On the influence of computed tomography's slice thickness on computer tomography based finite element analyses results

Background: Patient-specific autonomous finite element analyses of femurs, based on clinical computed tomog-raphy scans may be used to monitor the progression of bone-related diseases. Some CT scan protocols provide lower resolution (slice thickness of 3 mm) that affects the accuracy. To investigate the impact of low-resolution scans on the CT-based finite element analyses results, identical CT raw data were reconstructed twice to generate a 1 mm ("gold standard") and a 3 mm slice thickness scans.Methods: CT-based finite element analyses of twenty-four femurs (twelve patients) under stance and sideways fall loads were performed based on 1 and 3 mm slice thickness scans. Bone volume, load direction, and strains were extracted at different locations along the femurs and differences were evaluated. Findings: Average differences in bone volume were 1.0 +/- 1.5%. The largest average difference in strains in stance position was in the neck region (11.0 +/- 13.4%), whereas in other regions these were much smaller. For sidewise fall loading, the average differences were at most 9.2 +/- 16.0%.Interpretation: Whole-body low dose CT scans (3 mm-slice thickness) are suboptimal for monitoring strain changes in patient's femurs but may allow longitudinal studies if larger than 5% in all areas and larger than 12% in the upper neck. CT-based finite element analyses with slice thickness of 3 mm may be used in clinical practice for patients with smoldering myeloma to associate changes in strains with progression to active myeloma if above similar to 10%.