This article appears in the following Rheumatology issue: Management of Osteoporosis: A Physiological Answer for a Living Tissue. Proceedings of a satellite symposium held on the occasion of the EULAR Congress, Paris, France, June 13, 2008. The symposium and these proceedings were made possible by an unrestricted educational grant from Servier [View the issue table of contents]
Advanced CT bone imaging in osteoporosis
1University of California, 2Synarc, Inc., San Francisco, CA, USA, 3Department of Medical Physics, University of Erlangen-Nürnberg, Erlangen, 4Synarc, Inc., Hamburg, Germany and 5Department of Radiology, University of California, San Francisco, CA, USA.
Correspondence to: H. K. Genant, 7 Tara Hill Rd., Tiburon, CA 94920, USA. E-mail: harry.genant{at}ucsf.edu
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Abstract |
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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.
KEY WORDS: Osteoporosis, Computed tomography, Micro computed tomography, Bone imaging, Bone quality, Bone structure, Bone mineral density, Quantitative computed tomography, Dual X-ray absorptiometry
Submitted 31 January 2008;
revised version accepted 2 April 2008.
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