Purpose: Subchondral cortical and trabecular bone mineral density (BMD) may increase and/or decrease during different stages of osteoarthritis (OA) disease progression. 2D in-vivo imaging studies examining direct associations between increased proximal tibial BMD and knee OA offer conflicting results, which may be due to the inherent limitations of 2D BMD imaging tools. Our objective was to compare existing and novel 3D imaging techniques for distinguishing subchondral bone properties in OA and normal cadaveric tibiae.
Method: Eight intact cadaver knees from five donors (4M:1F; age: 77+/−10) were repositioned and scanned three times using QCT (0.5mm isotropic resolution, 0.15mSv dosage). BMD was assessed using
computed tomography absorptiometry (CT-OAM) which uses maximum intensity projections to assesses peak density values within subchondral bone, and
our novel computed tomography topographic mapping of subchondral density (CT-TOMASD) technique, which uses surface projections to assess both cortical and trabecular bone density at specific depths from the subchondral surface.
Average BMD at normalized depths of 0–2.5mm, 2.5–5.0mm, and 5.0–10mm from the surface were assessed using CT-TomasD. Regional analyses were performed consisting of:
medial/lateral (M/L) BMD ratio, and
BMD of a 10mm diameter core identified as having the maximum regional BMD.
Each bone was assessed for OA using a modified-KL scoring system: Normal (mKL=0); Early-OA (1–2); and Late-OA (3–4).
Results: OA was identified in four compartments of three tibiae (1 late OA+valgus, 1 late OA+varus, 1 early OA+neutral). Larger density differences between OA and normal knees were noted using CT-TOMASD compared with CT-OAM. CT-TomasD demonstrated that the two knees with late OA demonstrated M/L BMD ratios differing by more than 3.4 SD compared with normals, with peak cores higher than normals across all depths. The knee with early OA and neutral alignment demonstrated M/L ratios less than normals while core differences were highest proximally, with density becoming lower than normals with increasing depth.
Conclusion: CT-TomasD demonstrated larger differences between OA and normal subjects when compared with CT-OAM differences. This may be due to CT-OAM primarily assessing peak density within the thin subchondral cortical endplate; a region demonstrating fairly uniform peak densities within a limited range.
