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Evaluation of Cancellous Bone Density from C3 to L5 in 11 Body Donors: CT Versus Micro-CT Measurements
Guido Schröder1, Estelle Akl2, Justus Hillebrand2
1Clinic for Orthopaedics and Trauma Surgery, Sana Hospital Bad Doberan, Academic Teaching Hospital of the University of Rostock, 18209 Hohenfelde, Germany.
Insights
This study compared Hounsfield units (HU) and bone volume fraction (BVF%) to measure spinal bone density. Results show bone density decreases down the spine, with variations based on gender and fracture history, impacting osteoporosis diagnosis.
Area of Science:
- Orthopedics and Bone Health
- Radiology and Medical Imaging
- Biomedical Engineering
Background:
- Comparative studies on Hounsfield units (HU) and bone volume fraction (BVF%) for assessing cancellous bone density across the entire spine and intravertebral regions are scarce.
- Understanding variations in bone density is crucial for diagnosing osteoporosis and assessing fracture risk.
Purpose of the Study:
- To determine Hounsfield units (HU) in various spinal segments and sectional planes (sagittal, axial, coronary).
- To evaluate the significance of these measurements for bone loss and fracture risk assessment.
- To compare micro-CT derived bone volume fraction (BVF%) with CT-derived HU for bone density measurement.
Main Methods:
- Analysis of 11 human spines using high-resolution spiral CT and micro-CT.
- Measurement of cancellous bone density (HU) in vertebral bodies (C3-L5) across axial, sagittal, and coronary planes.
- Micro-CT analysis of 726 bone specimens from three quadrants (edge and central) of prepared vertebrae.
- Statistical analysis using a General Linear Model Repeated Measures, adjusted for gender, fracture status, age, and BMI.
Main Results:
- All analyzed spines exhibited osteoporosis.
- A significant craniocaudal reduction in cancellous bone density (HU and BVF%) was observed from C3 to L5 (p ≤ 0.018).
- Gender (p=0.002) and fracture status (p=0.001) significantly impacted bone density; men and individuals with fewer fractures showed higher density.
- CT measurements in the axial plane yielded higher density values than sagittal or coronary planes.
- CT measurement profiles were independent of quadrants, unlike micro-CT measurements.
Conclusions:
- Both CT-derived HU and micro-CT-derived BVF% demonstrate a craniocaudal decrease in spinal bone density.
- Significant differences in bone density exist between genders and fracture groups, with CT offering clearer visualization.
- Understanding the procedural advantages of CT and micro-CT is essential for patient-oriented osteoporosis diagnosis and management.
Abstract:
Introduction: Comparative studies on Hounsfield units (HU) and bone volume fraction (BVF%) for the demonstration of cancellous bone density in the entire spine and in the various intravertebral regions are rare. The aim of the present study was to determine HU in various segments and sectional planes (sagittal, axial, coronary) of the spine and their description in the context of bone density measurement on micro-CT, as well as the significance of the values for bone loss and fracture risk. Materials/Methods: The spines of 11 body donors were analyzed by means of high-resolution spiral CT and micro-CT. Vertebral deformities were identified on sagittal reformations and classified. Cancellous bone density in the individual vertebrae from C3 to L5, expressed in HU, was measured on CT images (in all 242 vertebral bodies). For this purpose, a manually positioned ROI was established in mid-vertebral cancellous bone in the axial, sagittal, and coronary planes. Using a Jamshidi® needle, we obtained 726 specimens from prepared vertebrae extracted from three quadrants (QI: right-sided edge, QII: central, QIII: left-sided edge) and analyzed these on a micro-CT device (SKYSCAN 1172, RJL Micro & Analytic GmbH, Germany). The study design with multiple measurements was reflected by a General Linear Model Repeated Measures. The model was adjusted to the bone density values of both procedures (HU, BVF%) in the viewed sectional planes and quadrants for 22 vertebrae, with the predictors gender and fracture status, controlled for age and body mass index (BMI). Analysis of variance provided estimations of density values and comparisons of several subgroups. Results: All spines were osteoporotic. Both procedures revealed a significant reduction in cancellous bone density from C3 to L5 (p ≤ 0.018). Gender (p = 0.002) and fracture status (p = 0.001) have an impact on bone density: men have higher bone density values than women; cases with fewer fractures also have higher bone density values. CT revealed both effects (p = 0.002 for each) with greater clarity. HU on CT measurements in the axial plane showed higher density values than in the sagittal or coronary planes. CT measurement profiles along the spine as well as along the individual profiles of the 11 body donors were independent of the measured quadrants, but the micro-CT measurements were not. Discussion: The craniocaudal reduction in bone density was demonstrated in different degrees of clarity by the two procedures. Likewise, the procedure-related visualization of differences in cancellous bone density between genders, fracture groups, sectional planes, and quadrants indicates the need for a better understanding of the advantages of each procedure for patient-oriented approaches to the diagnosis of osteoporosis. Future research should be focused on the determination of standard values and their clinical application for the prevention and treatment of osteoporosis.
