Opportunistic hip fracture risk prediction in Men from X-ray: Findings from the Osteoporosis in Men (MrOS) Study

Osteoporosis is a common disease that increases fracture risk. Hip fractures, especially in elderly people, lead to increased morbidity, decreased quality of life and increased mortality. Being a silent disease before fracture, osteoporosis often remains undiagnosed and untreated. Areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry (DXA) is the gold-standard method for osteoporosis diagnosis and hence also for future fracture prediction (prognostic). However, the required special equipment is not broadly available everywhere, in particular not to patients in developing countries. We propose a deep learning classification model (FORM) that can directly predict hip fracture risk from either plain radiographs (X-ray) or 2D projection images of computed tomography (CT) data. Our method is fully automated and therefore well suited for opportunistic screening settings, identifying high risk patients in a broader population without additional screening. FORM was trained and evaluated on X-rays and CT projections from the Osteoporosis in Men (MrOS) study. 3108 X-rays (89 incident hip fractures) or 2150 CTs (80 incident hip fractures) with a 80/20 split were used. We show that FORM can correctly predict the 10-year hip fracture risk with a validation AUC of 81.44 +- 3.11% / 81.04 +- 5.54% (mean +- STD) including additional information like age, BMI, fall history and health background across a 5-fold cross validation on the X-ray and CT cohort, respectively. Our approach significantly (p < 0.01) outperforms previous methods like Cox Proportional-Hazards Model and \frax with 70.19 +- 6.58 and 74.72 +- 7.21 respectively on the X-ray cohort. Our model outperform on both cohorts hip aBMD based predictions. We are confident that FORM can contribute on improving osteoporosis diagnosis at an early stage.Comment: Accepted at MICCAI 2022 Workshop (PRIME

Binary Local Fractal Dimension: a Precise Structure Parameter for 3D High Resolution Computed Tomography Images of the Human Spongiosa

We present the Binary Local Fractal Dimension (LFD) to analyze osteoporosis induced fracture risk with clinical 3D high resolution quantitative computed tomographic (HRCT) images of human vertebrae. We test if LFD parameters provide precise additional information besides bone mineral density (BMD) and standard descriptors of bone quality, for example bone surface ratio (BS/BV). We define a weighted LFD (wLFD) using the ¯R2 of the H¨older exponents. We compare the LFD with standard methods (distance transform, direct secant method and run-length method) on 5 vertebrae × 8 volumes of interest and 5 repeated scans. The wLFD contains the highest direct and BMD-independent precision (R2 = 0.985 and R2 = 0.949), followed by BS/BV (R2 = 0.977 and R2 = 0.920) including low correlation with BMD (wLFD: R2 = 0.704, BS/BV: R2 = 0.814). LFD improves the translation from reference μCT- to clinical HRCT-resolution. In conclusion, LFD provides a strong diagnostic tool to characterize bone quality to predict osteoporosis induced fracture risk.Sociedad Argentina de Informática e Investigación Operativ

Binary Local Fractal Dimension: a Precise Structure Parameter for 3D High Resolution Computed Tomography Images of the Human Spongiosa

We present the Binary Local Fractal Dimension (LFD) to analyze osteoporosis induced fracture risk with clinical 3D high resolution quantitative computed tomographic (HRCT) images of human vertebrae. We test if LFD parameters provide precise additional information besides bone mineral density (BMD) and standard descriptors of bone quality, for example bone surface ratio (BS/BV). We define a weighted LFD (wLFD) using the ¯R2 of the H¨older exponents. We compare the LFD with standard methods (distance transform, direct secant method and run-length method) on 5 vertebrae × 8 volumes of interest and 5 repeated scans. The wLFD contains the highest direct and BMD-independent precision (R2 = 0.985 and R2 = 0.949), followed by BS/BV (R2 = 0.977 and R2 = 0.920) including low correlation with BMD (wLFD: R2 = 0.704, BS/BV: R2 = 0.814). LFD improves the translation from reference μCT- to clinical HRCT-resolution. In conclusion, LFD provides a strong diagnostic tool to characterize bone quality to predict osteoporosis induced fracture risk.Sociedad Argentina de Informática e Investigación Operativ

Binary Local Fractal Dimension: a Precise Structure Parameter for 3D High Resolution Computed Tomography Images of the Human Spongiosa

We present the Binary Local Fractal Dimension (LFD) to analyze osteoporosis induced fracture risk with clinical 3D high resolution quantitative computed tomographic (HRCT) images of human vertebrae. We test if LFD parameters provide precise additional information besides bone mineral density (BMD) and standard descriptors of bone quality, for example bone surface ratio (BS/BV). We define a weighted LFD (wLFD) using the ¯R2 of the H¨older exponents. We compare the LFD with standard methods (distance transform, direct secant method and run-length method) on 5 vertebrae × 8 volumes of interest and 5 repeated scans. The wLFD contains the highest direct and BMD-independent precision (R2 = 0.985 and R2 = 0.949), followed by BS/BV (R2 = 0.977 and R2 = 0.920) including low correlation with BMD (wLFD: R2 = 0.704, BS/BV: R2 = 0.814). LFD improves the translation from reference μCT- to clinical HRCT-resolution. In conclusion, LFD provides a strong diagnostic tool to characterize bone quality to predict osteoporosis induced fracture risk.Sociedad Argentina de Informática e Investigación Operativ

Dual-Layer Spectral-Computed Tomography Enhances the Separability of Calcium-Based Implant Material from Bone: An Ex Vivo Quantitative Imaging Study

Local treatment of bone loss with an injection of a resorbable, calcium-based implant material to replace bone has a long history of clinical use. The in vivo discrimination of changes in bone versus implant is challenging with standard computed tomography (CT). However, spectral-CT techniques enable the separation between tissues of similar densities but different chemical compositions. Dual-layer spectral-CT imaging and postprocessing analysis methods were applied to investigate the separability of AGN1 (a triphasic calcium-based implant) and bone after AGN1 injection in n = 10 male cadaveric femurs ex vivo. Using the area under the curve (AUC) from receiver-operating characteristic (ROC) analyses, the separability of AGN1 from bone was assessed for AGN1 (postoperatively) versus compact and versus femoral neck cancellous bone (both preoperatively). CT techniques included conventional Hounsfield (HU) and density-equivalent units (BMD, mg hydroxyapatite [HA]/cm3 ) and spectral-CT measures of effective atomic number (Zeff) and electron density (ED). The samples had a wide range of femoral neck BMD (55.66 to 241.71 mg HA/cm3 ). At the injection site average BMD, HU, Zeff, and ED increased from 69.5 mg HA/cm3 , 109 HU, 104.38 EDW, and 8.30 Zeff in the preoperative to 1233 mg HA/cm3 , 1741 HU, 181.27 EDW, and 13.55 Zeff in the postoperative CT scan, respectively. For compact bone at the femoral shaft the preoperative values were 1124.15 mg HA/cm3 , 1648 HU, 177 EDW, and 13.06 Zeff and were maintained postoperatively. Zeff showed substantially sharper distributions and significantly greater separability compared to ED, BMD, and HU (all p < 0.002, for both regions) with average AUCs for BMD, HU, ED, and Zeff of 0.670, 0.640, 0.645, and 0.753 for AGN1 versus compact and 0.996, 0.995, 0.994, and 0.998 for AGN1 versus femoral neck cancellous sites, respectively

Correction: Large cortical bone pores in the tibia are associated with proximal femur strength

[This corrects the article DOI: 10.1371/journal.pone.0215405.

Assessment of anti-inflammatory tumor treatment efficacy by longitudinal monitoring employing sonographic micro morphology in a preclinical mouse model

<p>Abstract</p> <p>Background</p> <p>With the development of increasingly sophisticated three-dimensional volumetric imaging methods, tumor volume can serve as a robust and reproducible measurement of drug efficacy. Since the use of molecularly targeted agents in the clinic will almost certainly involve combinations with other therapeutic modalities, the use of volumetric determination can help to identify a dosing schedule of sequential combinations of cytostatic drugs resulting in long term control of tumor growth with minimal toxicity. The aim of this study is to assess high resolution sonography imaging for the in vivo monitoring of efficacy of Infliximab in pancreatic tumor.</p> <p>Methods</p> <p>In the first experiment, primary orthotopic pancreatic tumor growth was measured with Infliximab treatment. In the second experiment, orthotopic tumors were resected ten days after inoculation of tumor cells and tumor recurrence was measured following Infliximab treatment. Tumor progression was evaluated using 3D high resolution sonography.</p> <p>Results</p> <p>Sonography measurement of tumor volume in vivo showed inhibitory effect of Infliximab on primary tumor growth in both non-resected and resected models. Measurement of the dynamics of tumor growth by sonography revealed that in the primary tumor Infliximab is effective against established tumors while in the resection model, Infliximab is more effective at an early stage following tumor resection. Infliximab treatment is also effective in inhibiting tumor growth growth as a result of tumor cell contamination of the surgical field.</p> <p>Conclusions</p> <p>Clinical application of Infliximab is feasible in both the neoadjuvant and adjuvant setting. Infliximab is also effective in slowing the growth of tumor growth under the peritoneum and may have application in treating peritoneal carcinomatosis. Finally the study demonstrates that high resolution sonography is a sensitive imaging modality for the measurement of pancreatic tumor growth.</p

Effect of Constitution on Mass of Individual Organs and Their Association with Metabolic Rate in Humans—A Detailed View on Allometric Scaling

Resting energy expenditure (REE)-power relationships result from multiple underlying factors including weight and height. In addition, detailed body composition, including fat free mass (FFM) and its components, skeletal muscle mass and internal organs with high metabolic rates (i.e. brain, heart, liver, kidneys), are major determinants of REE. Since the mass of individual organs scales to height as well as to weight (and, thus, to constitution), the variance in these associations may also add to the variance in REE. Here we address body composition (measured by magnetic resonance imaging) and REE (assessed by indirect calorimetry) in a group of 330 healthy volunteers differing with respect to age (17–78 years), sex (61% female) and BMI (15.9–47.8 kg/m2). Using three dimensional data interpolation we found that the inter-individual variance related to scaling of organ mass to height and weight and, thus, the constitution-related variances in either FFM (model 1) or kidneys, muscle, brain and liver (model 2) explained up to 43% of the inter-individual variance in REE. These data are the first evidence that constitution adds to the complexity of REE. Since organs scale differently as weight as well as height the “fit” of organ masses within constitution should be considered as a further trait

FRAX (R): Prediction of Major Osteoporotic Fractures in Women from the General Population: The OPUS Study

Purposes: The aim of this study was to analyse how well FRAXH predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population. Patients and methods: The OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAXH performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI). Results: 85 (4.9%) patients had incident major fractures over 6 years. FRAXH with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAXH with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAXH. Conclusions: This study shows that FRAXH with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population