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      Cortical Bone Mapping: Measurement and Statistical Analysis of Localised Skeletal Changes

      review-article
      ,
      Current Osteoporosis Reports
      Springer US
      CT, Fracture, Cortical bone mapping, Statistical parametric mapping

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          Abstract

          Purpose of Review

          Cortical bone mapping (CBM) is a technique for measuring localised skeletal changes from computed tomography (CT) images. It can provide measurements with accuracy surpassing the underlying imaging resolution. CBM can detect changes in several properties of the cortex, with no prior assumptions about the likely location of said changes. This paper summarises the theory behind CBM, discusses its strengths and limitations, and reviews some studies in which it has been applied.

          Recent Findings

          CBM has revealed associations between fracture risk and cortical properties in specific regions of the proximal femur which present feasible therapeutic targets. Analyses of several pharmaceutical and exercise interventions quantify effects that are distinct both in location and in the nature of the micro-architectural changes. CBM has illuminated age-related changes in the proximal femur and has recently been applied to other bones, as well as to the assessment of cartilage.

          Summary

          The CBM processing pipeline is designed primarily for large cohort studies. Its main impact thus far has not been in the realm of clinical practice, but rather to improve our fundamental understanding of localised bone structure and changes.

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          Most cited references38

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          Evaluation of Skull Cortical Thickness Changes With Age and Sex From Computed Tomography Scans.

          Head injuries resulting from motor vehicle crashes (MVC) are extremely common, yet the details of the mechanism of injury remain to be well characterized. Skull deformation is believed to be a contributing factor to some types of traumatic brain injury (TBI). Understanding biomechanical contributors to skull deformation would provide further insight into the mechanism of head injury resulting from blunt trauma. In particular, skull thickness is thought be a very important factor governing deformation of the skull and its propensity for fracture. Previously, age- and sex-based skull cortical thickness changes were difficult to evaluate based on the need for cadaveric skulls. In this cross-sectional study, skull thickness changes with age and sex have been evaluated at homologous locations using a validated cortical density-based algorithm to accurately quantify cortical thickness from 123 high-resolution clinical computed tomography (CT) scans. The flat bones of the skull have a sandwich structure; therefore, skull thickness was evaluated for the inner and outer tables as well the full thickness. General trends indicated an increase in the full skull thickness, mostly attributed to an increase in the thickness of the diploic layer; however, these trends were not found to be statistically significant. There was a significant relationship between cortical thinning and age for both tables of the frontal, occipital, and parietal bones ranging between a 36% and 60% decrease from ages 20 to 100 years in females, whereas males exhibited no significant changes. Understanding how cortical and full skull thickness changes with age from a wide range of subjects can have implications in improving the biofidelity of age- and sex-specific finite element models and therefore aid in the prediction and understanding of TBI from impact and blast injuries.
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            Cortical bone: a challenging geography.

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              The Influence of High-Impact Exercise on Cortical and Trabecular Bone Mineral Content and 3D Distribution Across the Proximal Femur in Older Men: A Randomized Controlled Unilateral Intervention.

              Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localized rather than being evenly distributed across the proximal femur.
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                Author and article information

                Contributors
                gmt11@eng.cam.ac.uk
                Journal
                Curr Osteoporos Rep
                Curr Osteoporos Rep
                Current Osteoporosis Reports
                Springer US (New York )
                1544-1873
                1544-2241
                28 August 2018
                28 August 2018
                2018
                : 16
                : 5
                : 617-625
                Affiliations
                ISNI 0000000121885934, GRID grid.5335.0, Department of Engineering, , University of Cambridge, ; Cambridge, CB2 1PZ UK
                Article
                475
                10.1007/s11914-018-0475-3
                6153562
                30155843
                4d307243-6cc8-494f-80b6-66e88ffc5c6c
                © The Author(s) 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Funding
                Funded by: University of Cambridge
                Categories
                Imaging (T Lang and F Wehrli, Section Editors)
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2018

                Orthopedics
                ct,fracture,cortical bone mapping,statistical parametric mapping
                Orthopedics
                ct, fracture, cortical bone mapping, statistical parametric mapping

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