Patient-specific finite element computer models improve fracture risk assessments in cancer patients with femoral bone metastases compared to clinical guidelines

Autor: P. D. Sander Dijkstra, Marianne de Jong, Esther Tanck, Yvette M. van der Linden, Tom Rozema, P. Westhoff, Herman M. Kroon, Nico Verdonschot, Arjonne Laar, Onarisa Ayu, Florieke Eggermont, Gerco van der Wal, L.C. Derikx
Přispěvatelé: Biomechanical Engineering
Jazyk: angličtina
Rok vydání: 2020
Předmět:
0301 basic medicine
Fracture risk
Clinical guidelines
medicine.medical_specialty
Histology
Bone density
Physiology
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Finite Element Analysis
030209 endocrinology & metabolism
Bone Neoplasms
Risk Assessment
03 medical and health sciences
0302 clinical medicine
All institutes and research themes of the Radboud University Medical Center
Bone Density
medicine
Humans
Computer Simulation
Femur
Pathological
business.industry
Bone metastases
Pathological fracture
Cancer
Femoral fracture
Patient specific
medicine.disease
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
Radiation therapy
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10]
030104 developmental biology
Femoral bone
Radiology
business
Finite element model
Zdroj: Bone, 130
Bone, 130:115101. Elsevier
BONE, 130. ELSEVIER SCIENCE INC
ISSN: 8756-3282
Popis: Purpose To determine whether patient-specific finite element (FE) computer models are better at assessing fracture risk for femoral bone metastases compared to clinical assessments based on axial cortical involvement on conventional radiographs, as described in current clinical guidelines. Methods Forty-five patients with 50 femoral bone metastases, who were treated with palliative radiotherapy for pain, were included (64% single fraction (8 Gy), 36% multiple fractions (5 or 6 x 4 Gy)) and were followed for six months to determine whether they developed a pathological femoral fracture. All plain radiographs available within a two month period prior to radiotherapy were obtained. Patient-specific FE models were constructed based on the geometry and bone density obtained from the baseline quantitative CT scans used for radiotherapy planning. Femoral failure loads normalized for body weight (BW) were calculated. Patients with a failure load of 7.5 x BW or lower were identified as having high fracture risk, whereas patients with a failure load higher than 7.5 x BW were classified as low fracture risk. Experienced assessors measured axial cortical involvement on conventional radiographs. Following clinical guidelines, patients with lesions larger than 30 mm were identified as having a high fracture risk. FE predictions were compared to clinical assessments by means of diagnostic accuracy values (sensitivity, specificity and positive (PPV) and negative predictive values (NPV)). Results Seven femurs (14%) fractured during follow-up. Median time to fracture was 8 weeks. FE models were better at assessing fracture risk in comparison to axial cortical involvement (sensitivity 100% vs. 86%, specificity 74% vs. 42%, PPV 39% vs. 19%, and NPV 100% vs. 95%, for the FE computer model vs. axial cortical involvement, respectively). Conclusions Patient-specific FE computer models improve fracture risk assessments of femoral bone metastases in advanced cancer patients compared to clinical assessments based on axial cortical involvement, which is currently used in clinical guidelines.
Databáze: OpenAIRE
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