G. Van der Perre

Do quantitative ultrasound measurements reflect structure independently of density in human vertebral cancellous bone

Ultrasonic measurements were made in three orthogonal directions on 70 vertebral bone cubes. Apparent density (rho) was determined, and microcomputed tomography was used to derive a range of microstructural parameters. Qualitatively different ultrasonic behavior was observed in the craniocaudal (CC) axis, in which two distinct waves propagated. In this direction, only attenuation correlated strongly with rho (r2 = 80%), whereas, in the anteroposterior (AP) and mediolateral (ML) axes, there were significant correlations between all ultrasonic parameters and rho (r2 = 57%-79%). Microstructural parameters were, in general, correlated with ultrasonic properties, but when adjusted for rho, few significant relationships remained and the additional variance explained by individual microstructural parameters was relatively small (< 25% for CC axis, < 3% for AP, 0% for ML). In stepwise regression analysis including rho and all of the microstructural parameters, rho remained the primary determinant of ultrasonic properties in the transverse axes: Combinations of structural parameters explained, at most, an additional of 6% of the variability in ultrasonic properties in the AP axis, but failed to contribute significantly in the ML axis. In the CC axis, structural parameters played a greater role, but the pattern of associations was complex and the predictive power of the models was generally much less than that for the transverse axes. These data indicate that the ability of ultrasound to reflect aspects of trabecular structure is strongly dependent on the direction in which ultrasonic measurements are made, and provide only qualified support for the hypothesis that ultrasound reflects cancellous bone structure independently of bone density.

A comparison of time-domain and frequency-domain approaches to ultrasonic velocity measurement in trabecular bone

Different methods for ultrasonic velocity determination using broad-band pulse transmission have been investigated in 70 human calcanae in vitro. The work took place within the context of the EC BIOMED1 concerted action Assessment of Quality of Bone in Osteoporosis. Ultrasonic velocities were determined using three different transit time definitions: first arrival (TTV1), thresholding (TTV2), and first zero crossing (TTV3). Phase velocity (PV) was determined over a range of frequencies from 200 to 800 kHz using a new phase spectral analysis technique. The different velocity measurements were compared in terms of their magnitudes and their inter-correlations. There were significant differences of up to 260 m s-1 between different transit time velocities (p < 0.0001), indicating the sensitivity of the measurement to the arrival criteria used. Phase velocities were lower than all of the transit time velocities (p < 0.0001) and decreased with increasing frequency (p < 0.005). A strong correlation (r2 = 0.968) was observed between PV at 400 kHz (PV400) and TTV3, with much weaker correlations between PV and the other transit time velocities. Reproducibility for transit time velocity measurement was optimal for TTV3 (coefficient of variation, cv = 0.41%), and for PV it was optimal at 600 kHz (cv = 0.34%). These data indicate that transit time measurements may be subject to errors due to the modification of the pulse shape during propagation through bone by attenuation and dispersion. Velocity measurement by phase spectral analysis appears to offer advantages over the transit time approach, and should be the method of choice for velocity measurement in trabecular bone. Where transit time velocity measurements are made, the first-zero-crossing criterion appears to be have some advantages over other arrival criteria. We also note that PV measurements provide new information on dispersion which could prove to be relevant to the structural and mechanical characterization of trabecular bone.

Quantitative ultrasound and trabecular architecture in the human calcaneus.

Relationships between quantitative ultrasound (QUS), density (bone volume density [BV/TV]), and trabecular architecture were investigated in 69 calcaneal cancellous bone cubes. Ultrasound signal velocity, phase velocity, attenuation, and broadband ultrasonic attenuation (BUA) measurements were made along the mediolateral axis. Density and architectural parameters were measured using microcomputed tomography (μCT). Density yielded the best correlations with QUS (r2 = 73–77%). Of the individual architectural parameters, correlations with QUS were highest for the Structure Model Index (SMI), a parameter quantifying the relative proportion of rods and plates (r2 = 57–63%). After adjustment for density, significant associations with QUS remained for SMI, trabecular spacing (Tb.Sp), and trabecular number (Tb.N), although the variance in QUS attributable uniquely to individual architectural parameters was at best 4%. In multivariate regression models, combinations of density and architectural parameters explained 76–82% of the variance in QUS, representing an r2 increase of, at most, 8% compared with using density alone. However, multivariate models using combinations of architectural parameters alone (i.e., density excluded) also had a good predictive ability for QUS (r2 = 73–81%). Thus, although these data show modest but significant density‐independent relationships between QUS and trabecular architecture in the human calcaneus for the first time, the causal relationships behind the variation in acoustic properties remain obscure. Given the relative weakness and complexity of the emerging associations between QUS and architecture, it is prudent to regard QUS measurements in calcaneal bone primarily as an indicator of bone density.

Ultrasound velocity measurement in long bones: Measurement method and simulation of ultrasound wave propagation

A new method for the measurement of ultrasound velocity in long bones is presented. The method can be applied in vitro as well as in vivo. It automatically corrects for the influence of soft tissue, such that the real velocity in bone is obtained. In a series of simulation experiments, hypotheses on the followed wave path were verified. A very good agreement was found between the measurement obtained in the experimental set-up and the values calculated for the hypothesised wave path in the experimental structure. These simulations revealed the feasibility of the technique to determine the velocity in a local site of the structure. Clinical applications of this technique include the monitoring of callus consolidation after fracture and the detection of bone degenerative diseases such as osteoporosis.

A fast convolution-based methodology to simulate 2-Dd/3-D cardiac ultrasound images

This paper describes a fast convolution-based methodology for simulating ultrasound images in a 2-D/3-D sector format as typically used in cardiac ultrasound. The conventional convolution model is based on the assumption of a space-invariant point spread function (PSF) and typically results in linear images. These characteristics are not representative for cardiac data sets. The spatial impulse response method (IRM) has excellent accuracy in the linear domain; however, calculation time can become an issue when scatterer numbers become significant and when 3-D volumetric data sets need to be computed. As a solution to these problems, the current manuscript proposes a new convolution-based methodology in which the data sets are produced by reducing the conventional 2-D/3-D convolution model to multiple 1-D convolutions (one for each image line). As an example, simulated 2-D/3-D phantom images are presented along with their gray scale histogram statistics. In addition, the computation time is recorded and contrasted to a commonly used implementation of IRM (Field II). It is shown that COLE can produce anatomically plausible images with local Rayleigh statistics but at improved calculation time (1200 times faster than the reference method).

Structural and material mechanical properties of human vertebral cancellous bone

The structural Youngs modulus (i.e. that of the cancellous framework) was determined by non-destructive compressive mechanical testing in the three orthogonal axes of 48 vertebral bone cubes. In addition, the material Youngs modulus (i.e. of the trabeculae themselves) was estimated using an ultrasonic technique. Apparent and true density were determined by direct physical measurements. Significant mechanical anisotropy was observed: mean structural Youngs modulus varied from 165 MPa in the supero-inferior direction to 43 MPa in the lateral direction. Structural Youngs modulus correlated with apparent density, with power-law regression models giving the best correlations (r2 = 0.52-0.88). Mechanical anisotropy increased as a function of decreasing apparent density (p < 0.001). Material Youngs modulus was 10.0 +/- 1.3 GPa, and was negatively correlated with apparent density (p < 0.001). In multiple regression models, material Youngs modulus was a significant independent predictor of structural Youngs modulus only in the supero-inferior direction. The data suggest the presence of two effects in vertebral bone associated with decreasing apparent density and, by implication, bone loss in general: (a) increased mechanical anisotropy, such that there is relative conservation of stiffness in the axial direction compared with the transverse directions; and (b) increased stiffness of the trabeculae themselves.

Subject-specific hip geometry and hip joint centre location affects calculated contact forces at the hip during gait

Hip loading affects the development of hip osteoarthritis, bone remodelling and osseointegration of implants. In this study, we analyzed the effect of subject-specific modelling of hip geometry and hip joint centre (HJC) location on the quantification of hip joint moments, muscle moments and hip contact forces during gait, using musculoskeletal modelling, inverse dynamic analysis and static optimization. For 10 subjects, hip joint moments, muscle moments and hip loading in terms of magnitude and orientation were quantified using three different model types, each including a different amount of subject-specific detail: (1) a generic scaled musculoskeletal model, (2) a generic scaled musculoskeletal model with subject-specific hip geometry (femoral anteversion, neck-length and neck-shaft angle) and (3) a generic scaled musculoskeletal model with subject-specific hip geometry including HJC location. Subject-specific geometry and HJC location were derived from CT. Significant differences were found between the three model types in HJC location, hip flexion-extension moment and inclination angle of the total contact force in the frontal plane. No model agreement was found between the three model types for the calculation of contact forces in terms of magnitude and orientations, and muscle moments. Therefore, we suggest that personalized models with individualized hip joint geometry and HJC location should be used for the quantification of hip loading. For biomechanical analyses aiming to understand modified hip joint loading, and planning hip surgery in patients with osteoarthritis, the amount of subject-specific detail, related to bone geometry and joint centre location in the musculoskeletal models used, needs to be considered.

Subject-specific hip geometry affects predicted hip joint contact forces during gait

Hip loading affects bone remodeling and implant fixation. In this study, we have analyzed the effect of subject-specific modeling of hip geometry on muscle activation patterns and hip contact forces during gait, using musculoskeletal modeling, inverse dynamic analysis and static optimization. We first used sensitivity analysis to analyze the effect of isolated changes in femoral neck-length (NL) and neck-shaft angle (NSA) on calculated muscle activations and hip contact force during the stance phase of gait. A deformable generic musculoskeletal model was adjusted incrementally to adopt a physiological range of NL and NSA. In a second similar analysis, we adjusted hip geometry to the measurements from digitized radiographs of 20 subjects with primary hip osteoarthrosis. Finally, we studied the effect of hip abductor weakness on muscle activation patterns and hip contact force. This analysis showed that differences in NL (41-74 mm) and NSA (113-140 degrees ) affect the muscle activation of the hip abductors during stance phase and hence hip contact force by up to three times body weight. In conclusion, the results from both the sensitivity and subject-specific analysis showed that at the moment of peak contact force, altered NSA has only a minor effect on the loading configuration of the hip. Increased NL, however, results in an increase of the three hip contact-force components and a reduced vertical loading. The results of these analyses are essential to understand modified hip joint loading, and for planning hip surgery for patients with osteoarthrosis.

Use of microfocus computerized tomography as a new technique for characterizing bone tissue around oral implants.

Qualitative and quantitative analysis of peri-implant tissues around retrieved oral implants is typically done by means of light microscopy on thin histological sections containing the metal surface and the undecalcified bone. It remains, however, a labor-intensive and thus time-consuming job. Moreover, it is a destructive technique that allows tissue quantification in only a limited number of two-dimensional sections. As an alternative, we evaluated the bone structure around screw-shaped titanium implants by means of microfocus computerized tomography (micro-CT) because it presents a number of advantages compared to conventional sectioning techniques: micro-CT is nondestructive, fast, and allows a fully three-dimensional characterization of the bone structure around the implant. Images can be reconstructed in an arbitrary plane, and three-dimensional reconstructions are also possible. Because of its high resolution, individual trabeculae can be visualized. The accuracy of micro-CT was qualitatively evaluated by comparing histological sections with the corresponding CT slices for the same specimen. The overall trabecular structure is very similar according to both techniques. Even very close to the interface, the titanium implant does not seem to produce significant artifacts. Furthermore, because the complete digital data on the trabecular bone structure around the implant is available, it is possible to create finite-element models of the bone-implant system that model the trabeculae in detail so that mechanical stress transfer at the interface can be studied at the level of individual trabeculae. Therefore, micro-CT seems to be very promising for the in vitro assessment of the three-dimensional bone structure around oral implants. Further research will be needed to evaluate its accuracy in a more quantitative way.

Assessment of tibial stiffness by vibration testing in situ—II. Influence of soft tissues, joints and fibula

The influence of soft tissues and joints on the vibration of the human tibia was examined by modal analysis on amputated lower limbs, where the soft tissues and the fibula were dissected gradually. Measurements were made in two different set ups, IFR and BRA, which were both designed to monitor fracture healing. In IFR, vibrations are generated by hammer impact on a relaxed hanging lower leg, with the knee flexed. Resonant frequencies are determined by a computer Fourier transform procedure. In BRA, a steady state vibration is induced in a lower leg, supported near the ankle and the tibial tuberosity, using an electromagnetic shaker. Resonant frequencies are determined from the maxima in vibration amplitudes. In both set ups the soft tissues have a similar influence on the vibration of the tibia: the skin hardly influences the determined modal parameter. The mass of the muscles influences both the resonant frequency and the damping. The fibula has a stiffening effect on the tibia. The influence of the joints is small in the IFR-set up: the tibia vibrates in conditions close to those for the free-free vibration. In the BRA-set up, the supports determine the boundary conditions.