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Segmentation of cortical bone from trabecular bone offers little improvement

in FE predictions of local structural stiffness at the proximal tibia

Conference Paper · May 2017

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 Segmentation of cortical bone from trabecular bone offers little improvement in
FE predictions of local structural stiffness at the proximal tibia
Mehrdad Hosseini1, Majid Nazemi1, Morteza Amini1, Saija A. Kontulainen2, Jaques S. Milner 3, David W. Holdsworth3 , Bassam A. Masri4 , David R. Wilson4, James D. Johnston1
1. Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
2. College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
3. Robarts Research Institute, Western University, London, Canada
4. Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada

Introduction Methodology Table 1. Coefficient of determination (𝑅2 ) and RMSE% of prediction for the
Osteoarthritis (OA) is a debilitating joint disease marked by Thirteen proximal tibia compartments were employed in this study. They were previously imaged using CT (Fig. 3a) and adopted E-BMD equation and employed segmentation approach
mechanical and morphological changes to cartilage and tested, experimentally, to determine local subchondral bone stiffness at various surface sites (Fig. 2a) [6]. Initially, CT slices Cortical Trabecular Threshold Manual segmentation
underlying subchondral bone (Fig.1) [1]. These alterations are were segmented to separate the periosteal bone and surrounding soft tissue (Fig 3b). For the manual segmentation approach, E-BMD E-BMD R2 RMSE% R2 RMSE%
Rho 0.62 337.6 0.73 257.5
thought to affect bone stiffness, distort joint mechanics and bone tissue was further separated to cortical and trabecular regions using region growing (with thresholds of 465 and 500
Morgan
𝑚𝑔/𝑐𝑚3 at the endosteal and subchondral trabecular region, respectively) along with manual correction (Fig. 3c) [5, 7].
Snyder &
cause pain [2, 3]. Most observations, however, are based on Schneider 0.56 295.8 0.75 200.9

ex-vivo animal studies and have not been corroborated with Volumes were extracted out of the segmented CT slices (Fig. 3d) and smoothed prior to the FE analysis (Fig. 3e). A Rho 0.70 161.2 0.72 184.6
Snyder & Rho
in-vivo measurements on living people. Subject-specific finite combination of different site-specific E-BMD equations adopted from the literature (2 cortical-specific, 7 trabecular-specific) 0.63 189.7 0.75 141.4
Schneider
element (FE) models are non-invasive tools that can clarify the [8], were used to assign material properties to the QCT-FE model (Fig 3f). A linear elastic analysis was performed using the Rho 0.68 173.1 0.74 132.6
role of bone in OA and in initiating pain. ABAQUS FE package to predict local structural stiffness from 43 indentation sites at the subchondral surface (Fig. 3g). Snyder & Keyak
0.64 147.6 0.76 101.2
Schneider
Rho 0.72 104.4 0.74 82.07
Snyder & Linde
0.69 85.7 0.77 59.4
Schneider
Rho 0.74 77.6 0.73 60
Snyder & Hodgskinson
0.72 61.4 0.76 41.1
Schneider
Rho 0.74 68.6 0.74 54.4
Snyder & Anderson
0.72 53.6 0.77 36.5
Schneider
Rho 0.77 28.8 0.74 21.9
Snyder & Goulet
0.75 19.4 0.78 13
Schneider

Fig.1. Different layers of subchondral bone

Background
• Recently, a subject-specific model of the proximal tibia has
been developed and validated against macro indentation b

testing at the subchondral surface (Fig.2) [4].

• Quantitative Computed Tomography (QCT) provides the
geometry and mechanical properties for subject-specific FE
models.
• Empirical density-modulus (E-BMD) relationships from the
literature are used to convert imaged bone mineral density
(BMD) to the elastic modulus (E).
Fig.4. Linear regression between FE-predicted and experimental stiffness values
• A global BMD threshold is generally used to separate for the manually segmented models with Goulet and Snyder equations
cortical from trabecular bone [5].
• Global thresholding fails at regions with thin cortical bone. Discussion
• Use of semi-automatic manual segmentations explained
Objective similar stiffness variance as with global thresholding, but
The objective of this study was to identify the segmenting with slightly lower errors.
approach (manual versus global thresholding) which best • Changing the cortical-specific equation only slightly
predicted (with highest explained variance and least amount of altered stiffness predictions (2% to 4%), implying that
error) local subchondral bone structural stiffness at the cortical bone is not the primary structure mediating local
proximal tibia. stiffness of the proximal tibia.
• These results suggest that using the simple threshold-based
segmentation method with an optimal cut-off value could
be a suitable choice for QCT-FE modeling of the proximal
tibia.
Fig.3. a) The QCT image of a sagittal cross-section of a tibial lateral compartment; b) Segmented object map of the same sample (the half maximum height (HMH) Conclusion
method was used to separate the bone from surrounding materials); c) semi-automatically segmented cortical and trabecular bone; d) The extracted rough volume out of
the segmented CT slices (ANALYZE10); e) final smoothed volume generated from the extracted object map(GEOMAGIC STUDIO 12); f) mapped elastic modulus on the Our findings indicate that semi-automatic segmentation offers
QCT-FE model g) Displacement contour map for the QCT-FE simulation little improvement in stiffness predictions of the tibial
Results: subchondral bone. Future research will study the effects of
When a global BMD threshold of 500 𝑚𝑔/𝑐𝑚3 was used to separate cortical and trabecular region, QCT-FE models explained including material anisotropy and correcting for partial
between 56-77% of the variance in local proximal tibial subchondral bone stiffness with normalized root mean square errors volume effects.
(RMSE%) ranging from 17-338%. With manual segmentation, QCT-FE models explained 72%-78% of the measured stiffness References
variance with RMSE% ranging from 13% to 250% (Fig.4 and Table 1). [1] Radin et al. [2] Li and Aspen [3] Burnnet et al. [4] Nazemi et al. (2015) [5]
Fig.2. Schematic diagram of macro indentation test [6]
Gray et al. [6] Johnston et al. [7] Nazemi et al. (2016) [8] Helgason et al

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