Measurement of changes in trabecular bone at fracture sites using X-ray CT and automated image registration and processing
Measurement of changes in trabecular bone at fracture sites using X-ray CT and automated image registration and processing
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DOI：
10.1016/s0736-0266(03)00197-9
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发表时间：
2004-03-01
影响因子：
2.8
通讯作者：
Genant, HK
中科院分区：
文献类型：
--
作者：
Lynch, JA;Grigoryan, M;Genant, HK
目前，还没有体内技术来量化骨折内的愈合，主要涉及小梁骨。定量评估愈合情况的方法将有助于研究新的治疗方案，并可能有助于预测患者是否正在进行延迟愈合。利用CT和自动图像配准，我们开发了一种图像处理技术，用于测量骨折部位CT图像强度的变化。这项技术专注于量化骨折间隙内新矿化组织的形成，而忽略了因废弃骨质疏松症而造成的骨矿物质损失。对7例桡骨远端骨折患者进行了骨折后12周的检查。为了评估骨折线CT强度变化测量的重复性，由两个独立的读数分别在两个不同的场合进行测量。重复性与随时间变化的速率进行比较，以确定个体进展中可检测到的差异。与定量测量相比，扫描对愈合的特征和评分进行了定性评分。在12周的随访中，CT强度的平均变化(SD)为+128(65)Hounsfield单位(HU)。观察者间和观察者内的重复性都是相似的(+/-17HU)，是研究期间变化的1/7。在这个小的患者队列中，CT强度在骨折后2周显著增加。早期CT强度的大幅升高与硬化症的早期视觉表现和骨折线模糊有关。在这项初步的、前瞻性的研究中，我们开发了一种可重复性的定量技术，用于测量骨折线上的骨小梁CT强度的变化。还需要进一步的工作来确定它是否可以用来识别或监测正在接受延迟骨折修复的患者。这项技术似乎对测量骨折后立即发生的变化很敏感，并可能在检查新疗法在患者队列中的潜在影响方面发挥作用。(C)2003年骨科研究会。爱思唯尔有限公司出版。保留所有权利。
Currently, there are no in vivo techniques for quantifying healing within fractures involving mainly trabecular bone. Methods for quantitatively assessing healing would aid the investigation of new treatment regimes, and might also be useful for predicting whether a patient may be undergoing delayed union. Using CT and automated image registration, we have developed an image processing technique for measuring changes in CT image intensity at fracture sites. The technique focuses on quantifying the formation of new mineralised tissue within fracture gaps, while ignoring loss of bone mineral due to disuse osteoporosis. Seven patients with fractures of the distal radius were examined for 12 weeks following fracture. To assess reproducibility of measurements of change in CT intensity at the fracture line, measurements were performed on two separate occasions, by each of two independent readers. Reproducibility was compared to rates of change over time, to determine detectable differences in individual progression. Scans were scored qualitatively for features of healing and scores compared to the quantitative measurements. The mean (SD) change in CT intensity was +128 (65) Hounsfield Units (HU) over the 12 week follow-up. Inter- and intra-observer reproducibilities were both similar (+/-17 HU), 1/7 of the change seen during the Study. In this small patient cohort, a significant increase in CT intensity was seen 2 weeks post-fracture. Large early increases in CT intensity were associated with early visual appearance of sclerosis and blurring of the fracture line. In this preliminary, prospective study, we have developed a reproducible quantitative technique for measuring changes in CT intensity of trabecular bone at the fracture line in the distal radius. Further work is required to determine whether it can be used to identify, or monitor patients who are undergoing delayed fracture repair. The technique appears sensitive for measuring changes immediately post-fracture, and could have a role in examining potential effects of new therapies in patient cohorts. (C) 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.