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Radiographical Texture Analysis Improves the Prediction of Vertebral Fracture: An Ex Vivo Biomechanical Study

Guenoun, Daphne MD*; Le Corroller, Thomas MD, PhD*; Acid, Souad MD*; Pithioux, Martine PhD; Pauly, Vanessa PhD; Ariey-Bonnet, Damien*; Chabrand, Patrick PhD; Champsaur, Pierre MD, PhD*

doi: 10.1097/BRS.0b013e3182a28fa9

Study Design. Compression biomechanical tests using fresh cadaveric thoracolumbar motion segments.

Objective. The purpose of this study was to determine if the combination of bone texture parameters using bone microarchitecture, and bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry provided a better prediction of vertebral fracture than BMD evaluation alone.

Summary of Background Data. Bone strength is routinely evaluated using BMD, as measured by dual-energy x-ray absorptiometry. Currently, there is an ongoing debate about the strengths and limitations of bone densitometry in clinical practice. To assess the fracture risk properly, other factors are important to be taken into account such as the macro- and microarchitecture of the bone. Recently, a new high-resolution x-ray device with direct digitization, named bone microarchitecture (BMA, D3A Medical Systems), has been developed to provide a better precision of texture parameters than those previously obtained on digitized films.

Methods. Twenty-seven 3-level thoracolumbar motion segments (T11, T12, L1, and L2, L3, L4) of excised spines, obtained at the Anatomy Department of Marseille, were studied using bone microarchitecture to estimate 3 textural parameters: fractal parameter Hmean, co-occurrence matrix, and run-length matrix, dual-energy x-ray absorptiometry to measure BMD, and mechanical compression tests to failure. All specimens were examined by computed tomography before and after compression. The prediction of the vertebral failure load was evaluated using multiple regression analyses.

Results. Twenty-seven vertebral fractures were observed with a mean failure load of 2636.3 N (standard deviation, 996 N). Fractal parameter Hmean, co-occurrence matrix, and run-length matrix were each significantly correlated with BMD (P< 0.01) and bone strength (P< 0.01). Combining bone texture parameters and BMD significantly improved the fracture load prediction from adjusted r 2 = 0.701 to adjusted r 2 = 0.806 (P< 0.01).

Conclusion. In these excised vertebrae, the combination of bone texture parameters with BMD demonstrated a better performance in the failure load prediction than that of BMD alone.

Level of Evidence: N/A

Twenty-seven 3-level thoracolumbar motion segments of excised spines were studied using a high-resolution x-ray device (BMA, D3A Medical Systems), dual-energy x-ray absorptiometry to measure bone mineral density, and mechanical compression tests.

*APHM, Hôpital Sainte Marguerite, Radiology Department, Marseille, France

Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France Marseille, France; and

Aix-Marseille Université, Laboratoire de Santé Publique EA 3279, Marseille, France, Department of Public Health, APHM, Marseille, France.

Address correspondence and reprint requests to Daphne Guenoun, MD, APHM, Hôpital Sainte Marguerite, Radiology Department, 13009 Marseille, France; E-mail:

Acknowledgment date: January 31, 2013. First revision date: May 24, 2013. Second revision date: June 7, 2013. Acceptance date: June 17, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins