Identify fracture-critical regions inside the proximal femur using statistical parametric mapping
Identify fracture-critical regions inside the proximal femur using statistical parametric mapping
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DOI：
10.1016/j.bone.2008.12.008
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发表时间：
2009-04-01
期刊：
影响因子：
4.1
通讯作者：
Lang, Thomas
中科院分区：
文献类型：
--
作者：
Li, Wenjun;Kornak, John;Lang, Thomas
我们确定了股骨近端内与髋部骨折最密切相关的区域。基于此类骨折关键区域的骨密度测量显示，区分骨折患者和对照组的能力有所提高。简介：髋部骨折通常发生在侧向跌倒时，局部组织局部机械故障，其中所施加的应力超过了强度。在这项研究中，我们描述了一种新的方法来识别与髋部骨折最相关的近端股骨组织元素。我们假设，在这些子体积中测量的骨矿物质密度 (BMD) 比股骨颈和转子等标准解剖区域的 BMD 更能区分髋部骨折风险。 材料和方法：我们采用受试者间配准将 37 名髋部骨折患者和 38 名年龄匹配对照的髋部 QCT 图像转换为基于体素的统计图谱。在体素内，我们在两组之间进行 t 检验，以确定差异最大的区域。然后，我们将 75 次扫描随机分为训练集和测试集。从训练集中，我们根据与骨折的关联得出了骨折驱动的感兴趣区域 (ROI)。在测试集中，我们测量了该 ROI 中的 BMD，以使用 ROC 分析确定骨折辨别功效。此外，我们还比较了29例颈部骨折患者和8例转子骨折患者之间的BMD分布差异。结果：通过基于ROC分析评估骨折辨别能力，骨折驱动的ROI的AUC（曲线下面积）为0.92，而解剖ROI（包括整个股骨近端、股骨颈、转子及其皮质和小梁室）的AUC值为0.92。 0.78 和 0.87。我们还观察到颈骨折患者在股骨颈和股骨头附近的小区域具有较低的BMD（p = 0.014），而股骨转子骨折患者在转子区域（例如内距隔）具有较低的BMD（p = 0.006）。结论：我们已经确定了与髋部骨折关联性最强的股骨近端组织的子体积。通过关注骨折关键区域（而不是标准 ROI）的 BMD 测量，可以提高预测骨折的能力。 (C) 2008 Elsevier Inc. 保留所有权利。
We identified regions inside the proximal femur that are most strongly associated with hip fracture. Bone densitometry based on such fracture-critical regions showed improved power in discriminating fracture patients from controls.Introduction: Hip fractures typically occur in lateral falls, with focal mechanical failure of the sub-volumes of tissue in which the applied stress exceeds the strength. In this Study, we describe a new methodology to identify proximal femoral tissue elements with highest association with hip fracture. We hypothesize that bone mineral density (BMD) measured in such sub-volumes discriminates hip fracture risk better than BMD in standard anatomic regions such as the femoral neck and trochanter.Materials and methods: We employed inter-subject registration to transform hip QCT images of 37 patients with hip fractures and 38 age-matched controls into a voxel-based statistical atlas. Within voxels, we performed t-tests between the two groups to identify the regions which differed most. We then randomly divided the 75 scans into a training set and a test set. From the training set, we derived a fracture-driven region of interest (ROI) based on association with fracture. In the test set, we measured BMD in this ROI to determine fracture discrimination efficacy using ROC analysis. Additionally, we compared the BMD distribution differences between the 29 patients with neck fractures and the 8 patients with trochanteric fractures.Results: By evaluating fracture discrimination power based on ROC analysis, the fracture-driven ROI had an AUC (area under curve) of 0.92, while anatomic ROIs (including the entire proximal femur, the femoral neck, trochanter and their cortical and trabecular compartments) had AUC values between 0.78 and 0.87. We also observed that the neck fracture patients had lower BMD (p=0.014) in a small region near the femoral neck and the femoral head, and patients with trochanteric fractures had lower BMD in trochanteric regions such as in the internal calcar septum (p=0.006).Conclusions: We have identified the sub-volumes of proximal femoral tissue which have the strongest association with hip fracture. The power to predict fracture can be improved, by focusing on BMD measurements in the fracture-critical regions, rather than in standard ROIs. (C) 2008 Elsevier Inc. All rights reserved.