Increasing soft tissue thickness does not affect trabecular bone score reproducibility: a phantom study
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ORIGINAL ARTICLE
Increasing soft tissue thickness does not affect trabecular bone score reproducibility: a phantom study Carmelo Messina 1,2 Alessandro Poloni3 Vito Chianca4 Domenico Albano5 Luca Petruccio Piodi6 Fabio Massimo Ulivieri7 Luca Maria Sconfienza1,2 ●
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Received: 22 February 2018 / Accepted: 3 June 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose Trabecular Bone Score (TBS) provides an indirect score of trabecular microarchitecture from lumbar spine (LS) dual energy X-ray absorptiometry. Increasing soft tissue thickness artifactually reduces TBS values; we evaluated the effect of a fictitious increase of soft tissue thickness on TBS and bone mineral density (BMD) reproducibility on a phantom model. Methods A Hologic spine phantom was scanned with a QDR-Discovery W Hologic densitometer. Fresh pork rind layers of 5 mm were used to simulate the in-vivo soft tissues. For each scan mode (fast array [FA], array, high definition [HD]), 25 scans were consecutively performed without phantom repositioning, at 0 (no layers), 1 cm, 3 cm, and 6 cm of thickness. BMD and TBS reproducibility was calculated as the complement to 100% of least significant change. Results Both BMD and TBS reproducibility slightly decreased with increasing soft tissue; this difference was statistically significant only for BMD using HD modality (reproducibility decreased from 99.4% at baseline to 98.4% at 6-cm of thickness). TBS reproducibility was slightly lower compared to that of BMD, and ranged between 98.8% (array, 0 cm) and 97.4% (FA, 6 cm). Without taking into account manufacturer BMI optimization, we found a progressive decrease of TBS mean values with increasing soft tissue thickness. The highest TBS difference between baseline scan and 6 cm was −0.179 (−14.27%) using HD. Conclusions Despite being slightly lower than that of BMD, TBS reproducibility was not affected up to 6 cm of increasing soft tissue thickness, and was even less influenced by fat than BMD reproducibility. Keywords Trabecular bone score Reproducibility Precision Dual energy X-ray absorptiometry Phantom ●
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Introduction * Carmelo Messina [email protected] 1
Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
2
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
3
Reparto di Radiologia, ASST Bergamo Est Ospedale Bolognini, Via Paderno 21, 24068 Seriate, Italy
4
Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Via Panzini 5, Napoli, Italy
5
Sezione di Scienze Radiologiche, Di.Bi.Med., Università degli Studi di Palermo, Via del Vespro 127, 90127 Palermo, Italy
6
Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
7
Bone Metabolic Unit, Nuclear Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Trabecular Bone Score (TBS) is a textural
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