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The online version of this article (doi:10.1186/s13047-017-0192-7) contains supplementary material, which is available to authorized users.
The accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique. Such measurement is particularly valuable in populations at risk of foot bone pathology such as in those with long term diabetes. With research and development, computed tomography may prove to be a useful tool for this assessment. The aim of this study was to establish the reliability of a novel method of foot bone density measurement in people with diabetes using computed tomography.
Ten feet in people with diabetes were scanned with computed tomography twice with repositioning. Bone density (in Hounsfield units) was assessed in the trabecular and cortical bone in all tarsals and metatarsals. Reliability was assessed with intra-class correlation coefficients (95% confidence intervals), limits of agreement and standard error of measurement.
The reliability of the trabecular density of most bones was excellent with intra-class correlation coefficients ranging from 0.68 to 0.91. Additionally, cortical bone density showed fair to good reliability at the talus (0.52), calcaneus (0.59), navicular (0.70), cuboid (0.69), intermediate cuneiform (0.46) and first metatarsal (0.61).
The study established the reliability of a practical method of assessing the trabecular and cortical foot bone density using computed tomography scanning. This methodology may be useful in the investigation of foot bone disease occurring in diabetes and its early diagnosis, intervention and assessment of treatment efficacy. Further development of this method is warranted.
Additional file 1: Limits of agreement graphs for cortical bone of a) talus, b) calcaneus, c) navicular, d) cuboid, e) medial cuneiform, f) intermediate cuneiform. (JPG 145 kb)13047_2017_192_MOESM1_ESM.jpg
Additional file 2: Limits of agreement graphs for cortical bone of a) lateral cuneiform, b) first metatarsal, c) second metatarsal, d) third metatarsal, e) fourth metatarsal and f) fifth metatarsal. (JPG 25 kb)13047_2017_192_MOESM2_ESM.jpg
Additional file 3: Limits of agreement graphs for trabecular bone of a) talus, b) calcaneus, c) navicular, d) cuboid, e) medial cuneiform, f) intermediate cuneiform. (JPG 131 kb)13047_2017_192_MOESM3_ESM.jpg
Additional file 4: Limits of agreement graphs for trabecular bone of a) lateral cuneiform, b) first metatarsal, c) second metatarsal, d) third metatarsal, e) fourth metatarsal and f) fifth metatarsal. (JPG 136 kb)13047_2017_192_MOESM4_ESM.jpg
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- Computed tomography derived bone density measurement in the diabetic foot
Xanne Janse de Jonge
- BioMed Central