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Bone texture analysis using CT-simulation scans to individuate risk parameters for radiation-induced insufficiency fractures

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Abstract

Summary

This study deals with the role of texture analysis as a predictive factor of radiation-induced insufficiency fractures in patients undergoing pelvic radiation.

Introduction

This study aims to assess the texture analysis (TA) of computed tomography (CT) simulation scans as a predictive factor of insufficiency fractures (IFs) in patients with pelvic malignancies undergoing radiation therapy (RT).

Methods

We performed an analysis of patients undergoing pelvic RT from January 2010 to December 2014, 24 of whom had developed pelvic bone IFs. We analyzed CT-simulation images using ImageJ macro software and selected two regions of interest (ROIs), which are L5 body and the femoral head. TA parameters included mean (m), standard deviation (SD), skewness (sk), kurtosis (k), entropy (e), and uniformity (u). The IFs patients were compared (1:2 ratio) with controlled patients who had not developed IFs and matched for sex, age, menopausal status, type of tumor, use of chemotherapy, and RT dose. A reliability test of intra- and inter-reader ROI TA reproducibility with the intra-class correlation coefficient (ICC) was performed. Univariate and multivariate analyses (logistic regression) were applied for TA parameters observed both in the IFs and the controlled groups.

Results

Inter- and intra-reader ROI TA was highly reproducible (ICC > 0.90). Significant TA parameters on paired t test included L5 m (p = 0.001), SD (p = 0.002), k (p = 0.006), e (p = 0.004), and u (p = 0.015) and femoral head m (p < 0.001) and SD (p = 0.001), whereas on logistic regression analysis, L5 e (p = 0.003) and u (p = 0.010) and femoral head m (p = 0.027), SD (p = 0.015), and sex (p = 0.044).

Conclusions

In our experience, bone CT TA could be correlated to the risk of radiation-induced IFs. Studies on a large patient series and methodological refinements are warranted.

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Authors and Affiliations

  1. Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy

    V. Nardone, P. Tini, L. Sebaste, T. Carfagno, G. Battaglia, G. Rubino, P. Pastina & L. Pirtoli

  2. Unit of Diagnostic Imaging, University Hospital of Siena, Siena, Italy

    S. F. Carbone, A. Grassi & M. A. Mazzei

  3. Unit of Medical Physics, University Hospital of Siena, Siena, Italy

    M. Biondi, E. Vanzi, G. De Otto, G. Belmonte, L. N. Mazzoni & F. Banci Buonamici

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  1. V. Nardone
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Corresponding author

Correspondence to V. Nardone.

Ethics declarations

The retrospective analysis of the data was authorized by the Internal Institutional Review Board. A signed informed consent was obtained both for any treatment and for the anonymous use of clinical data. All procedures were undertaken in compliance with the ethical statements of the Helsinki Declaration (1964, amended most recently in 2008) of the World Medical Association.

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Nardone, V., Tini, P., Carbone, S. et al. Bone texture analysis using CT-simulation scans to individuate risk parameters for radiation-induced insufficiency fractures. Osteoporos Int 28, 1915–1923 (2017). https://doi.org/10.1007/s00198-017-3968-5

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  • DOI: https://doi.org/10.1007/s00198-017-3968-5

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