Relationships between static histomorphometry and ultrasound in the human calcaneus.

The aim of this study was to explore the relationship(s) between histomorphometric measurements of cancellous bone structure and ultrasound. Ultrasonic measurements were made using a CUBA research system consisting of a pair of 1 Mhz unfocused transducers. Speed of sound (SOS) and broadband ultrasonic attenuation (BUA) were determined in 15 human cadaveric heels, with mean precision for all measurements coefficients of variation (CV) = 0.6% and 12%, respectively. The calcaneus was dissected and a 7.5 mm transcortical cylinder was removed from the path of ultrasound (US) transmission. The cortices were removed and the remaining cancellous core was sectioned into approximately 5 mm blocks, numbered from 1 to 6 (medial-lateral). Histomorphometric measurements were performed on decalcified, 5 microm-thick sections from blocks 1-6 using an automatic color image analysis system. There were significant differences between blocks 1 and 3-6 for BS/TV, BV/TV, Tb.N, and Tb. Sp (all P < 0.001), all decreasing in a medial-lateral direction (except Tb.Sp), implying that the medial portion of the calcaneus had more trabeculae with less spacing between them than the lateral portion. Furthermore, Tb.Th and BS/BV variables were uniform across the calcaneus, suggesting that individual trabeculae were of similar dimension. We found no significant correlations between US and histomorphometric parameters either averaged over all blocks or by using each block region separately. In conclusion, this study does not support the notion that US measurements of SOS and BUA through the heel reflect calcaneal cancellous bone structure, however, further studies using larger sample sizes may be warranted.

Water bath and contact methods in ultrasonic evaluation of bone.

Ultrasonic devices for the measurement of speed of sound (SOS) and broadband ultrasonic attenuation (BUA) generally use either a contact or water bath method. The aim of this study was to compare these two methods while determining the influence of soft tissue, pathlength (heel width and bone width), and a fixed heel dimension on SOS (m/second) and BUA (dB/MHz). Ultrasonic measurements were made using a CUBA Research system utilizing a pair of 1 MHz unfocused transducers with mean precision CV = 0.7% and 6.0% for all SOS and BUA measurements, respectively. SOS and BUA were determined in 24 human cadaveric heels under three conditions: contact method (heel intact), water bath method (heel intact), water bath method (no soft tissue). Although there were significant differences between measurements using contact and water bath techniques (heel intact), their correlations were high (r = 0.858 for SOS and r = 0. 937 for BUA; P < 0.001). After removal of soft tissue, SOS significantly increased (78 m/second; P < 0.001) whereas there was no change in BUA (P > 0.05). Heel width correlated with SOS measurements (-0.224 < r < -0.347; P < 0.001) and bone width correlated with BUA measurements (0.198 < r < 0.276; P < 0.001). The practice of using a fixed heel dimension (Lunar Achilles) was investigated by comparing SOS calculated with measured heel thickness and a value of 4 cm (Lunar Achilles). SOS increased by 42 m/second (2.7%) using the fixed heel dimension compared with measured heel widths. This study demonstrates the similarity between contact and water bath-based methods, while showing that the presence of soft tissue reduces SOS but has no effect on BUA. The use of a fixed heel dimension for calculation of SOS overestimates values obtained when using measured heel dimensions, though the values correlate highly (r = 0.98, P < 0.001). In addition, an increase in heel width tends to cause an underestimation of SOS whereas an increase in bone width tends to overestimate BUA, although the effects are relatively small.