The 3D-based scaling index algorithm to optimize structure analysis of trabecular bone in postmenopausal women with and without osteoporotic spine fractures

The scaling index method (SIM) is a recently proposed non-linear technique to extract texture measures for the quantitative characterisation of the trabecular bone structure in high resolution magnetic resonance imaging (HR-MRI). The three-dimensional tomographic images are interpreted as a point distribution in a state space where each point (voxel) is defined by its x, y, z coordinates and the grey value. The SIM estimates local scaling properties to describe the nonlinear morphological features in this four-dimensional point distribution. Thus, it can be used for differentiating between cluster-, rod-, sheet-like and unstructured (background) image components, which makes it suitable for quantifying the microstructure of human cancellous bone. The SIM was applied to high resolution magnetic resonance images of the distal radius in patients with and without osteoporotic spine fractures in order to quantify the deterioration of bone structure. Using the receiver operator characteristic (ROC) analysis the diagnostic performance of this texture measure in differentiating patients with and without fractures was compared with bone mineral density (BMD). The SIM demonstrated the best area under the curve (AUC) value for discriminating the two groups. The reliability of our new texture measure and the validity of our results were assessed by applying bootstrapping resampling methods. The results of this study show that trabecular structure measures derived from HR-MRI of the radius in a clinical setting using a recently proposed algorithm based on a local 3D scaling index method can significantly improve the diagnostic performance in differentiating postmenopausal women with and without osteoporotic spine fractures.