Multicenter precision of cortical and trabecular bone quality measures assessed by high-resolution peripheral quantitative computed tomography

Authors

  • Andrew J Burghardt,

    Corresponding author
    1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
    • Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA 94158, USA.
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  • Jean-Baptiste Pialat,

    1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
    2. INSERM Research Unit 1033 and Université de Lyon, Lyon, France
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  • Galateia J Kazakia,

    1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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  • Stephanie Boutroy,

    1. INSERM Research Unit 1033 and Université de Lyon, Lyon, France
    2. Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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  • Klaus Engelke,

    1. Synarc Inc., Hamburg, Germany
    2. Institute of Medical Physics, University of Erlangen, Erlangen, Germany
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  • Janina M Patsch,

    1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
    2. Department of Radiology, Medical University of Vienna, Vienna, Austria
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  • Alexander Valentinitsch,

    1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
    2. Department of Radiology, Medical University of Vienna, Vienna, Austria
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  • Danmei Liu,

    1. Department of Orthopedics, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
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  • Eva Szabo,

    1. Faculty of Medicine and Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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  • Cesar E Bogado,

    1. Instituto de Investigaciones Metabólicas and Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
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  • Maria Belen Zanchetta,

    1. Instituto de Investigaciones Metabólicas and Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
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  • Heather A McKay,

    1. Department of Orthopedics, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
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  • Elizabeth Shane,

    1. Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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  • Steven K Boyd,

    1. Faculty of Medicine and Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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  • Mary L Bouxsein,

    1. Endocrine Unit, Massachusetts General Hospital and Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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  • Roland Chapurlat,

    1. INSERM Research Unit 1033 and Université de Lyon, Lyon, France
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  • Sundeep Khosla,

    1. Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
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  • Sharmila Majumdar

    1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Abstract

High-resolution peripheral quantitative computed tomography (HR-pQCT) has recently been introduced as a clinical research tool for in vivo assessment of bone quality. The utility of this technology to address important skeletal health questions requires translation to standardized multicenter data pools. Our goal was to evaluate the feasibility of pooling data in multicenter HR-pQCT imaging trials. Reproducibility imaging experiments were performed using structure and composition-realistic phantoms constructed from cadaveric radii. Single-center precision was determined by repeat scanning over short-term (<72 hours), intermediate-term (3–5 months), and long-term intervals (28 months). Multicenter precision was determined by imaging the phantoms at nine different HR-pQCT centers. Least significant change (LSC) and root mean squared coefficient of variation (RMSCV) for each interval and across centers was calculated for bone density, geometry, microstructure, and biomechanical parameters. Single-center short-term RMSCVs were <1% for all parameters except cortical thickness (Ct.Th) (1.1%), spatial variability in cortical thickness (Ct.Th.SD) (2.6%), standard deviation of trabecular separation (Tb.Sp.SD) (1.8%), and porosity measures (6% to 8%). Intermediate-term RMSCVs were generally not statistically different from short-term values. Long-term variability was significantly greater for all density measures (0.7% to 2.0%; p < 0.05 versus short-term) and several structure measures: cortical thickness (Ct.Th) (3.4%; p < 0.01 versus short-term), cortical porosity (Ct.Po) (15.4%; p < 0.01 versus short-term), and trabecular thickness (Tb.Th) (2.2%; p < 0.01 versus short-term). Multicenter RMSCVs were also significantly higher than short-term values: 2% to 4% for density and micro–finite element analysis (µFE) measures (p < 0.0001), 2.6% to 5.3% for morphometric measures (p < 0.001), whereas Ct.Po was 16.2% (p < 0.001). In the absence of subject motion, multicenter precision errors for HR-pQCT parameters were generally less than 5%. Phantom-based multicenter precision was comparable to previously reported in in vivo single-center precision errors, although this was approximately two to five times worse than ex vivo short-term precision. The data generated from this study will contribute to the future design and validation of standardized procedures that are broadly translatable to multicenter study designs. © 2013 American Society for Bone and Mineral Research.

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