Dark-field radiography for the detection of bone microstructure changes in osteoporotic human lumbar spine specimens

Dark-field radiography imaging exploits the wave character of x-rays to measure small-angle scattering on material interfaces, providing structural information with low radiation exposure. We explored the potential of dark-field imaging of bone microstructure to improve the assessment of bone strength in osteoporosis.

We prospectively examined 14 osteoporotic/osteopenic and 21 non-osteoporotic/osteopenic human cadaveric vertebrae (L2-L4) with a clinical dark-field radiography system, micro-computed tomography (CT), and spectral CT. Dark-field images were obtained in both vertical and horizontal sample positions. Bone microstructural parameters (trabecular number, Tb.N; trabecular thickness, Tb.Th; bone volume fraction, BV/TV; degree of anisotropy, DA) were measured using standard ex vivo micro-CT, while hydroxyapatite density was measured using spectral CT. Correlations were assessed using Spearman rank correlation coefficients.

The measured dark-field signal was lower in osteoporotic/osteopenic vertebrae (vertical position, 0.23 ± 0.05 versus 0.29 ± 0.04, p < 0.001; horizontal position, 0.28 ± 0.06 versus 0.34 ± 0.04, p = 0.003). The dark-field signal from the vertical position correlated significantly with Tb.N (ρ = 0.46, p = 0.005), BV/TV (ρ = 0.45, p = 0.007), DA (ρ = -0.43, p = 0.010), and hydroxyapatite density (ρ = 0.53, p = 0.010). The calculated ratio of vertical/horizontal dark-field signal correlated significantly with Tb.N (ρ = 0.43, p = 0.011), BV/TV (ρ = 0.36, p = 0.032), DA (ρ = -0.51, p = 0.002), and hydroxyapatite density (ρ = 0.42, p = 0.049).

Dark-field radiography is a feasible modality for drawing conclusions on bone microarchitecture in human cadaveric vertebral bone.

Gaining knowledge of the microarchitecture of bone contributes crucially to predicting bone strength in osteoporosis. This novel radiographic approach based on dark-field x-rays provides insights into bone microstructure at a lower radiation exposure than that of CT modalities.

Dark-field radiography can give information on bone microstructure with low radiation exposure. The dark-field signal correlated positively with bone microstructure parameters. Dark-field signal correlated negatively with the degree of anisotropy. Dark-field radiography helps to determine the directionality of trabecular loss.