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Clinically, osteoporosis is defined by low bone mineral density (BMD); however, increasing evidence suggests that trabecular bone (TB) microarchitectural quality is an important determinant of bone strength and fracture risk. A tensor scale based algorithm for <jats:italic>in vivo<\/jats:italic> characterization of TB plate\u2010rod microarchitecture at the distal tibia using multirow detector CT (MD\u2010CT) imaging is presented and its performance and applications are examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>The tensor scale characterizes individual TB on the continuum between a perfect plate and a perfect rod and computes their orientation using optimal ellipsoidal representation of local structures. The accuracy of the method was evaluated using computer\u2010generated phantom images at a resolution and signal\u2010to\u2010noise ratio achievable <jats:italic>in vivo<\/jats:italic>. The robustness of the method was examined in terms of stability across a wide range of voxel sizes, repeat scan reproducibility, and correlation between TB measures derived by imaging human ankle specimens under <jats:italic>ex vivo<\/jats:italic> and <jats:italic>in vivo<\/jats:italic> conditions. Finally, the application of the method was evaluated in pilot human studies involving healthy young\u2010adult volunteers (age: 19 to 21 yr; 51 females and 46 males) and patients treated with selective serotonin reuptake inhibitors (SSRIs) (age: 19 to 21 yr; six males and six females).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>An error of (3.2% \u00b1 2.0%) (mean \u00b1 SD), computed as deviation from known measures of TB plate\u2010width, was observed for computer\u2010generated phantoms. An intraclass correlation coefficient of 0.95 was observed for tensor scale TB measures in repeat MD\u2010CT scans where the measures were averaged over a small volume of interest of 1.05 mm diameter with limited smoothing effects. The method was found to be highly stable at different voxel sizes with an error of (2.29% \u00b1 1.56%) at an <jats:italic>in vivo<\/jats:italic> voxel size as compared to the original <jats:italic>ex vivo<\/jats:italic> voxel size. Tensor scale measures derived from imaging under <jats:italic>in vivo<\/jats:italic> and <jats:italic>ex vivo<\/jats:italic> conditions with significantly different modulation transfer function, i.e., difference in \u201ctrue resolution,\u201d showed strong linear correlation (<jats:italic>r<\/jats:italic> = 0.92). The study of healthy volunteers shows that, after adjustment for height and weight, males have a 14% higher mean TB plate\u2010width as compared to females (<jats:italic>p<\/jats:italic> &lt; 0.05). SSRI\u2010treated patients have 12.5% lower mean TB plate\u2010width (<jats:italic>p<\/jats:italic> = 0.052) as compared to age\u2010similar and sex\u2010, height\u2010, and weight\u2010matched healthy controls. In contrast, the observed group difference in dual\u2010energy x\u2010ray absorptiometry (DXA)\u2010derived hip BMD was 10.5% between males and females and only 5.04% between healthy controls and patients on SSRIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Tensor scale analysis of MD\u2010CT images yields accurate and reproducible characterization of TB plate\u2010rod microarchitecture that may be more sensitive than DXA\u2010derived BMD to sex differences and to the skeletal changes associated with medical conditions or their treatments.<\/jats:p><\/jats:sec>","DOI":"10.1118\/1.4928481","type":"journal-article","created":{"date-parts":[[2015,8,21]],"date-time":"2015-08-21T17:49:52Z","timestamp":1440179392000},"page":"5410-5425","update-policy":"https:\/\/doi.org\/10.1063\/aip-crossmark-policy-page","source":"Crossref","is-referenced-by-count":25,"title":["Characterization of trabecular bone plate\u2010rod microarchitecture using multirow detector CT 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