The recently introduced Photon Counting CT (PCCT) offers major advances in spatial resolution and material discrimination compared to conventional multi-detector CT. We investigate whether these new capabilities may enable accurate in vivo quantification of the trabecular microstructure of human bone. Human femoral bone was imaged using reference HR-pQCT (isotropic 60 μm voxels) and PCCT operated in a High Resolution mode (HR, 80 μm in-plane voxel size. 200 μm slice thickness) and in a Calcium-selective mode (CA, isotropic 390 μm voxels). 468 spherical Regions-of-Interest (ROIs) of 5 mm diameter were placed at corresponding locations in the HR-pQCT and PCCT volumes. The bone voxels of HR-pQCT and CA PCCT ROIs were segmented (binarized) using global Otsu thresholding; local Bernsen segmentation was used for HR PCCT. Trabecular thickness (TbTh), spacing (TbSp), number (TbN), and bone volume fraction (BV/TV) were measured in the binarized ROIs. The performance of PCCT morphometrics was evaluated in terms of correlation coefficient and numerical agreement with HR-pQCT. For ROIs with mean TbTh⪆250 μm (approaching the nominal resolution of HR PCCT), the average trabecular measurements obtained from HR PCCT achieved excellent correlations with the reference HR-pQCT: 0.88 for BvTv, 0.89 for TbTh, 0.81 for TbSp and 0.78 for TbN. For ROIs with mean TbTh of 200 μm – 250 μm, the correlations were slightly worse, ranging from 0.61 for TbTh to 0.84 for BvTv. The spatial resolution of CA PCCT in its current implementation is insufficient for microarchitectural measurements, but the material discrimination capability appears to enable accurate estimation of BvTv (correlation of 0.89 to HR-pQCT). The results suggest that the introduction of PCCT may enable microstructural evaluation of the trabecular bone of the lumbar spine and hip, which are inaccessible to current in vivo high-resolution bone imaging technologies. The findings of this work will inform the development of clinical indications for PCCT trabecular bone assessment.
The measurements of bone macro- and microstructures provide major insight into bone health and risk fracture. The accuracy of these measurements is limited when Conventional CT is used. However, CT technology has advanced with the introduction of photon-counting detectors that offer significant improvements in spatial resolution. This advancement offers potential improvements in resolving trabecular microstructures, and the quantification of bone through current or emerging biomarkers. Additionally, the spectral separation available in photon-counting CT (PCCT) may further aid in quantification. The purpose of this study was to objectively investigate PCCT capabilities in accurate quantification of bone macro- and micro-structures. To do so, 5 human bone specimens were scanned using a PCCT scanner (NAEOTOM Alpha, Siemens) and an energy-integrating CT (EICT) (FORCE, Siemens). Each specimen was imaged at a CTDIvol of 4 and 8mGy, and then reconstructed with 2 matrix sizes and at least 2 kernels. For PCCT, a 70keV virtual mono-energetic image series was acquired to evaluate the potential benefits of spectral maps. The same specimens were also scanned using a high-resolution peripheral quantitative CT to provide a ground truth for the bone metrics. Each image series was analyzed in terms of bone mineral density (BMD) and trabecular bone volume to total bone volume. PCCT demonstrated major improvements (5.5% compared to 17% error for EICT) in quantifying bone microstructures (BV/TV). However, the BMD measurements remained similar across imaging conditions and scanners, and did not significantly change by the PCCT spatial resolution enhancement. For BV/TV measurements, PCCT T3D was the most accurate when the sharpest kernel available and 1024-matrix size for (error: 5.53%±4.72%) were used. Similarly, EICT images were the most accurate for BV/TV measurements (error: 16.70%±10.55%) when a medium-sharpness kernel and 1024-matrix size were used. The overall results suggest that PCCT technology can further improve trabecular bone measurements and thus enhance the clinical decision making for patients with bone disease.
Purpose: To advance the development of radiomic models of bone quality using the recently introduced Ultra-High Resolution CT (UHR CT), we investigate inter-scan reproducibility of trabecular bone texture features to spatially-variant azimuthal and radial blurs associated with focal spot elongation and gantry rotation. Methods: The UHR CT system features 250x250 μm detector pixels and an x-ray source with a 0.4x0.5 mm focal spot. Visualization of details down to ~150 μm has been reported for this device. A cadaveric femur was imaged on UHR CT at three radial locations within the field-of-view: 0 cm (isocenter), 9 cm from the isocenter, and 18 cm from the isocenter; we expect the non-stationary blurs to worsen with increasing radial displacement. Gray level cooccurrence (GLCM) and gray level run length (GLRLM) texture features were extracted from 237 trabecular regions of interest (ROIs, 5 cm diameter) placed at corresponding locations in the femoral head in scans obtained at the different shifts. We evaluated concordance correlation coefficient (CCC) between texture features at 0 cm (reference) and at 9 cm and 18 cm. We also investigated whether the spatially-variant blurs affect K-means clustering of trabecular bone ROIs based on their texture features. Results: The average CCCs (against the 0 cm reference) for GLCM and GLRM features were ~0.7 at 9 cm. At 18 cm, the average CCCs were reduced to ~0.17 for GLCM and ~0.26 for GLRM. The non-stationary blurs are incorporated in radiomic features of cancellous bone, leading to inconsistencies in clustering of trabecular ROIs between different radial locations: an intersection-over-union overlap of corresponding (most similar) clusters between 0 cm and 9 cm shift was >70%, but dropped to <60% for the majority of corresponding clusters between 0 cm and 18 cm shift. Conclusion: Non-stationary CT system blurs reduce inter-scan reproducibility of texture features of trabecular bone in UHR CT, especially for locations <15 cm from the isocenter. Radiomic models of bone quality derived from UHR CT measurements at isocenter might need to be revised before application in peripheral body sites such as the hips.
Purpose: A high-resolution cone-beam CT (CBCT) system for extremity imaging has been developed using a custom complementary metal–oxide–semiconductor (CMOS) x-ray detector. The system has spatial resolution capability beyond that of recently introduced clinical orthopedic CBCT. We evaluate performance of this new scanner in quantifying trabecular microstructure in subchondral bone of the knee. Methods: The high-resolution scanner uses the same mechanical platform as the commercially available Carestream OnSight 3D extremity CBCT, but replaces the conventional amorphous silicon flat-panel detector (a-Si:H FPD with 0.137 mm pixels and a ~0.7 mm thick scintillator) with a Dalsa Xineos3030 CMOS detector (0.1 mm pixels and a custom 0.4 mm scintillator). The CMOS system demonstrates ~40% improved spatial resolution (FWHM of a ~0.1 mm tungsten wire) and ~4x faster scan time than FPD-based extremity CBCT (FPD-CBCT). To investigate potential benefits of this enhanced spatial resolution in quantitative assessment of bone microstructure, 26 trabecular core samples were obtained from four cadaveric tibias and imaged using FPD-CBCT (75 μm voxels), CMOS-CBCT (75 μm voxels), and reference micro-CT (μCT, 15 μm voxels). CBCT bone segmentations were obtained using local Bernsen’s thresholding combined with global histogram-based pre-thresholding; μCT segmentation involved Otsu’s method. Measurements of trabecular thickness (Tb.Th), spacing (Tb.Sp), number (Tb.N) and bone volume (BV/TV) were performed in registered regions of interest in the segmented CBCT and μCT reconstructions. Results: CMOS-CBCT achieved noticeably improved delineation of trabecular detail compared to FPD-CBCT. Correlations with reference μCT for metrics of bone microstructure were better for CMOS-CBCT than FPD-CBCT, in particular for Tb.Th (increase in Pearson correlation from 0.84 with FPD-CBCT to 0.96 with CMOS-CBCT) and Tb.Sp (increase from 0.80 to 0.85). This improved quantitative performance of CMOS-CBCT is accompanied by a reduction in scan time, from ~60 sec for a clinical high resolution protocol on FPD-CBCT to ~17 sec for CMOS-CBCT. Conclusion: The CMOS-based extremity CBCT prototype achieves improved performance in quantification of bone microstructure, while retaining other diagnostic capabilities of its FPD-based precursor, including weight-bearing imaging. The new system offers a promising platform for quantitative imaging of skeletal health in osteoporosis and osteoarthritis.
It is often necessary to register partial objects in medical imaging. Due to limited field of view (FOV), the entirety of an object cannot always be imaged. This study presents a novel application of an existing registration algorithm to this problem. The spin-image algorithm [1] creates pose-invariant representations of global shape with respect to individual mesh vertices. These ‘spin-images,’ are then compared for two different poses of the same object to establish correspondences and subsequently determine relative orientation of the poses. In this study, the spin-image algorithm is applied to 4DCT-derived capitate bone surfaces to assess the relative accuracy of registration with various amounts of geometry excluded.
The limited longitudinal coverage under the 4DCT technique (38.4mm, [2]), results in partial views of the capitate when imaging wrist motions. This study assesses the ability of the spin-image algorithm to register partial bone surfaces by artificially restricting the capitate geometry available for registration. Under IRB approval, standard static CT and 4DCT scans were obtained on a patient. The capitate was segmented from the static CT and one phase of 4DCT in which the whole bone was available. Spin-image registration was performed between the static and 4DCT. Distal portions of the 4DCT capitate (10-70%) were then progressively removed and registration was repeated. Registration accuracy was evaluated by angular errors and the percentage of sub-resolution fitting. It was determined that 60% of the distal capitate could be omitted without appreciable effect on registration accuracy using the spin-image algorithm (angular error < 1.5 degree, sub-resolution fitting < 98.4%).
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