A novel framework for the temporal analysis of bone mineral density in metastatic lesions using CT images of the femur

Tom H. Knoop, Loes C. Derikx, Nico Verdonschot, Cornelis H. Slump*

*Corresponding author for this work

    Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

    2 Citations (Scopus)
    8 Downloads (Pure)


    In the progressive stages of cancer, metastatic lesions in often develop in the femur. The accompanying pain and risk of fracture dramatically affect the quality of life of the patient. Radiotherapy is often administered as palliative treatment to relieve pain and restore the bone around the lesion. It is thought to affect the bone mineralization of the treated region, but the quantitative relation between radiation dose and femur remineralization remains unclear. A new framework for the longitudinal analysis of CT-scans of patients receiving radiotherapy is presented to investigate this relationship. The implemented framework is capable of automatic calibration of Hounsfield Units to calcium equivalent values and the estimation of a prediction interval per scan. Other features of the framework are temporal registration of femurs using elastix, transformation of arbitrary Regions Of Interests (ROI), and extraction of metrics for analysis. Build in Matlab, the modular approach aids easy adaptation to the pertinent questions in the explorative phase of the research. For validation purposes, an in-vitro model consisting of a human cadaver femur with a milled hole in the intertrochanteric region was used, representing a femur with a metastatic lesion. The hole was incrementally stacked with plates of PMMA bone cement with variable radiopaqueness. Using a Kolmogorov-Smirnov (KS) test, changes in density distribution due to an increase of the calcium concentration could be discriminated. In a 21 cm3 ROI, changes in 8% of the volume from 888 ± 57mg · ml-1 to 1000 ± 80mg · ml-1 could be statistically proven using the proposed framework. In conclusion, the newly developed framework proved to be a useful and flexible tool for the analysis of longitudinal CT data.

    Original languageEnglish
    Title of host publicationMedical Imaging 2015
    Subtitle of host publicationComputer-Aided Diagnosis
    EditorsLubomir M. Hadjiiski, Georgia D. Tourassi
    Place of PublicationWashington, DC
    Number of pages11
    ISBN (Print)9781628415049
    Publication statusPublished - 1 Jan 2015
    EventSPIE Medical Imaging 2015 - Orlando, United States
    Duration: 21 Feb 201526 Feb 2015

    Publication series

    NameProceedings of SPIE
    ISSN (Print)0277-786X
    NameProgress in biomedical optics and imaging
    ISSN (Print)1605-7422


    ConferenceSPIE Medical Imaging 2015
    Country/TerritoryUnited States


    • Bone mineral density
    • Calibration
    • CT
    • Elastix
    • Femur
    • Metastatic lesion
    • Registration
    • Temporal analysis


    Dive into the research topics of 'A novel framework for the temporal analysis of bone mineral density in metastatic lesions using CT images of the femur'. Together they form a unique fingerprint.

    Cite this