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Quantitative Ultrasound and Osteoporosis
sional spatiotemporal Fourier transform of the signal re- ceived by each element (Minonzio et al., 2010). Background noise can be filtered by choosing the appropriate number of singular values to optimize the signal-to-noise ratio. In ad- dition, BDAT allows visualization of the low-energy modes.
Once dispersion curves are obtained, waveguide character- istics are retrieved through an inversion method, based on a two-dimensional transverse isotropic free-plate model, that allows the concurrent identification of cortical thickness and porosity (Figure 8). Site-matched microcomputed tomogra- phy images of the bone specimens imaged served as the gold standard to assess the accuracy of thickness and porosity estimates. Excellent agreement was observed for thickness, and relatively good overall agreement was obtained for po- rosity. In a pilot in vivo study, BDAT could determine corti- cal thickness nearly as accurately as conventional HR X-ray computed tomography (Vallet et al., 2016).
BDAT is currently under clinical evaluation. In a study in- cluding 205 postmenopausal women, including 102 with 1 or more nontraumatic fractures, fracture prediction was signifi- cant for hip fractures with cortical thickness and for vertebral fractures with cortical porosity (Minonzio et al., 2017).
Looking Ahead
DXA remains the primary modality for the management of osteoporosis because it has imaging capability, can tar- get the hip and spine, and has abundant evidence to support clinical utility. However, calcaneal ultrasound has demon- strated comparable performance for fracture risk prediction in clinical trials involving thousands of women. Cortical ultrasound has also demonstrated substantial clinical util- ity. Moreover, quantitative ultrasound device technology is rapidly evolving, with several new device designs introduced just in the last few years. Because of its established clinical utility, lack of ionizing radiation, low cost, and portability, quantitative ultrasound has a promising future, especially for screening.
The mention of commercial products, their sources, or their use in connection with material reported herein is not to be construed as either an actual or implied endorsement of such products by the Department of Health and Human Services.
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