PATIENT-SPECIFIC FINITE ELEMENT MODELS DIFFERENTIATE BETWEEN PATIENTS WITH AND WITHOUT A PATHOLOGICAL FRACTURE IN METASTATIC BONE DISEASE

2012 ◽  
Vol 45 ◽  
pp. S534 ◽  
Author(s):  
Loes Derikx ◽  
Yvette van der Linden ◽  
An Snyers ◽  
Nico Verdonschot ◽  
Esther Tanck
Keyword(s):  
Finite Element ◽  
Bone Disease ◽  
Pathological Fracture ◽  
Metastatic Bone Disease ◽  
Patient Specific ◽  
Finite Element Models

scholarly journals Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians?

2018 ◽  
Vol 7 (6) ◽  
pp. 430-439 ◽  
Author(s):  
F. Eggermont ◽  
L. C. Derikx ◽  
N. Verdonschot ◽  
I. C. M. van der Geest ◽  
M. A. A. de Jong ◽  
...  
Keyword(s):  
Finite Element ◽  
Fracture Risk ◽  
Bone Disease ◽  
Failure Load ◽  
Metastatic Bone Disease ◽  
Patient Specific ◽  
Finite Element Models ◽  
Fe Model ◽  
Clinical Assessments ◽  
Number Of Patients

Objectives In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians. Methods A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians. Results In institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments. Conclusion FE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines. Cite this article: F. Eggermont, L. C. Derikx, N. Verdonschot, I. C. M. van der Geest, M. A. A. de Jong, A. Snyers, Y. M. van der Linden, E. Tanck. Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians? Towards computational modelling in daily clinical practice. Bone Joint Res 2018;7:430–439. DOI: 10.1302/2046-3758.76.BJR-2017-0325.R2.

scholarly journals Diagnostic use of intramedullary reaming biopsy in metastatic long bone disease

2017 ◽  
Vol 99 (6) ◽  
pp. 452-455
Author(s):  
RA Afinowi ◽  
A Chaturvedi ◽  
HR Cattermole
Keyword(s):  
Diagnostic Accuracy ◽  
Metastatic Disease ◽  
Bone Disease ◽  
Pathological Fracture ◽  
Metastatic Bone Disease ◽  
Long Bone ◽  
Histopathological Analysis ◽  
Diagnostic Use ◽  
Intramedullary Reaming ◽  
Adequate Tissue

INTRODUCTION Bone is the third most common site of metastasis. A histological diagnosis is important in guiding therapy and prognosis. In up to 15% of cases of metastatic disease, the primary tumour remains unknown. This emphasises the importance of adequate, reliable and accurate sampling when performing any type of biopsy. Reaming biopsy is commonly performed during intramedullary nailing of metastatic long-bone disease but there is little published evidence on the diagnostic use and reliability of this technique. AIMS AND METHODS We reviewed 49 cases of confirmed metastatic bone disease to determine adequacy for analysis, diagnostic accuracy and factors affecting reliability. RESULTS Adequate tissue for histopathological analysis was obtained in 96% of cases but metastasis was confirmed in only 51% of cases. The presence of a pathological fracture had no effect on accuracy of the results but metastasis was more likely to be missed in the presence of tissue crushing and or necrosis (P = 0.015). DISCUSSION This study determines the use and accuracy of bone reaming biopsy in metastatic disease and, to the best of our knowledge, is the only study determining the effect of additional factors such as the presence of a pathological fracture and tissue necrosis or crushing on the diagnostic accuracy of this technique. CONCLUSIONS In spite of adequate tissue sampling, the diagnostic accuracy and, hence, reliability of intramedullary reaming biopsy in metastatic bone disease is less than optimal. A reaming histopathology report suggesting no evident metastasis should always be taken in clinical context.

Predisposing Factors for Orthodontic Mini-Implant Failure Defined by Bone Strains in Patient-Specific Finite Element Models

2016 ◽  
Vol 44 (10) ◽  
pp. 2948-2956 ◽  
Author(s):  
Mhd Hassan Albogha ◽  
Toru Kitahara ◽  
Mitsugu Todo ◽  
Hiroto Hyakutake ◽  
Ichiro Takahashi
Keyword(s):  
Finite Element ◽  
Predisposing Factors ◽  
Implant Failure ◽  
Patient Specific ◽  
Finite Element Models ◽  
Bone Strains

When and where do patients with bone metastases actually break their femurs?

2020 ◽  
Vol 102-B (5) ◽  
pp. 638-645 ◽  
Author(s):  
A. Sternheim ◽  
F. Traub ◽  
N. Trabelsi ◽  
S. Dadia ◽  
Y. Gortzak ◽  
...  
Keyword(s):  
Bone Disease ◽  
Pathological Fracture ◽  
Roc Curves ◽  
Metastatic Bone Disease ◽  
Risk Of Fracture ◽  
Receiver Operating Characteristic Curves ◽  
Predicted Values ◽  
Sensitivity Specificity ◽  
Imminent Risk

Aims Accurate estimations of the risk of fracture due to metastatic bone disease in the femur is essential in order to avoid both under-treatment and over-treatment of patients with an impending pathological fracture. The purpose of the current retrospective in vivo study was to use CT-based finite element analyses (CTFEA) to identify a clear quantitative differentiating factor between patients who are at imminent risk of fracturing their femur and those who are not, and to identify the exact location of maximal weakness where the fracture is most likely to occur. Methods Data were collected on 82 patients with femoral metastatic bone disease, 41 of whom did not undergo prophylactic fixation. A total of 15 had a pathological fracture within six months following the CT scan, and 26 were fracture-free during the five months following the scan. The Mirels score and strain fold ratio (SFR) based on CTFEA was computed for all patients. A SFR value of 1.48 was used as the threshold for a pathological fracture. The sensitivity, specificity, positive, and negative predicted values for Mirels score and SFR predictions were computed for nine patients who fractured and 24 who did not, as well as a comparison of areas under the receiver operating characteristic curves (AUC of the ROC curves). Results The sensitivity of SFR was 100% compared with 88% for the Mirels score, and the specificity of SFR was 67% compared with 38% for the Mirels score. The AUC was 0.905 for SFR compared with 0.578 for the Mirels score (p = 0.008). Conclusion All the patients who sustained a pathological fracture of the femur had an SFR of > 1.48. CTFEA was far better at predicting the risk of fracture and its location accurately compared with the Mirels score. CTFEA is quick and automated and can be incorporated into the protocol of CT scanners. Cite this article: Bone Joint J 2020;102-B(5):638–645.

An efficient tissue classifier for building patient-specific finite element models from X-ray CT images

1996 ◽  
Vol 43 (3) ◽  
pp. 333-337 ◽  
Author(s):  
N. Shrinidhi ◽  
D.R. Haynor ◽  
Yanqun Wang ◽  
D.B. Jorgenson ◽  
G.H. Bardy ◽  
...  
Keyword(s):  
Finite Element ◽  
Ct Images ◽  
Patient Specific ◽  
Finite Element Models ◽  
X Ray

3D patient-specific finite element models of the proximal femur based on DXA towards the classification of fracture and non-fracture cases

Bone ◽  
2019 ◽  
Vol 121 ◽  
pp. 89-99 ◽  
Author(s):  
Carlos Ruiz Wills ◽  
Andy Luis Olivares ◽  
Simone Tassani ◽  
Mario Ceresa ◽  
Veronika Zimmer ◽  
...  
Keyword(s):  
Finite Element ◽  
Proximal Femur ◽  
Patient Specific ◽  
Finite Element Models
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