Abstract
Objective
To present a method for an automated volumetric analysis of corticocancellous bones such as the superior pubic ramus using CT data and to assess the reliability of this method.
Materials and methods
Computed tomography scans of a consecutive series of 250 patients were analyzed. A Hounsfield unit (HU) thresholding-based reconstruction technique (“Vessel Tracking,” GE Healthcare) was used. A contiguous space of cancellous bone with similar HU values between the starting and end points was automatically identified as the region of interest. The identification was based upon the density gradient to the adjacent cortical bone. The starting point was defined as the middle of the parasymphyseal corticocancellous transition zone on the axial slice showing the parasymphyseal superior pubic ramus in its maximum anteroposterior width. The end point was defined as the middle of the periarticular corticocancellous transition zone on the axial slice showing the quadrilateral plate as a thin cortical plate. The following parameters were automatically obtained on both sides: length of the center line, volume of the superior pubic ramus between the starting point and end point, minimum, maximum and mean diameter perpendicular to the center line, and mean cross-sectional area perpendicular to the center line.
Results
An automated analysis without manual adjustments was successful in 207 patients (82.8%). The center line showed a significantly greater length in female patients (67.6 mm vs 65.0 mm). The volume was greater in male patients (21.8 cm3 vs 19.4 cm3). The intersite reliability was high with a mean difference between the left and right sides of between 0.1% (cross-sectional area) and 2.3% (volume).
Conclusions
The method presented allows for an automated volumetric analysis of a corticocancellous bone using CT data. The method is intended to provide preoperative information for the use of intramedullary devices in fracture fixation and percutaneous cement augmentation techniques.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res. 2003;(408):279–85.
Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. 2009;23:106–12.
Furia JP, Juliano PJ, Wade AM, Schaden W, Mittermayr R. Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. J Bone Joint Surg Am. 2010;92:846–54.
Leumann A, Pagenstert G, Fuhr P, Hintermann B, Valderrabano V. Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis. Arch Orthop Trauma Surg. 2008;128:1425–30.
Boulton CL, Salzler M, Mudgal CS. Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am. 2010;35:1260–3.
Starr AJ, Nakatani T, Reinert CM, Cederberg K. Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure? J Orthop Trauma. 2008;22:81–7.
Altman GT, Altman DT, Routt ML. Symptomatic hypertrophic pubic ramus nonunion treated with a retrograde medullary screw. J Orthop Trauma. 2000;14:582–5.
Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M. Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporosis Int. 2000;11:443–8.
Alost T, Waldrop RD. Profile of geriatric pelvic fractures presenting to the emergency department. Am J Emerg Med. 1997;15:576–8.
Hill RM, Robinson CM, Keating JF. Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg Br. 2001;83:1141–4.
Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33:166–8.
Beall DP, D'Souza SL, Costello RF, Prater SD, Van Zandt BL, Martin HD, et al. Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures. Skeletal Radiol. 2007;36:979–83.
Butler CL, Given CA, Michel SJ, Tibbs PA. Percutaneous sacroplasty for the treatment of sacral insufficiency fractures. AJR Am J Roentgenol. 2005;184:1956–9.
Evans AJ, Jensen ME, Kip KE, DeNardo AJ, Lawler GJ, Negin GA, et al. Vertebral compression fractures: Pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 2003;226:366–72.
Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (free): a randomised controlled trial. Lancet. 2009;373:1016–24.
Beall DP, Datir A, D’souza SL, D’souza LS, Gunda D, Morelli J, et al. Percutaneous treatment of insufficiency fractures. Skeletal Radiol. 2010;39:117–30.
Gansslen A, Krettek C. Retrograde transpubic screw fixation of transpubic instabilities. Oper Orthop Traumatol. 2006;18:330–40.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.
Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.
Kamysz J, Rechitsky M. Pubic bone cement osteoplasty for pubic insufficiency fractures. J Vasc Interv Radiol. 2008;19:1386–9.
Kelekis A, Lovblad KO, Mehdizade A, Somon T, Yilmaz H, Wetzel SG, et al. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J Vasc Interv Radiol. 2005;16:81–8.
Limthongkul W, Karaikovic EE, Savage JW, Markovic A. Volumetric analysis of thoracic and lumbar vertebral bodies. Spine J. 2010;10:153–8.
Conflict of interest
None of the authors has a conflict of interest that relates to the content discussed in this manuscript. All authors have contributed to and read the paper and have given permission for their names to be included as an author. The manuscript has not already been published and will not be submitted or published simultaneously elsewhere. No financial support of this project has been given.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Krappinger, D., von Linde, A., Rosenberger, R. et al. Volumetric analysis of corticocancellous bones using CT data. Skeletal Radiol 41, 503–508 (2012). https://doi.org/10.1007/s00256-010-1073-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-010-1073-3