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Erschienen in: Current Osteoporosis Reports 1/2024

20.01.2024

Quantitative Skeletal Imaging and Image-Based Modeling in Pediatric Orthopaedics

verfasst von: Melissa R. Requist, Megan K. Mills, Kristen L. Carroll, Amy L. Lenz

Erschienen in: Current Osteoporosis Reports | Ausgabe 1/2024

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Abstract

Purpose of Review

Musculoskeletal imaging serves a critical role in clinical care and orthopaedic research. Image-based modeling is also gaining traction as a useful tool in understanding skeletal morphology and mechanics. However, there are fewer studies on advanced imaging and modeling in pediatric populations. The purpose of this review is to provide an overview of recent literature on skeletal imaging modalities and modeling techniques with a special emphasis on current and future uses in pediatric research and clinical care.

Recent Findings

While many principles of imaging and 3D modeling are relevant across the lifespan, there are special considerations for pediatric musculoskeletal imaging and fewer studies of 3D skeletal modeling in pediatric populations. Improved understanding of bone morphology and growth during childhood in healthy and pathologic patients may provide new insight into the pathophysiology of pediatric-onset skeletal diseases and the biomechanics of bone development. Clinical translation of 3D modeling tools developed in orthopaedic research is limited by the requirement for manual image segmentation and the resources needed for segmentation, modeling, and analysis.

Summary

This paper highlights the current and future uses of common musculoskeletal imaging modalities and 3D modeling techniques in pediatric orthopaedic clinical care and research.
Literatur
1.
Zurück zum Zitat • Schwarzenberg P, Darwiche S, Yoon RS, Dailey HL. Imaging modalities to assess fracture healing. Curr Osteoporos Rep. 2020;18(3):169–79. https://doi.org/10.1007/s11914-020-00584-5. This paper outlines use of radiographic, CT, DXA, and MRI-based approaches for analyzing fracture union and non-union. It additionally highlights the information that can be derived from finite element modeling of bone calluses and compares novel techniques to the radiographic gold standard.CrossRefPubMed • Schwarzenberg P, Darwiche S, Yoon RS, Dailey HL. Imaging modalities to assess fracture healing. Curr Osteoporos Rep. 2020;18(3):169–79. https://​doi.​org/​10.​1007/​s11914-020-00584-5. This paper outlines use of radiographic, CT, DXA, and MRI-based approaches for analyzing fracture union and non-union. It additionally highlights the information that can be derived from finite element modeling of bone calluses and compares novel techniques to the radiographic gold standard.CrossRefPubMed
15.
Zurück zum Zitat •• Wang F, Zheng L, Theopold J, Schleifenbaum S, Heyde CE, Osterhoff G. Methods for bone quality assessment in human bone tissue: a systematic review. J Orthop Surg Res. 2022;17(1):174. https://doi.org/10.1186/s13018-022-03041-4. This paper reviews the methods for bone density, microstructrue, and quality assessment using a variety of imaging modalieties including radiographs, DXA, CT, and MRI as well as mechanical testing methods used to test bone quality in a research setting. It summarizes the benefits and pitfalls of each modality and highlights the importance of quantitative bone assessment.CrossRefPubMedCentralPubMed •• Wang F, Zheng L, Theopold J, Schleifenbaum S, Heyde CE, Osterhoff G. Methods for bone quality assessment in human bone tissue: a systematic review. J Orthop Surg Res. 2022;17(1):174. https://​doi.​org/​10.​1186/​s13018-022-03041-4. This paper reviews the methods for bone density, microstructrue, and quality assessment using a variety of imaging modalieties including radiographs, DXA, CT, and MRI as well as mechanical testing methods used to test bone quality in a research setting. It summarizes the benefits and pitfalls of each modality and highlights the importance of quantitative bone assessment.CrossRefPubMedCentralPubMed
26.
Zurück zum Zitat Havrda JB (2012)Pediatric bone densitometry. Radiol Technol 84(2):155–77 Havrda JB (2012)Pediatric bone densitometry. Radiol Technol 84(2):155–77
41.
Zurück zum Zitat • Wang CY, et al. Quantitative imaging of ultrasound backscattered signals with information entropy for bone microstructure characterization. Sci Rep. 2022;12(1):414. https://doi.org/10.1038/s41598-021-04425-y. This paper provides a novel methodology for quantitative and radiation-free examination of bone microstructure using ultrasound. The results are promisiong for the translational potential of this modality in osteoporosis assessment and eventual bone density assesment in a variety of diseases. The use of ultrasound makes this a lower-cost and radiation-free alternative to existing methods.CrossRefPubMedCentralPubMed • Wang CY, et al. Quantitative imaging of ultrasound backscattered signals with information entropy for bone microstructure characterization. Sci Rep. 2022;12(1):414. https://​doi.​org/​10.​1038/​s41598-021-04425-y. This paper provides a novel methodology for quantitative and radiation-free examination of bone microstructure using ultrasound. The results are promisiong for the translational potential of this modality in osteoporosis assessment and eventual bone density assesment in a variety of diseases. The use of ultrasound makes this a lower-cost and radiation-free alternative to existing methods.CrossRefPubMedCentralPubMed
60.
Zurück zum Zitat • Tse JJ, Smith ACJ, Kuczynski MT, Kaketsis DA, Manske SL. Advancements in osteoporosis imaging, screening, and study of disease etiology. Curr Osteoporos Rep. 2021;19(5):532–41. https://doi.org/10.1007/s11914-021-00699-3. This paper discusses emerging methods for quantitative CT and MRI imaging for improved osteoporosis diagnosis. The methods outlined in this paper are applicable for broader bone quality assessment from in-vivo imaging and discuss reltaive benefits of specific MRI sequences and CT types, such as cone beam CT.CrossRefPubMed • Tse JJ, Smith ACJ, Kuczynski MT, Kaketsis DA, Manske SL. Advancements in osteoporosis imaging, screening, and study of disease etiology. Curr Osteoporos Rep. 2021;19(5):532–41. https://​doi.​org/​10.​1007/​s11914-021-00699-3. This paper discusses emerging methods for quantitative CT and MRI imaging for improved osteoporosis diagnosis. The methods outlined in this paper are applicable for broader bone quality assessment from in-vivo imaging and discuss reltaive benefits of specific MRI sequences and CT types, such as cone beam CT.CrossRefPubMed
67.
Zurück zum Zitat •• Lans A, et al. Quality assessment of machine learning models for diagnostic imaging in orthopaedics: a systematic review. Artif Intell Med. 2022;132:102396. https://doi.org/10.1016/j.artmed.2022.102396. This review paper analyzes machine learning models for musculoskeltal imaging and diagnositcs. While machine learning models are not currently part of the standard-of-care, clinical translation of image analysis and image-based modeling rely on machine-learned algorithms for automatic image segmentation and model generation to overcome the resource requirement for implementation. This paper highlights the limited existence of machine learning models in the field and the risk of bias in several existing models. These concerns are necessary to address for advancement of musculoskeletal image processing.CrossRefPubMed •• Lans A, et al. Quality assessment of machine learning models for diagnostic imaging in orthopaedics: a systematic review. Artif Intell Med. 2022;132:102396. https://​doi.​org/​10.​1016/​j.​artmed.​2022.​102396. This review paper analyzes machine learning models for musculoskeltal imaging and diagnositcs. While machine learning models are not currently part of the standard-of-care, clinical translation of image analysis and image-based modeling rely on machine-learned algorithms for automatic image segmentation and model generation to overcome the resource requirement for implementation. This paper highlights the limited existence of machine learning models in the field and the risk of bias in several existing models. These concerns are necessary to address for advancement of musculoskeletal image processing.CrossRefPubMed
69.
Zurück zum Zitat • Holbrook HS, Bowers AF, Mahmoud K, Kelly DM. Weight-bearing computed tomography of the foot and ankle in the pediatric population. J Pediatr Orthop. 2022;42(6):321–6. https://doi.org/10.1097/BPO.0000000000002168. This paper examines the common indications for standard CT versus weight bearing CT (WBCT) imaging in pediatric populations with foot and ankle pathology and the average reimbursement for each of these. It highlights the benefits of WBCT in pediatric patients, including a decreased cost, lower radiation exposure, and potential improvement for identifying deformity with loaded imaging.CrossRefPubMed • Holbrook HS, Bowers AF, Mahmoud K, Kelly DM. Weight-bearing computed tomography of the foot and ankle in the pediatric population. J Pediatr Orthop. 2022;42(6):321–6. https://​doi.​org/​10.​1097/​BPO.​0000000000002168​. This paper examines the common indications for standard CT versus weight bearing CT (WBCT) imaging in pediatric populations with foot and ankle pathology and the average reimbursement for each of these. It highlights the benefits of WBCT in pediatric patients, including a decreased cost, lower radiation exposure, and potential improvement for identifying deformity with loaded imaging.CrossRefPubMed
82.
Zurück zum Zitat Leardini A, et al. Weight-bearing CT technology in musculoskeletal pathologies of the lower limbs: techniques, initial applications, and preliminary combinations with gait-analysis measurements at the Istituto Ortopedico Rizzoli. Semin Musculoskelet Radiol. 2019;23(6):643–56. https://doi.org/10.1055/s-0039-1697939.CrossRefPubMed Leardini A, et al. Weight-bearing CT technology in musculoskeletal pathologies of the lower limbs: techniques, initial applications, and preliminary combinations with gait-analysis measurements at the Istituto Ortopedico Rizzoli. Semin Musculoskelet Radiol. 2019;23(6):643–56. https://​doi.​org/​10.​1055/​s-0039-1697939.CrossRefPubMed
85.
94.
Zurück zum Zitat • Chong LR, Lee K, Sim FY. 3D MRI with CT-like bone contrast - an overview of current approaches and practical clinical implementation. Eur J Radiol. 2021;143:109915. https://doi.org/10.1016/j.ejrad.2021.109915. This paper highlights emerging MRI acquisition sequences that improve skeletal imaging with the goal of achieving radiation-free CT-like image contrast. The common sequences used for this are ultrashort and zero echo time, T1-weighted gradient recalled echo, and susceptibility-weighted imaging. Further, machine learning methods may improve reconstruction of CT-like images from these MRI scans. This represents a promising direction for radiation-free musculoskeletal imaging.CrossRefPubMed • Chong LR, Lee K, Sim FY. 3D MRI with CT-like bone contrast - an overview of current approaches and practical clinical implementation. Eur J Radiol. 2021;143:109915. https://​doi.​org/​10.​1016/​j.​ejrad.​2021.​109915. This paper highlights emerging MRI acquisition sequences that improve skeletal imaging with the goal of achieving radiation-free CT-like image contrast. The common sequences used for this are ultrashort and zero echo time, T1-weighted gradient recalled echo, and susceptibility-weighted imaging. Further, machine learning methods may improve reconstruction of CT-like images from these MRI scans. This represents a promising direction for radiation-free musculoskeletal imaging.CrossRefPubMed
114.
Zurück zum Zitat Klein AA-O, Warszawski J, Hillengaß J, Maier-Hein KH (2019) Automatic bone segmentation in whole-body CT images. Int J Comput Assist Radiol Surg 14:21–9. Klein AA-O, Warszawski J, Hillengaß J, Maier-Hein KH (2019) Automatic bone segmentation in whole-body CT images. Int J Comput Assist Radiol Surg 14:21–9.
126.
Zurück zum Zitat • Pahr DH, Reisinger AG. A review on recent advances in the constitutive modeling of bone tissue. Curr Osteoporos Rep. 2020;18(6):696–704. https://doi.org/10.1007/s11914-020-00631-1. This paper provides an overview of current finite element modling methods for understanding bone mechanics. It highlights novel models that differentiate between cortical and trabecular bone and incorporate microstructural changes. Additionally, it discusses the limitations and errors of existing models and the imaging standards necessary for generating valid models.CrossRefPubMedCentralPubMed • Pahr DH, Reisinger AG. A review on recent advances in the constitutive modeling of bone tissue. Curr Osteoporos Rep. 2020;18(6):696–704. https://​doi.​org/​10.​1007/​s11914-020-00631-1. This paper provides an overview of current finite element modling methods for understanding bone mechanics. It highlights novel models that differentiate between cortical and trabecular bone and incorporate microstructural changes. Additionally, it discusses the limitations and errors of existing models and the imaging standards necessary for generating valid models.CrossRefPubMedCentralPubMed
130.
Zurück zum Zitat •• Lenz AL, Lisonbee RJ. Biomechanical insights afforded by shape modeling in the foot and ankle. Foot Ankle Clin. 2023;28(1):63–76. https://doi.org/10.1016/j.fcl.2022.11.001. This paper provides an overview of current uses of statistical shape modeling in musculoskeltal research, sumamrizing the state of the technology with recent advancements in multi-domain modeling. It also highlights the importance of high-resolution quantitative imaging in the creation of useful models and explains the barriers and potential benefits of clinical translation of statistical shape modeling in the foot and ankle.CrossRefPubMedCentralPubMed •• Lenz AL, Lisonbee RJ. Biomechanical insights afforded by shape modeling in the foot and ankle. Foot Ankle Clin. 2023;28(1):63–76. https://​doi.​org/​10.​1016/​j.​fcl.​2022.​11.​001. This paper provides an overview of current uses of statistical shape modeling in musculoskeltal research, sumamrizing the state of the technology with recent advancements in multi-domain modeling. It also highlights the importance of high-resolution quantitative imaging in the creation of useful models and explains the barriers and potential benefits of clinical translation of statistical shape modeling in the foot and ankle.CrossRefPubMedCentralPubMed
Metadaten
Titel
Quantitative Skeletal Imaging and Image-Based Modeling in Pediatric Orthopaedics
verfasst von
Melissa R. Requist
Megan K. Mills
Kristen L. Carroll
Amy L. Lenz
Publikationsdatum
20.01.2024
Verlag
Springer US
Erschienen in
Current Osteoporosis Reports / Ausgabe 1/2024
Print ISSN: 1544-1873
Elektronische ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-023-00845-z

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