each 1-mm alteration of the proximal boundary. Comparing BMD classification groups, patients with osteoporosis and osteopenia demonstrated greater BMD changes than patients with normal BMD for the distal boundary (0.68%, 0.64%, and 0.54%, respectively) and patients with osteoporosis demonstrated greater BMD changes than patients with osteoporosis and normal BMD for the proximal boundary (0.37%, 0.13%, and 0.03%, respectively). In conclusion, our study found that a consistent ROI setting, especially on the distal boundary, is necessary for the accurate measurement of total proximal femur BMD. Based on the findings, we recommend confirming that the ROI setting shown on the BMD result form is consistent with changes in serial BMD.

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Funding

This study was supported by the Japan Osteoporosis Foundation Grant for Bone Research and the Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (KAKENHI) Numbers 19H01176, 20H04550, and 21K16655.

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Authors and Affiliations

  1. Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Keisuke Uemura, Masaki Takao, Makoto Iwasa & Hidetoshi Hamada

  2. Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan

    Keisuke Uemura, Yoshito Otake & Yoshinobu Sato

  3. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Wataru Ando & Nobuhiko Sugano

Authors
  1. Keisuke Uemura
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  2. Masaki Takao
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  3. Yoshito Otake
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  7. Yoshinobu Sato
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  8. Nobuhiko Sugano
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Contributions

Conceptualization: KU; Methodology: KU; Code writing: KU and YO; Formal analysis and investigation: KU; Writing—original draft preparation: KU; Writing—reviewing and editing: WA, MT, YO, YS, and NS; Funding acquisition: KU, YO, and YS. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and to ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly resolved.

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Correspondence to Keisuke Uemura.

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Conflict of interest

Keisuke Uemura, Masaki Takao, Yoshito Otake, Makoto Iwasa, Hidetoshi Hamada, Wataru Ando, Yoshinobu Sato, and Nobuhiko Sugano have nothing to disclose.

Human and Animal Rights

All procedures performed in this study were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

This study was approved by the Institutional Review Board of each participating institution, and informed consent was obtained from all patients in the form of opt-out.

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Uemura, K., Takao, M., Otake, Y. et al. The Effect of Region of Interest on Measurement of Bone Mineral Density of the Proximal Femur: Simulation Analysis Using CT Images. Calcif Tissue Int 111, 475–484 (2022). https://doi.org/10.1007/s00223-022-01012-9

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