New imaging modalities in bone

Abstract

The digital era has witnessed an exponential growth in bone imaging as new modalities and analytic techniques improve the potential for noninvasive study of bone anatomy, physiology, and pathophysiology. Bone imaging very much lends itself to input across medical and engineering disciplines. It is in part a reflection of this multidisciplinary input that developments in the field of bone imaging over the past 30 years have in some respects outshone those in many other fields of medicine. These developments have resulted in much deeper knowledge of bone macrostructure and microstructure in osteoporosis and a much better understanding of the subtle changes that occur with age, concurrent disease, and treatment. This new knowledge is already being translated into improved day-to day clinical care with better recognition, treatment, and monitoring of the osteoporotic process. As "the more you know, the more you know you don't know" certainly holds true with osteoporosis and bone disease, there is little doubt that further advances in bone imaging and analytical techniques will continue to hold center stage in osteoporosis and related research.

Figures

Fig. 1

Volumetric quantitative CT of the lumbar spine with automated anatomic coordinates outlining the periosteal, endosteal, and juxta-endosteal (“peeled”) contours of the vertebral body. Several different volume of interests (VOIs) can be evaluated, such as the total, trabecular, peeled, elliptical, and Pacman VOIs in the axial plane, as well as the superior, mid-vertebral, and inferior VOIs in the sagittal plane. (Image courtesy of Klaus Engelke)

Fig. 2

Volumetric quantitative CT provides a basis for finite element analysis of the proximal femur. Note how stress distribution as related to color code is highest along the inferomedial aspect of the femoral neck and proximal shaft. (Image courtesy of Klaus Engelke)

Fig. 3

High-resolution peripheral quantitative CT (XtremeCT; Scanco Medical, Brüttisellen, Switzerland) of the distal radius. a, Systemic lupus erythematosus (SLE) patient on steroids without vertebral fracture. b, SLE patient on steroids with vertebral fracture. Note the relative deterioration in trabecular architecture and thinning with increased porosity of cortex in the patient with vertebral fracture compared with the patient without vertebral fracture. (Image courtesy of Edmund Li)

Fig. 4

High-resolution in vivo MRI of the distal radius and ulna. The circle in the midportion of the distal radius represents an area selected for virtual core biopsy as shown. (Image courtesy of Felix Wehrli)