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Osteologie
DOI: 10.1055/a-2586-3887
Review

Next-Generation Multiparametrische Quantitative Ultraschallbildgebung des Knochens

Next-generation Multiparametric Quantitative Ultrasound Imaging of Bone
Gabriele Armbrecht
1   Zentrum für Muskel- und Knochenforschung, Charité – Universitätsmedizin Berlin, Berlin, Germany
,
Edgar Wiebe
2   Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie
,
Kay Raum
3   Zentrum für Biomedizin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Zusammenfassung

Quantitativer Ultraschall (QUS) zur Knochendiagnostik hat sich in den letzten Jahren fundamental weiterentwickelt. Systeme der ersten Generation waren meist nicht-bildgebend und nutzten Parameter wie die Schallgeschwindigkeit (SOS) und die breitbandige Ultraschalldämpfung (BUA) zur Abschätzung von Osteoporose und Frakturrisiko. Neuere Verfahren setzen auf bildgeführte, multiparametrische Analysen. Die Radiofrequenz-Echografische Multi-Spektrometrie (REMS) nutzt erstmals medizinische Bildgebung zur spektral basierten Abschätzung der Knochenmineraldichte an Wirbelsäule und Femur. Die axiale Transmission verwendet geführte Ultraschallwellen zur Bestimmung der kortikalen Dicke und Porosität. Beide Methoden zeigen in Studien eine vergleichbare oder bessere Frakturdiskriminierung als DXA. Die kortikale Rückstreuanalyse (CortBS) und die multifokale Bildgebung (MultiFocus) bilden eine neue Generation der dreidimensionalen QUS-Bildgebung (3D-QUSIB). CortBS analysiert die mikrostrukturellen und viskoelastischen Eigenschaften des kortikalen Knochens durch spektrale Rückstreuanalyse. MultiFocus korrigiert Schallbrechungseffekte zur Bestimmung der kortikalen Dicke und Schallgeschwindigkeit. Durch multidirektionale 3D-Scans und spektrale Analysen werden intrakortikale Porengrößen bis zu 20 µm quantifiziert. Erste Studien zeigen, dass 3D-QUSIB vertebrale und nichtvertebrale Frakturen besser differenziert als DXA. Die vergleichende Betrachtung verschiedener Methoden unterstreicht das Potenzial dieser Technologie für eine präzisere Frakturprognose und das klinische Management metabolischer Knochenerkrankungen.

Abstract

Quantitative ultrasound (QUS) for bone diagnostics has advanced significantly in recent years. First-generation systems were mostly non-imaging and relied on parameters such as speed of sound (SOS) and broadband ultrasound attenuation (BUA) to assess osteoporosis and fracture risk. Newer methods employ image-guided, multiparametric analyses. Radiofrequency Echographic Multi-Spectrometry (REMS) was the first to use ultrasound medical imaging for spectral-based estimation of bone mineral density (BMD) at the spine and femur. Axial transmission utilizes guided ultrasound waves to determine cortical thickness and porosity. Both methods have shown comparable or superior fracture discrimination compared to DXA in studies. Cortical backscatter analysis (CortBS) and multifocal imaging (MultiFocus) represent a new generation of three-dimensional QUS imaging (3D-QUSIB). CortBS analyzes the microstructural and viscoelastic properties of cortical bone through spectral backscatter analysis. MultiFocus corrects for refraction effects to determine cortical thickness and sound velocity. Multidirectional 3D scans and spectral analyses allow quantification of intracortical pore sizes down to 20 µm. Early studies indicate that 3D-QUSIB differentiates vertebral and non-vertebral fractures more effectively than DXA. The comparative evaluation of different methods highlights the potential of this technology for more precise fracture prediction and improved clinical management of metabolic bone diseases.

Schlüsselwörter

Knochen - Ultraschall - Frakturdiskriminierung - Bildgebung

Keywords

Bone - Ultrasound - Fracture discrimination - Imaging


Publication History

Received: 11 March 2025

Accepted: 13 April 2025

Article published online:
12 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
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