Tomografia computadorizada quantitativa periférica de alta resolução para avaliação de parâmetros morfológicos e funcionais ósseos / High resolution peripheral quantitative computed tomography for the assessment of morphological and mechanical bone parameters

RESUMOA tomografia computadorizada quantitativa periférica de alta resolução (HR-pQCT) é uma nova tecnologia disponível comercialmente há menos de 10 anos que permite a feitura de exames in vivo para a avaliação de parâmetros ósseos. A HR-pQCT avalia a forma, o número, o volume, a densidade, a conectividade e a separação das trabéculas; a densidade e a espessura do osso cortical e o volume e a densidade total, em alta definição, o que permite a construção digital da microarquitetura óssea adicionalmente. A aplicação de cálculos matemáticos aos dados capturados, método denominado elemento finito (FE), permite a estimativa das propriedades físicas do tecido e simula cargas suportadas de forma não invasiva. Desse modo, a HR-pQCT adquire simultaneamente dados antes fornecidos separadamente pela densitometria óssea, pela ressonância magnética e pela histomorfometria e agrega estimativas biomecânicas antes só possíveis em tecidos extraídos. A reprodutibilidade do método é satisfatória, com coeficientes de variação que raramente ultrapassam os 3%. Quanto à acurácia, os parâmetros apresentam de regular a boa concordância (r2= 0,37-0,97).A principal aplicação clínica é na quantificação e no monitoramento das doenças osteometabólicas, porque avalia de modo mais completo a resistência óssea e o risco de fratura. Na artrite reumatoide permite-se a aferição do número e do tamanho das erosões e dos cistos, além do espaço articular. Na osteoartrite é possível caracterizar as áreas edema-símile que guardam correlação com a degradação da cartilagem.Restritas ainda a um instrumento de pesquisa, dado o seu elevado custo, a alta resolução e a eficiência mostram-se como vantagens em relação aos métodos atualmente usados para a avaliação óssea, com um potencial para tornar-se uma importante ferramenta na prática clínica.

ABSTRACTHigh resolution peripheral quantitative computed tomography (HR-pQCT) is a new technology commercially available for less than 10 years that allows performing in vivo assessment of bone parameters. HR-pQCT assesses the trabecular thickness, trabecular separation, trabecular number and connectivity density and, in addition, cortical bone density and thickness and total bone volume and density in high-definition mode, which additionally allows obtaining digital constructs of bone microarchitecture. The application of mathematics to captured data, a method called finite element analysis (FEA), allows the estimation of the physical properties of the tissue, simulating supported loads in a non-invasive way. Thus, HR-pQCT simultaneously acquires data previously provided separately by dual energy x-ray absorptiometry (DXA), magnetic resonance imaging and histomorphometry, aggregating biomechanical estimates previously only possible in extracted tissues. This method has a satisfactory reproducibility, with coefficients of variation rarely exceeding 3%. Regarding accuracy, the method shows a fair to good agreement (r2 = 0.37-0.97).The main clinical application of this method is in the quantification and monitoring of metabolic bone disorders, more fully evaluating bone strength and fracture risk. In rheumatoid arthritis patients, this allows gauging the number and size of erosions and cysts, in addition to joint space. In osteoarthritis, it is possible to characterize the bone marrow edema-like areas that show a correlation with cartilage breakdown.Given its high cost, HR-pQCT is still a research tool, but the high resolution and efficiency of this method reveal advantages over the methods currently used for bone assessment, with a potential to become an important tool in clinical practice.

[High resolution peripheral quantitative computed tomography for the assessment of morphological and mechanical bone parameters]. / Tomografia computadorizada quantitativa periférica de alta resolução para avaliação de parâmetros morfológicos e funcionais ósseos.

High resolution peripheral quantitative computed tomography (HR-pQCT) is a new technology commercially available for less than 10 years that allows performing in vivo assessment of bone parameters. HR-pQCT assesses the trabecular thickness, trabecular separation, trabecular number and connectivity density and, in addition, cortical bone density and thickness and total bone volume and density in high-definition mode, which additionally allows obtaining digital constructs of bone microarchitecture. The application of mathematics to captured data, a method called finite element analysis (FEA), allows the estimation of the physical properties of the tissue, simulating supported loads in a non-invasive way. Thus, HR-pQCT simultaneously acquires data previously provided separately by dual energy x-ray absorptiometry (DXA), magnetic resonance imaging and histomorphometry, aggregating biomechanical estimates previously only possible in extracted tissues. This method has a satisfactory reproducibility, with coefficients of variation rarely exceeding 3%. Regarding accuracy, the method shows a fair to good agreement (r(2) = 0.37-0.97). The main clinical application of this method is in the quantification and monitoring of metabolic bone disorders, more fully evaluating bone strength and fracture risk. In rheumatoid arthritis patients, this allows gauging the number and size of erosions and cysts, in addition to joint space. In osteoarthritis, it is possible to characterize the bone marrow edema-like areas that show a correlation with cartilage breakdown. Given its high cost, HR-pQCT is still a research tool, but the high resolution and efficiency of this method reveal advantages over the methods currently used for bone assessment, with a potential to become an important tool in clinical practice.