Tarsal and metatarsal bone mineral density measurement using volumetric quantitative computed tomography

A new method for measuring bone mineral density (BMD) of the tarsal and metatarsals is described using volumetric quantitative computed tomography (VQCT) in subjects with diabetes mellitus and peripheral neuropathy. VQCT images of a single foot were acquired twice from eight subjects (mean age 51 [11 SD], seven males, one female). The cortical shells of the seven tarsal and five metatarsal bones were identified and semiautomatically segmented from adjacent bones. Volume and BMD of each bone were measured separately from the two acquired scans for each subject. Whole-bone semiautomatic segmentation measurement errors were determined as the root mean square coefficient of variation for the volume and BMD of 0.8% and 0.9%, respectively. In addition to the whole-bone segmentation methods, we performed atlas-based partitioning of subregions within the second metatarsal for all subjects, from which the volumes and BMDs were obtained for each subregion. The subregion measurement BMD errors (root mean square coefficient of variation) within the shaft, proximal end, and distal end were shown to vary by approximately 1% between the two scans of each subject. The new methods demonstrated large variations in BMDs between the 12 bones of the foot within a subject and between subjects, and between subregions within the second metatarsal. These methods can provide an important outcome measure for clinical research trials investigating the effects of interventions, aging, or disease progression on bone loss, or gain, in individual foot bones.