Predicting Fracture Risk in Patients with Metastatic Bone Disease of the Femur: A Pictorial Review Using Three Different Techniques

Table 2

Comparison of Mirels, CTRA, and FEA technical considerations.

Prediction method	Imaging method	Specialized software	Analysis time	Reported sensitivity (%) [16]	Reported specificity (%) [16]	Types of loading	Anatomic/modeling limitations
Mirels	Planar X-ray	No	<5 minutes	71–100	13–94	Not applicable	None
CTRA	Computed tomography (CT)	Yes, to calculate section rigidities	<15 minutes, with custom software	100	60–90	Axial, bending, torsion	Errors associated with the ends of long bones
FEA	Computed tomography (CT)	Yes, to build model and run analysis	2–8 hours, requiring engineering expertise	80–100	63–86	Functional loading (stance, gait, stair climb, etc.)	Models and loading for proximal femur different from distal femur