A Novel Ultrasound Methodology for Estimating Spine Mineral Densityby Francesco Conversano, Roberto Franchini, Antonio Greco, Giulia Soloperto, Fernanda Chiriacò, Ernesto Casciaro, Matteo Aventaggiato, Maria Daniela Renna, Paola Pisani, Marco Di Paola, Antonella Grimaldi, Laura Quarta, Eugenio Quarta, Maurizio Muratore, Pascal Laugier, Sergio Casciaro

Ultrasound in Medicine & Biology

About

Year
2015
DOI
10.1016/j.ultrasmedbio.2014.08.017
Subject
Radiology Nuclear Medicine and imaging / Biophysics / Radiological and Ultrasound Technology

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Abstract—We investigated the possible clinical feasibility and accuracy of an innovative ultrasound (US) method general predictors of osteoporotic fractures (Lewiecki 2010), together with the related high degree of health impairment and worse quality of life in the case of fracUltrasound in Med. & Biol., Vol. 41, No. 1, pp. 281–300, 2015

Copyright  2015 World Federation for Ultrasound in Medicine & Biology

Printed in the USA. All rights reserved http://dx.doi.org/10.1016/j.ul

Address correspondence to: Sergio Casciaro, Consiglio Nazionale delle Ricerche, Istituto di Fisiologia Clinica (CNR-IFC), c/o CampusINTRODUCTION

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and fracture risk (Liu et al. 2011). Unfortunately, this pathology is often still underdiagnosed (Curtis and

Safford 2012; van den Bergh et al. 2012), resulting in a high incidence of osteoporotic fractures worldwide (Baim and Leslie 2012)—a serious problem for the elderly population and an enormous cost for national health care systems (Byberg et al. 2012; Pike et al. 2010; Sambrook and Cooper 2006). Therefore, introducing novel methods for anticipating and improving osteoporosis diagnosis and patient management is of great importance.

Currently, dual X-ray absorptiometry (DXA) is the most widely used method for diagnosing osteoporosis and is considered the ‘‘gold standard’’ reference for measuring bone mineral density (BMD) (Baim and

Leslie 2012; Link 2012; Nayak et al. 2006; Pais et al. 2010; Schnitzer et al. 2012). BMD measurements are the basis of the operational definition of osteoporosis provided by the World Health Organization (WHO): osteoporosis is diagnosed when the hip or spine BMD is $2.5 standard deviations (SD) lower than the young adult mean (Kanis 1994). Hip and spine are the reference anatomic sites because it has been found that BMD measurements performed at these sites are the most accurateEcotek sergio.for diagnosis of osteoporosis of the spine. A total of 342 female patients (aged 51–60 y) underwent spinal dual X-ray absorptiometry and abdominal echographic scanning of the lumbar spine. Recruited patients were subdivided into a reference database used for US spectral model construction and a study population for repeatability and accuracy evaluation. US images and radiofrequency signals were analyzed via a new fully automatic algorithm that performed a series of spectral and statistical analyses, providing a novel diagnostic parameter called the osteoporosis score (O.S.). If dual X-ray absorptiometry is assumed to be the gold standard reference, the accuracy of

O.S.-based diagnoses was 91.1%, with k 5 0.859 (p , 0.0001). Significant correlations were also found between

O.S.-estimated bone mineral densities and corresponding dual X-ray absorptiometry values, with r2 values up to 0.73 and a root mean square error of 6.3%–9.3%. The results obtained suggest that the proposed method has the potential for future routine application in US-based diagnosis of osteoporosis. (E-mail: sergio.casciaro@ cnr.it)  2015 World Federation for Ultrasound in Medicine & Biology.

Key Words: Osteoporosis diagnosis, Quantitative ultrasound, Bone mineral density measurement, Lumbar spine,

Bone densitometry, Radiofrequency signal analysis.A NOVEL ULTRASOUND METHO

MINERA

FRANCESCO CONVERSANO,* ROBERTO FRANC

FERNANDA CHIRIACO,* ERNESTO CASCIARO,* M

PAOLA PISANI,* MARCO DI PAOLA,* ANTONELL

MAURIZIO MURATORE,z PASCAL *National Research Council, Institute of Clinical Physiology, ‘‘Galateo’’ Hospital, San Cesario di Lecce, ASL-LE, Lec

Universites, UPMC 06, INne (Ed. A7), via per Monteroni, 73100 Lecce, Italy. E-mail: casciaro@cnr.it 281LOGY FOR ESTIMATING SPINE

ENSITY

I,* ANTONIO GRECO,y GIULIA SOLOPERTO,*

EO AVENTAGGIATO,y MARIA DANIELA RENNA,*

RIMALDI,z LAURA QUARTA,z EUGENIO QUARTA,z

GIER,x and SERGIO CASCIARO* e, Italy; yEcholight srl, Lecce, Italy; zO.U. of Rheumatology, ly; and xLaboratoire d’Imagerie Biomedicale, Sorbonne

M, CNRS, Paris, France 0301-5629/$ - see front matter trasmedbio.2014.08.017tures at these anatomic sites. In particular, hip BMD is 282 Ultrasound in Medicine and Biology Volume 41, Number 1, 2015a stronger predictor of hip fracture than BMD measured at other sites (Cummings et al. 1993, 2006), and spine

BMD is the preferred choice for treatment monitoring because of its high sensitivity to BMD variations (Lewiecki 2010).

Dual X-ray absorptiometry measurements cannot, however, be employed for population mass screenings because of several intrinsic limitations, related mainly to exposure to ionizing radiation with associated risks (Brambilla et al. 2013; Picano and Matucci-Cerinic 2011; Picano and Vano 2012; Semelka et al. 2012), high cost and the need for dedicated structures with certified operators. This has led to increasing interest in the investigation of quantitative ultrasound (QUS) methods for osteoporosis screening purposes (Breban et al. 2010; Nayak et al. 2006; Paggiosi et al. 2012; Pais et al. 2010; Schnitzer et al. 2012; Trimpou et al. 2010).

Proposed QUS methods have several potential advantages over DXA (absence of ionizing radiation, portable machines, lower cost), but as yet there is no widespread consensus regarding their accuracy in identifying osteoporotic patients. In fact, commercially available QUS devices currently work only on peripheral sites (e.g., calcaneus), and several studies investigating the correlations between QUS parameters and DXA-measured BMDs at the reference sites obtained contradictory results (Breban et al. 2010; Dane et al. 2008; El Maghraoui et al. 2009; Iida et al. 2010; Kwok et al. 2012; Liu et al. 2012; Moayyeri et al. 2012;

Schnitzer et al. 2012; Stewart et al. 2006; Trimpou et al. 2010).