Dirk Mueller

Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins.

Structural Analysis of Trabecular Bone of the Proximal Femur Using Multislice Computed Tomography: A Comparison with Dual X-Ray Absorptiometry for Predicting Biomechanical Strength In Vitro

We investigated whether trabecular microstructural parameters determined in multislice spiral computed tomographic (MSCT) images of proximal femur specimens differed in male and female donors and improved the prediction of biomechanical strength of the femur compared to bone mineral density (BMD) and content (BMC) determined with dual X-ray absorptiometry (DXA) as the standard diagnostic technique. Proximal femur specimens (n = 119) were harvested from formalin-fixed human cadavers (mean age 80 ± 10 years). BMD was determined using DXA. Trabecular microstructural parameters (bone volume fraction, fractal dimension, and trabecular thickness, spacing, and number) were calculated in MSCT-derived images of the proximal femur. Failure load (FL) was measured using a biomechanical side-impact test. An age-, height-, and weight-matched subgroup (n = 54) was chosen to compare male and female donors. BMC, BMD, and structural parameters correlated significantly with FL, with r up to 0.75, 0.71, and 0.71, respectively. In a multiple regression model, an increase up to r = 0.82 was obtained when combining trabecular structural parameters and BMC. BMD differed between males and females only at the trochanter. BMC showed significant gender differences in all regions. This experimental study showed that a combination of BMC and microstructural parameters could improve the prediction of FL, suggesting that bone mass and trabecular structure carry overlapping but complementary information and that a combination of the two provides the best prediction of bone strength. Male donors had larger femora even after adjustment for body size and height, but no differences in trabecular structure were found between males and females.

Volumetric Quantitative CT of the Spine and Hip Derived from Contrast-Enhanced MDCT: Conversion Factors

OBJECTIVE The purposes of this study were to perform volumetric quantitative CT (QCT) of the spine and hip using nondedicated contrast-enhanced standard MDCT data sets and to derive a conversion factor for bone mineral density (BMD) assessment based on dedicated volumetric QCT data sets. SUBJECTS AND METHODS Forty postmenopausal women with a mean +/- SD age of 71 +/- 9 years underwent routine contrast-enhanced abdominal and pelvic MDCT. Before this imaging examination, standard volumetric QCT of the spine (L1-L3, n = 40) and hip (n = 21) was performed. Relations between QCT and contrast-enhanced MDCT findings were assessed with linear regression analysis. RESULTS Mean lumbar BMD was 84.1 +/- 35.8 mg/mL, and mean femoral BMD was 0.62 +/- 0.12 g/cm2, as determined with QCT. Contrast-enhancement values with MDCT were on average 30.3% higher than those of QCT in the spine and 2.3% higher in the proximal femur (p < 0.05). Based on linear regression, a correlation coefficient of r = 0.98 was calculated for lumbar BMD with the equation BMD(QCT) = 0.96xBMD(MDCT) - 20.9 mg/mL. A coefficient of r = 0.99 was calculated for the proximal femur with the equation BMD(QCT) = 0.99xBMD(MDCT) - 12 mg/cm2 (p < 0.01). In 17 of 40 patients, 33 vertebral fractures were found. The dedicated QCT and enhanced MDCT data sets did not show a significant difference (p > 0.05) between patients with fractures and those without fractures. CONCLUSION With the conversion factors, reliable volumetric BMD measurements can be calculated for the hip and the spine from routine abdominal and pelvic MDCT data sets.

Analysis of Trabecular Bone Structure with Multidetector Spiral Computed Tomography in a Simulated Soft-Tissue Environment

We investigated the influence of soft tissue (ST) on image quality by high-resolution multidetector computed tomography (MDCT) scans and assessed the effect of surrounding ST on the quantification of trabecular bone structure. Eight bone cores obtained from human proximal femoral heads discarded during hip replacement surgery were scanned with micro-computed tomography (μCT) as well as with MDCT both without (w/o) and with (w) simulated surrounding ST, where a phantom imitated a human torso. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured in all scans. Apparent trabecular bone structure parameters were calculated and compared to similar parameters obtained in coregistered sections of the μCT scans. Residual errors were calculated as root-mean-square (RMS) errors relative to the μCT measurements. Compared to μCT results, trabecular structure parameters were overestimated by MDCT both w and w/o ST. SNR and CNR were significantly higher in the scans w/o ST. Significant correlations between μCT and MDCT results were found for bone fraction (r = 0.90 w/o ST, r = 0.84 w ST), trabecular number, and separation. RMS ranged from 10% to 15% for MDCT w/o ST and from 10% to 17% for MDCT w ST. Only bone fraction showed significantly different RMS and correlations for scans w/o vs. w ST (P < 0.05). This study showed that MDCT is able to visualize trabecular bone structure in an in vivo-like setting at skeletal sites within the torso such as the proximal femur. Even though ST scatter compromises image quality substantially, the major characteristics of the trabecular network can still be appreciated and quantified.

Local 3D scaling properties for the analysis of trabecular bone extracted from high-resolution magnetic resonance imaging of human trabecular bone : Comparison with bone mineral density in the prediction of biomechanical strength in vitro

Rationale and Objectives. A novel, nonlinear morphologic measure [&Dgr;P(&agr;)] based on local 3D scaling properties was applied to high-resolution magnetic resonance images (HR-MRI) of human trabecular bone to predict biomechanical strength in vitro. Methods. We extracted &Dgr;P(&agr;) and traditional morphologic parameters (apparent trabecular volume fraction, apparent trabecular separation) from HR-MR images of 32 femoral and 13 spinal bone specimens. Furthermore, bone mineral density (BMD) and maximum compressive strength (MCS) were determined. The morphologic measures were compared with BMD in predicting the biomechanical strength. Results. In the vertebral (femoral) specimens, R2 for MCS versus &Dgr;P(&agr;) was 0.87 (0.61) (P < 0.001). Correlation between BMD and MCS was 0.53 (P = 0.05) (0.79 [P < 0.001]) for the vertebral (femoral) specimens. For the femoral specimens, prediction of MCS could be improved further by combining BMD and morphologic parameters by multiple regression (R2 = 0.88). Conclusions. Morphologic measures extracted from HR-MRI considering local 3D-scaling properties can be used to predict biomechanical properties of bone in vitro. They are superior to 2-dimensional standard linear morphometric measures and, depending on the anatomic location, more reliably predict bone strength as measured by MCS than does BMD.

Prediction of bone strength by μCT and MDCT-based finite-element-models: How much spatial resolution is needed?

OBJECTIVES Finite-element-models (FEM) are a promising technology to predict bone strength and fracture risk. Usually, the highest spatial resolution technically available is used, but this requires excessive computation time and memory in numerical simulations of large volumes. Thus, FEM were compared at decreasing resolutions with respect to local strain distribution and prediction of failure load to (1) validate MDCT-based FEM and to (2) optimize spatial resolution to save computation time. MATERIALS AND METHODS 20 cylindrical trabecular bone specimens (diameter 12 mm, length 15-20mm) were harvested from elderly formalin-fixed human thoracic spines. All specimens were examined by micro-CT (isotropic resolution 30 μm) and whole-body multi-row-detector computed tomography (MDCT, 250 μm × 250 μm × 500 μm). The resolution of all datasets was lowered in eight steps to ~ 2,000 μm × 2000 μm × 500 μm and FEM were calculated at all resolutions. Failure load was determined by biomechanical testing. Probability density functions of local micro-strains were compared in all datasets and correlations between FEM-based and biomechanically measured failure loads were determined. RESULTS The distribution of local micro-strains was similar for micro-CT and MDCT at comparable resolutions and showed a shift toward higher average values with decreasing resolution, corresponding to the increasing apparent trabecular thickness. Small micro-strains (εeff<0.005) could be calculated down to 250 μm × 250 μm × 500 μm. Biomechanically determined failure load showed significant correlations with all FEM, up to r=0.85 and did not significantly change with lower resolution but decreased with high thresholds, due to loss of trabecular connectivity. CONCLUSION When choosing connectivity-preserving thresholds, both micro-CT- and MDCT-based finite-element-models well predicted failure load and still accurately revealed the distribution of local micro-strains in spatial resolutions, available in vivo (250 μm × 250 μm × 500 μm), that thus seemed to be the optimal compromise between high accuracy and low computation time.

Advances of 3T MR imaging in visualizing trabecular bone structure of the calcaneus are partially SNR-independent: analysis using simulated noise in relation to micro-CT, 1.5T MRI, and biomechanical strength.

To investigate differences in magnetic resonance imaging (MRI) of trabecular bone at 1.5T and 3.0T and to specifically study noise effects on the visualization and quantification of trabecular architecture using conventional histomorphometric and nonlinear measures of bone structure.

Assessing methods for characterising local and global structural and biomechanical properties of the trabecular bone network

We apply noval techniques, the Scaling Index Method (SIM), which reveals local topology of the structure, and the Minkowski Functionals (MF), which provide four global topological characteristics, to assess strength of the trabecular network of the human bone. We compare capabilities of these methods with the standard analysis, biomechanical Finite Element Method (FEM) and morphological parameters, in prediction of bone strength and fracture risk. Our study is based on a sample of 151 specimens taken from the trabecular part of human thoracic and lumbar vertebrae in vitro, visualised using µCT imaging (isotropic resolution 26µm) and tested by uniaxial compression. The sample of donors is heterogeneous, consisting of 58 male and 54 female cadavers with a mean age of 80 ±10 years. To estimate the predictive power of the methods, we correlate texture measures derived from µCT images with the maximum compressive strength (MCS) as obtained in biomechanical tests. A linear regression analysis reveals that the failure load estimated by FEM shows the highest correlation with MCS (Pearsons correlation coefficient r=0.76). None of the methods in current study is superior to the FEM: morphometric parameters give r<0.5, global topological characteristics show r=0.73 for the first Minkowski Functional MF₁, which coincides with bone volume fraction BV/TV and r=0.61 for the second Minkowski functional MF₂, which coincides with bone surface BS. Although scaling indices provided by SIM correlate only moderately with MCS (r=0.55), texture measures based on the nonlinear combination of local (SIM) and global (MF) topological characteristics demonstrate high correlation with experimental MCS (r=0.74) and with failure load estimated by FEM (r=0.95). Additional advantage of the proposed texture measures is possibility to reveal the role of the topologically different trabecular structure elements for the bone strength.

Quantifying changes in the bone microarchitecture using Minkowski-functionals and scaling vectors: a comparative study

Osteoporosis is a metabolic bone disease leading to de-mineralization and increased risk of fracture. The two major factors that determine the biomechanical competence of bone are the degree of mineralization and the micro-architectural integrity. Today, modern imaging modalities exist that allow to depict structural details of trabecular bone tissue. Recently, non-linear techniques in 2D and 3D based on the scaling vector method (SVM) and the Minkowski functionals (MF) have been introduced, which show excellent performance in predicting bone strength and fracture risk. However, little is known about the performance of the various parameters with respect to monitoring structural changes due to progression of osteoporosis or as a result of medical treatment. We test and compare the two methodologies using realistic two-dimensional simulations of bone structures, which model the effect of osteoblasts and osteoclasts on the local change of relative bone density. Different realizations with slightly varying control parameters are considered. Our results show that even small changes in the trabecular structures, which are induced by variation of a control parameter of the system, become discernible by applying both the MF and the locally adapted scaling vector method. The results obtained with SVM are superior to those obtained with the Minkowski functionals. An additive combination of both measures drastically increases the sensitivity to slight changes in bone structures. These findings may be especially important for monitoring the treatment of patients, where the early recognition of (drug-induced) changes in the trabecular structure is crucial.

Improving the textural characterization of trabecular bone structure to quantify its changes: the locally adapted scaling vector method

We extend the recently introduced scaling vector method (SVM) to improve the textural characterization of oriented trabecular bone structures in the context of osteoporosis. Using the concept of scaling vectors one obtains non-linear structural information from data sets, which can account for global anisotropies. In this work we present a method which allows us to determine the local directionalities in images by using scaling vectors. Thus it becomes possible to better account for local anisotropies and to implement this knowledge in the calculation of the scaling properties of the image. By applying this adaptive technique, a refined quantification of the image structure is possible: we test and evaluate our new method using realistic two-dimensional simulations of bone structures, which model the effect of osteoblasts and osteoclasts on the local change of relative bone density. The partial differential equations involved in the model are solved numerically using cellular automata (CA). Different realizations with slightly varying control parameters are considered. Our results show that even small changes in the trabecular structures, which are induced by variation of a control parameters of the system, become discernible by applying the locally adapted scaling vector method. The results are superior to those obtained by isotropic and/or bulk measures. These findings may be especially important for monitoring the treatment of patients, where the early recognition of (drug-induced) changes in the trabecular structure is crucial.