Enhanced correlation between quantitative ultrasound and structural and mechanical properties of bone using combined transmission-reflection measurement.

Quantitative ultrasound (QUS) is capable of predicting the principal structural orientation of trabecular bone; this orientation is highly correlated with the mechanical strength of trabecular bone. Irregular shape of bone, however, would increase variation in such a prediction, especially under human in vivo measurement. This study was designed to combine transmission and reflection modes of QUS measurement to improve the prediction for the structural and mechanical properties of trabecular bone. QUS, mechanical testing, and micro computed tomography (μCT) scanning were performed on 24 trabecular bone cubes harvested from a bovine distal femur to obtain the mechanical and structural parameters. Transmission and reflection modes of QUS measurement in the transverse and frontal planes were performed in a confined 60° angle range with 5° increment. The QUS parameters, attenuation (ATT) and velocity (UV), obtained from transmission mode, were normalized to the specimen thickness acquired from reflection mode. Analysis of covariance showed that the combined transmission-reflection modes improved prediction for the structural and Young's modulus of bone in comparison to the traditional QUS measurement performed only in the medial-lateral orientation. In the transverse plane, significant improvement between QUS and μCT was found in ATT vs bone surface density (BS/BV) (p < 0.05), ATT vs trabecular thickness (Tb.Th) (p < 0.01), ATT vs degree of anisotropy (DA) (p < 0.05), UV vs trabecular bone number (Tb.N) (p < 0.05), and UV vs Tb.Th (p < 0.001). In the frontal plane, significant improvement was found in ATT vs structural model index (SMI) (p < 0.01), ATT vs bone volume fraction (BV/TV) (p < 0.01), ATT vs BS/BV (p < 0.001), ATT vs Tb.Th (p < 0.001), ATT vs DA (p < 0.001), and ATT vs modulus (p < 0.001), UV vs SMI (p < 0.01), UV vs BV/TV (p < 0.05), UV vs BS/BV (p < 0.05), UV vs Tb.Th (p < 0.01), UV vs trabecular spacing (p < 0.05), and UV vs modulus (p < 0.01). These data suggested that the combined transmission-reflection QUS method is capable of providing information more relevant to the structural and mechanical properties of trabecular bone.