Advanced CT bone imaging in osteoporosis

• Published in: Rheumatology (Oxford, England) Vol. 47; no. suppl-4; pp. iv9 - iv16
• Main Authors: Genant, H. K., Engelke, K., Prevrhal, S.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Oxford University Press 01.07.2008; Oxford Publishing Limited (England)
• Subjects: Absorptiometry, Photon - methods; Biological and medical sciences; Bone and Bones - diagnostic imaging; Bone imaging; Bone mineral density; Bone quality; Bone structure; Computed tomography; Diseases of the osteoarticular system; Dual X-ray absorptiometry; Humans; Image Processing, Computer-Assisted; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Micro computed tomography; Osteoarticular system. Muscles; Osteoporosis; Osteoporosis - diagnostic imaging; Osteoporosis. Osteomalacia. Paget disease; Quantitative computed tomography; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Tomography, X-Ray Computed - methods; Osteoporosis; Micro computed tomography; Computed tomography; Quantitative computed tomography; Dual X-ray absorptiometry; Bone quality; Bone mineral density; Bone imaging; Bone structure; Radiodiagnosis; Diseases of the osteoarticular system; Rheumatology; X ray; Quality; Medical imagery; Computerized axial tomography; Bone; Quantitative analysis
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/ken180

Non-invasive and/or non-destructive techniques can provide structural information about bone, beyond simple bone densitometry. While the latter provides important information about osteoporotic fracture risk, many studies indicate that BMD only partly explains bone strength. Quantitative assessment of macro- and microstructural features may improve our ability to estimate bone strength. Methods for quantitatively assessing macrostructure include (besides conventional radiographs) DXA and CT, particularly volumetric quantitative CT (vQCT). Methods for assessing microstructure of trabecular bone non-invasively and/or non-destructively include high-resolution CT (hrCT), microCT (μCT), high-resolution magnetic resonance (hrMR) and microMR (μMR). vQCT, hrCT and hrMR are generally applicable in vivo; μCT and μMR are principally applicable in vitro. Despite recent progress made with these advanced imaging techniques, certain issues remain. The important balances between spatial resolution and sampling size, or between signal-to-noise and radiation dose or acquisition time, need further consideration, as do the complexity and expense of the methods vs their availability and accessibility. Clinically, the challenges for bone imaging include balancing the advantages of simple bone densitometry vs the more complex architectural features of bone or the deeper research requirements vs the broader clinical needs. The biological differences between the peripheral appendicular skeleton and the central axial skeleton must be further addressed. Finally, the relative merits of these sophisticated imaging techniques must be weighed with respect to their applications as diagnostic procedures, requiring high accuracy or reliability, compared with their monitoring applications, requiring high precision or reproducibility.