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Texture Analysis, Bone Mineral Density, and Cortical Thickness of the Proximal Femur: Fracture Risk Prediction

Rodríguez-Soto, Ana Elvira BSc*; Fritscher, Karl D. MD, PhD; Schuler, Benedikt MSc; Issever, Ahi S. MD*; Roth, Tobias MD; Kamelger, Florian MD; Kammerlander, Christian MD; Blauth, Michael MD; Schubert, Rainer MD; Link, Thomas M. MD*

Journal of Computer Assisted Tomography: November-December 2010 - Volume 34 - Issue 6 - p 949-957
doi: 10.1097/RCT.0b013e3181ec05e4
Musculoskeletal Radiology

Objective: The objectives of this study were to perform a clinical study analyzing bone quality in multidetector computed tomographic images of the femur using bone mineral density (BMD), cortical thickness, and texture algorithms in differentiating osteoporotic fracture and control subjects; to differentiate fracture types.

Methods: Femoral head, trochanteric, intertrochanteric, and upper and lower neck were segmented (fracture, n = 30; control, n = 10). Cortical thickness, BMD, and texture analysis were obtained using co-occurrence matrices, Minkowski dimension, and functional and scaling index method.

Results: Bone mineral density and cortical thickness performed best in the neck region, and texture measures performed best in the trochanter. Only cortical thickness and texture measures differentiated femoral neck and intertrochanteric fractures.

Conclusions: This study demonstrates that differentiation of osteoporotic fracture subjects and controls is achieved with texture measures, cortical thickness, and BMD; however, performance is region specific.

From the *Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA; †University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; and ‡Department for Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria.

Received for publication March 3, 2010; accepted June 8, 2010.

Reprints: Thomas M. Link, MD, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 400 Parnassus Ave, A-367, San Francisco, CA 94131 (e-mail:

This study was funded by a research grant from the AO Foundation, Davos, Switzerland (Fracture Fixation in Osteoporotic Bone).

© 2010 Lippincott Williams & Wilkins, Inc.