This article is part of the Topical Collection on Imaging
Cortical bone mapping (CBM) is a technique for measuring localised skeletal changes from computed tomography (CT) images. It can provide measurements with accuracy surpassing the underlying imaging resolution. CBM can detect changes in several properties of the cortex, with no prior assumptions about the likely location of said changes. This paper summarises the theory behind CBM, discusses its strengths and limitations, and reviews some studies in which it has been applied.
CBM has revealed associations between fracture risk and cortical properties in specific regions of the proximal femur which present feasible therapeutic targets. Analyses of several pharmaceutical and exercise interventions quantify effects that are distinct both in location and in the nature of the micro-architectural changes. CBM has illuminated age-related changes in the proximal femur and has recently been applied to other bones, as well as to the assessment of cartilage.
The CBM processing pipeline is designed primarily for large cohort studies. Its main impact thus far has not been in the realm of clinical practice, but rather to improve our fundamental understanding of localised bone structure and changes.
Treece GM, Gee AH, Tonkin C, Ewing SK, Cawthon PM, Black DM, et al. Predicting hip fracture type with cortical bone mapping (CBM) in the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. 2015;30(11):2067–77. CrossRef
Zebaze R, Seeman E. Cortical bone: a challenging geography. J Bone Miner Res. 2015;30(1):24–9. CrossRef
Engelke K, Lang T, Khosla S, Qin L, Zysset P, Leslie WD, et al. Clinical use of quantitative computed tomography–based advanced techniques in the management of osteoporosis in adults: the 2015 ISCD official positions—part III. J Clin Densitom. 2015;18(3):393–407. CrossRef
Ferrari S, Reginster JY, Brandi ML, Kanis JA, Devogelaer JP, Kaufman JM, et al. Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture. Arch Osteoporos. 2016;11(1):37. CrossRef
Carballido-Gamio J, Nicolella DP. Computational anatomy in the study of bone structure. Curr Osteoporos Rep. 2013;11(3):237–45. CrossRef
• Treece GM, Gee AH. Independent measurement of femoral cortical thickness and cortical bone density using clinical CT. Med Image Anal. 2015;20:249–64. The most recent study that thoroughly evaluates the ability of CBM to make accurate measurements of very thin cortices from QCT. CrossRef
Carballido-Gamio J, Bonaretti S, Kazakia GJ, Khosla S, Majumdar S, Lang TF, et al. Statistical parametric mapping of HR-pQCT images: a tool for population-based local comparisons of micro-scale bone features. Ann Biomed Eng. 2017;45(4):949–62. CrossRef
Tsegai ZJ, Stephens NB, Treece GM, Skinner MM, Kivell TL, Gee AH. Cortical bone mapping: an application to hand and foot bones in hominoids. Comptes Rendus Palevol. 2017;16(5–6):690–701. CrossRef
Treece GM, Gee AH, Mayhew PM, Poole KES. High resolution cortical bone thickness measurement from clinical CT data. Med Image Anal. 2010;14(3):276–90. CrossRef
Treece GM, Poole KES, Gee AH. Imaging the femoral cortex: thickness, density and mass from clinical CT. Med Image Anal. 2012;16(5):952–65. CrossRef
Prevrhal S, Fox JC, Shepherd JA, Genant HK. Accuracy of CT-based thickness measurement of thin structures: modeling of limited spatial resolution in all three dimensions. Med Phys. 2003;30(1):1–8. CrossRef
Hangartner TN. Thresholding technique for accurate analysis of density and geometry in QCT, PQCT and μCT images. J Musculoskelet Neuronal Interact. 2007;7(1):9–16. PubMed
Streekstra GJ, Strackee SD, Maas M, ter Wee R, Venema HW. Model-based cartilage thickness measurement in the submillimeter range. Med Phys. 2007;34(9):3562–70. CrossRef
Humbert L, Hazrati Marangalou J, del Río Barquero LM, van Lenthe GH, van Rietbergen B. Cortical thickness and density estimation from clinical CT using a prior thicknessdensity relationship. Med Phys. 2016;43(4):1945–54. CrossRef
Pakdel A, Robert N, Fialkov J, Maloul A, Whyne C. Generalized method for computation of true thickness and X-ray intensity information in highly blurred sub-millimeter bone features in clinical CT images. Phys Med Biol. 2012;57(23):8099–116. CrossRef
Pakdel A, Hardisty M, Fialkov J, Whyne C. Restoration of thickness, density, and volume for highly blurred thin cortical bones in clinical CT images. Ann Biomed Eng. 2016;44(11):3359–71. CrossRef
Moreland K. Diverging color maps for scientific visualization. In: Bebis G. et al. (eds) Advances in Visual Computing. ISVC 2009. Lecture notes in computer science, vol 5876. pp. 92–103, Springer, Berlin, Heidelberg. CrossRef
Friston KJ, Holmes AP, Worsley KJ, Poline JP, Frith CD, Frackowiak RSJ. Statistical parametric maps in functional imaging: a general linear approach. Hum Brain Mapp. 1994;2(4):189–210. CrossRef
Gee AH, Treece GM. Systematic misregistration and the statistical analysis of surface data. Med Image Anal. 2014 Feb;18(2):385–93. CrossRef
Gee AH, Treece GM, Poole KES. How does the femoral cortex depend on bone shape? A methodology for the joint analysis of surface texture and shape. Med Image Anal. 2018;45:55–67. CrossRef
Zhang J, Hislop-Jambrich J, Besier TF. Predictive statistical models of baseline variations in 3-D femoral cortex morphology. Med Eng Phys. 2016;38(5):450–7. CrossRef
Atkins PR, Elhabian SY, Agrawal P, Harris MD, Whitaker RT, Weiss JA, et al. Quantitative comparison of cortical bone thickness using correspondence-based shape modeling in patients with cam femoroacetabular impingement. J Orthop Res. 2017;35(8):1743–53. CrossRef
Lillie EM, Urban JE, Weaver AA, Powers AK, Stitzel JD. Estimation of skull table thickness with clinical CT and validation with microCT. J Anat. 2015;226(1):73–80. CrossRef
Treece GM, Gee AH, Tonkin CJ, Poole KES. Rate of change of cortical mass with age over the femoral surface. In: Proceedings of the American Society for Bone and Mineral Research; Seattle, 2015.
Poole KES, Treece GM, Ridgway GR, Mayhew PM, Borggrefe J, Gee AH. Targeted regeneration of bone in the osteoporotic human femur. PLoS ONE. 2011;6(1):e16190. CrossRef
Poole KE, Treece GM, Gee AH, Brown JP, McClung MR, Wang A, et al. Denosumab rapidly increases cortical bone in key locations of the femur: a 3D bone mapping study in women with osteoporosis. J Bone Miner Res. 2015;30(1):46–54. CrossRef
Brooke-Wavell K, Treece GM, Allison SJ, Folland JP, Rennie WJ, Summers GD, et al. Brief high impact exercise increased cortical mass and trabecular density at regions predictive of femoral neck and trochanteric fracture. Osteoporos Int. 2016;27:626–7.
• Allison SJ, Poole KE, Treece GM, Gee AH, Tonkin C, Rennie WJ, et al. The influence of high-impact exercise on cortical and trabecular bone mineral content and 3D distribution across the proximal femur in older men: a randomized controlled unilateral intervention. J Bone Miner Res. 2015;30(9):1709–16. CBM used to demonstrate small but significant local bone effects due to exercise. Also demonstrates the ability to reach significance on a small sample over a short time scale. CrossRef
Fuchs RK, Kersh ME, Carballido-Gamio J, Thompson WR, Keyak JH, Warden SJ. Physical activity for strengthening fracture prone regions of the proximal femur. Curr Osteoporos Rep. 2017;15(1):43–52. CrossRef
Whitmarsh T, Treece GM, Gee AH, Poole KE. Mapping bone changes at the proximal femoral cortex of postmenopausal women in response to alendronate and teriparatide alone, combined or sequentially. J Bone Miner Res. 2015;30(7):1309–18. CrossRef
Whitmarsh T, Treece GM, Gee AH, Poole KE. The effects on the femoral cortex of a 24 month treatment compared to an 18 month treatment with teriparatide: a multi-trial retrospective analysis. PLoS One. 2016;11(2):e0147722. CrossRef
• Poole KE, Skingle L, Gee AH, Turmezei TD, Johannesdottir F, Blesic K, et al. Focal osteoporosis defects play a key role in hip fracture. Bone. 2017;94:124–34. The first work (though the paper was published later) demonstrating significantly different patterns of cortical bone on those suffering different hip fracture types. CrossRef
Yu A, Carballido-Gamio J, Wang L, Lang TF, Su Y, Wu X, et al. Spatial differences in the distribution of bone between femoral neck and trochanteric fractures. J Bone Miner Res. 2017 Aug;32(8):1672–80. CrossRef
Carballido-Gamio J, Harnish R, Saeed I, Streeper T, Sigurdsson S, Amin S, et al. Structural patterns of the proximal femur in relation to age and hip fracture risk in women. Bone. 2013;57(1):290–9. CrossRef
Gee A, Treece G, Tonkin C, Black D, Poole K. Association between femur size and a focal defect of the superior femoral neck. Bone. 2015;81:60–6. CrossRef
Nishiyama KK, Gilchrist S, Guy P, Cripton P, Boyd SK. Proximal femur bone strength estimated by a computationally fast finite element analysis in a sideways fall configuration. J Biomech. 2013;46(7):1231–6. CrossRef
Nishiyama KK, Ito M, Harada A, Boyd SK. Classification of women with and without hip fracture based on quantitative computed tomography and finite element analysis. Osteoporos Int. 2014 Aug;25(2):619–26. CrossRef
Okoukoni C, Randolph DM, McTyre ER, Kwok A, Weaver AA, Blackstock AW, et al. Early dose-dependent cortical thinning of the femoral neck in anal cancer patients treated with pelvic radiation therapy. Bone. 2017;94:84–9. CrossRef
Whitmarsh T, Treece G, Gee A, Bolognese M, Brown J, S Goemaere, et al. Romosozumab and Teriparatide effects on vertebral cortical mass, thickness, and density in postmenopausal women with low bone mineral density (BMD). In: Proceedings of the American Society for Bone and Mineral Research, 36th Annual Meeting. Houston, Texas, USA; 2014.
Valentinitsch A, Trebeschi S, Alarcón E, Baum T, Kaesmacher J, Zimmer C, et al. Regional analysis of age-related local bone loss in the spine of a healthy population using 3D voxel-based modeling. Bone. 2017;103:233–40. CrossRef
Okoukoni C, Lynch SK, McTyre ER, Randolph DM, Weaver AA, Blackstock AW, et al. A cortical thickness and radiation dose mapping approach identifies early thinning of ribs after stereotactic body radiation therapy. Radiother Oncol. 2016;119(3):449–53. CrossRef
Lynch SK. Characterization of rib cortical bone thickness changes with age and sex: Wake Forest University; 2015.
Lillie EM, Urban JE, Lynch SK, Weaver AA, Stitzel JD. Evaluation of skull cortical thickness changes with age and sex from computed tomography scans. J Bone Miner Res. 2016;31(2):299–307. CrossRef
Stephens NB, Kivell TL, Pahr DH, Gee AH, Treece GM, Hublin JJ, et al. Signals of loading and function in the human hand: a multi-method analysis of the external cortical and internal trabecular bone of the metacarpals. Am J Phys Anthropol. 2016;159:302–3.
Pearson RA, Treece GM. Measurement of the bone endocortical region using clinical CT. Med Image Anal. 2018;44:28–40. CrossRef
Turmezei TD, Treece GM, Gee AH, Fotiadou AF, Poole KE. Quantitative 3D analysis of bone in hip osteoarthritis using clinical computed tomography. Eur Radiol. 2016;26(7):2047–54. CrossRef
McDonnell S, Turmezei T, Graves M, McCaskie A, Kaggie J. Advances in osteoarthritis imaging: what will make it into clinical practice? J Trauma Orthop. 2016;4(3):60–3.
- Cortical Bone Mapping: Measurement and Statistical Analysis of Localised Skeletal Changes
- Springer US
Neu im Fachgebiet Orthopädie und Unfallchirurgie
e.Med Kampagnen-Visual, Mail Icon II