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CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone

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Abstract

Summary

This study compares the results of computed tomography X-ray absorptiometry (CTXA) hip volumetric BMD (vBMD) analyses of cortical and trabecular bone with and without partial volume correction. For cortical bone in some circumstances, corrected cortical volumes were negative and corrected vBMD was very high. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.

Purpose

Previous studies have reported concerns about the reliability of CTXA hip cortical vBMD measurements generated using partial volume (PV) correction (the “default” analysis, with cortical PV correction). To date, no studies have examined the results of the alternative (“new”) analysis (with trabecular PV correction). This study presents in vivo and phantom data comparing the corrected and uncorrected data for cortical and trabecular bone respectively.

Methods

We used the commercial QCTPro CTXA software to analyze CT scans of 129 elderly Chinese men and women and an anthropomorphic European Proximal Femur phantom (EPFP) and accessed data for two alternative scan analyses using the database dump utility. The CTXA software gives the user two methods of performing the PV correction: (1) a default analysis in which only cortical bone results are corrected; (2) a new analysis in which only trabecular bone results are corrected. Both methods are based on a numerical recalculation of vBMD values without any change in volume of interest (VOI) placement.

Result

In vivo, the results of the two analyses for integral bone were the same while cortical and trabecular results were different. PV correction of cortical bone led to a decrease of cortical volume for all four VOIs: total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter (IT) volumes were reduced on average by 7.8 cm3, 0.9 cm3, 2.5 cm3, and 4.3 cm3 respectively. For TR, where cortex was thinnest, average corrected cortical volume was negative (− 0.4± 1.3 cm3). Corrected cortical vBMD values were much larger than uncorrected ones for TH, FN, and IT. Scatter plots of corrected cortical vBMD against cortical bone thickness showed that elevated results correlated with thinner cortices. When trabecular bone was corrected for the PV effect, trabecular volumes of TH, FN, TR, and IT were reduced on average by 7.9 cm3, 0.8 cm3, 2.6 cm3, and 4.4 cm3 respectively, while vBMD measurements were increased correspondingly. The trabecular volume and vBMD measurements of the two datasets both had highly positive correlations. For the EPFP, the PV-corrected FN data deviated from the nominal phantom value, but was closer for the TR and IT VOIs. Both corrected and uncorrected data overestimated trabecular vBMD, with the corrected results showing greater deviation from nominal values.

Conclusion

The default and new CTXA analyses for volumetric data generate different results, both for cortical and trabecular bone. For cortical bone, the uncorrected results are subject to partial volume effects but the correction method of the default analysis overcorrects the effect leading to in part unreasonable results for cortical bone volume and BMD. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.

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Acknowledgments

The authors would like to thank Prof. Klaus Engelke (Department of Medicine 3, University Hospital, University of Erlangen-Nürnberg FAU) and Prof. Glen M. Blake (School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital) for their most helpful comments on drafts of this paper.

Funding

This study was supported by grants from the Beijing Bureau of Health 215 program (grant nos. 2013-3-033, 2009-2-03), the Beijing Natural Science Foundation-Haidian Primitive Innovation Joint Fund (grant no. L172019), the National Natural Science Foundation of China (grant no. 81771831; 81901718), Beijing Jishuitan Hospital Nova Program (grant no. XKXX201812), and Beijing Talents Fund (grant no. 015000021467G177).

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Author notes

  1. Y. Liu and L. Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China

    Y. Liu, L. Wang, Y. Su, R. Yang, Y. Zhang, Z. Guo, W. Zhang, D. Yan & X. Cheng

  2. Mindways Software, Austin, 78704, TX, USA

    K. Brown

  3. Department of Radiology, The First Affiliated Hospital of USTC South District, Hefei, 230036, China

    Y. Duanmu

  4. Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China

    C. Yan

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Correspondence to X. Cheng.

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Conflict of interest

K. Brown is a stockholder of Mindways Inc. Y. Liu, L. Wang, Y. Su, R. Yang, Y. Zhang, Y. Duanmu, Z. Guo, W. Zhang, C. Yan, D. Yan, and X. Cheng declare that they have no conflict of interest.

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Y. Liu and L. Wang should be considered co-first authors.

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Liu, Y., Wang, L., Su, Y. et al. CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone. Arch Osteoporos 15, 50 (2020). https://doi.org/10.1007/s11657-020-00721-8

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