• A J Burghardt, G J Kazakia, T M Link, and S Majumdar.
• Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA 94158, ... more USA. andrew.burghardt@radiology.ucsf.edu less
• Osteoporos Int. 2009 Dec 1; 20 (12): 2017-24.

SummaryAn automated image processing method is presented for simulating areal bone mineral density measures using high-resolution peripheral quantitative computed tomography (HR-pQCT) in the ultra-distal radius. The accuracy of the method is validated against clinical dual X-ray absorptiometry (DXA). This technique represents a useful reference to gauge the utility of novel 3D quantification methods applied to HR-pQCT in multi-center clinical studies and potentially negates the need for separate forearm DXA measurements.IntroductionOsteoporotic status is primarily assessed by measuring areal bone mineral density (aBMD) using 2D dual X-ray absorptiometry (DXA). However, this technique does not sufficiently explain bone strength and fracture risk. High-resolution peripheral quantitative computed tomography (HR-pQCT) has been introduced as a method to quantify 3D bone microstructure and biomechanics. In this study, an automated method is proposed to simulate aBMD measures from HR-pQCT distal radius images.MethodsA total of 117 subject scans were retrospectively analyzed from two clinical bone quality studies. The distal radius was imaged by HR-pQCT and DXA on one of two devices (Hologic or Lunar). Areal BMD was calculated by simulation from HR-pQCT images (aBMD(sim)) and by standard DXA analysis (aBMD(dxa)).ResultsThe reproducibility of the simulation technique was 1.1% (root mean-squared coefficient of variation). HR-pQCT-based aBMD(sim) correlated strongly to aBMD(dxa) (Hologic: R (2) = 0.82, Lunar: R (2) = 0.87), though aBMD(sim) underestimated aBMD(dxa) for both DXA devices (p < 0.0001). Finally, aBMD(sim) predicted aBMD at the proximal femur and lumbar spine with equal power compared to aBMD(dxa).ConclusionThe results demonstrate that aBMD can be simulated from HR-pQCT images of the distal radius. This approach has the potential to serve as a surrogate forearm aBMD measure for clinical HR-pQCT studies when axial bone mineral density values are not required.

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