Finite element fracture load analysis and dark-field X-ray imaging of osteoporotic and healthy vertebrae in human lumbar spine specimens

TY - JOUR

T1 - Finite element fracture load analysis and dark-field X-ray imaging of osteoporotic and healthy vertebrae in human lumbar spine specimens

AU - Hesse, N.

AU - Strack, D.

AU - Rischewski, J. F.

AU - Gassert, F. T.

AU - Kufner, A.

AU - Urban, T.

AU - Lochschmidt, M. E.

AU - Schwaiger, B. J.

AU - Braun, C.

AU - Mueller, D. P.

AU - Pfeiffer, D.

AU - Baum, T.

AU - Subburaj, K.

AU - Pfeiffer, F.

AU - Gersing, A. S.

N1 - Publisher Copyright: © The Author(s) 2025.

PY - 2025/12

Y1 - 2025/12

N2 - Purpose: This study investigated the association of measurements from a clinical X-ray dark-field prototype system and CT-based finite element analysis (FEA) in lumbar spine specimens. Materials and Methods: In this prospective study, human cadaveric spine specimens (L2 to L4) were examined using a clinical prototype for dark-field radiography, yielding both attenuation and dark-field images. Specimens were scanned in vertical and horizontal positions. Volumetric bone mineral density (BMD) values were derived from quantitative CT measurements. Bone segmentation masks derived from CT-images were used for FEA-estimated fracture load (FL) calculations. FEA-estimated FL, dark-field, and attenuation signals were compared between osteoporotic/osteopenic (BMD < 120 mg/cm3) and non-osteoporotic/osteopenic specimens using the paired t-test and the Wilcoxon Mann–Whitney U test. Associations were tested using Spearman correlation. Results: Fifty-nine vertebrae from 20 lumbar spine specimens (mean age, 73 years ± 13; 11 women) were studied. FEA-estimated FL correlated with BMD (r = 0.75, p <.001) and was significantly lower in osteoporotic/osteopenic vertebrae (1222 ± 566 vs. 2880 ± 1182, p <.001). Dark-field and attenuation signals were positively correlated with FEA-estimated FL, in both vertical (rdarkfield = 0.64, p <.001, rattenuation = 0.82, p <.001) and horizontal position (rdarkfield = 0.55, p <.001, rattenuation = 0.81, p <.001). Conclusion: Dark-field and attenuation signals assessed using a clinical X-ray dark-field system significantly correlated with FEA-estimated FL in human spine specimens with and without osteoporosis/osteopenia. Dark-Field imaging may complement existing assessment methods for bone strength as a dose-efficient, accessible tool.

AB - Purpose: This study investigated the association of measurements from a clinical X-ray dark-field prototype system and CT-based finite element analysis (FEA) in lumbar spine specimens. Materials and Methods: In this prospective study, human cadaveric spine specimens (L2 to L4) were examined using a clinical prototype for dark-field radiography, yielding both attenuation and dark-field images. Specimens were scanned in vertical and horizontal positions. Volumetric bone mineral density (BMD) values were derived from quantitative CT measurements. Bone segmentation masks derived from CT-images were used for FEA-estimated fracture load (FL) calculations. FEA-estimated FL, dark-field, and attenuation signals were compared between osteoporotic/osteopenic (BMD < 120 mg/cm3) and non-osteoporotic/osteopenic specimens using the paired t-test and the Wilcoxon Mann–Whitney U test. Associations were tested using Spearman correlation. Results: Fifty-nine vertebrae from 20 lumbar spine specimens (mean age, 73 years ± 13; 11 women) were studied. FEA-estimated FL correlated with BMD (r = 0.75, p <.001) and was significantly lower in osteoporotic/osteopenic vertebrae (1222 ± 566 vs. 2880 ± 1182, p <.001). Dark-field and attenuation signals were positively correlated with FEA-estimated FL, in both vertical (rdarkfield = 0.64, p <.001, rattenuation = 0.82, p <.001) and horizontal position (rdarkfield = 0.55, p <.001, rattenuation = 0.81, p <.001). Conclusion: Dark-field and attenuation signals assessed using a clinical X-ray dark-field system significantly correlated with FEA-estimated FL in human spine specimens with and without osteoporosis/osteopenia. Dark-Field imaging may complement existing assessment methods for bone strength as a dose-efficient, accessible tool.

KW - Bone

KW - Dark-field imaging

KW - Finite element analysis

KW - Osteoporosis

KW - Spine

UR - http://www.scopus.com/inward/record.url?scp=105007211858&partnerID=8YFLogxK

U2 - 10.1186/s12891-025-08709-6

DO - 10.1186/s12891-025-08709-6

M3 - Journal article

C2 - 40462036

AN - SCOPUS:105007211858

SN - 1471-2474

VL - 26

JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

IS - 1

M1 - 545

ER -