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Intra-operator Repeatability of Manual Segmentations of the Hip Muscles on Clinical Magnetic Resonance Images. J Digit Imaging 2023; 36:143-152. [PMID: 36219348 PMCID: PMC9984589 DOI: 10.1007/s10278-022-00700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/11/2022] [Accepted: 09/02/2022] [Indexed: 01/10/2023] Open
Abstract
The manual segmentation of muscles on magnetic resonance images is the gold standard procedure to reconstruct muscle volumes from medical imaging data and extract critical information for clinical and research purposes. (Semi)automatic methods have been proposed to expedite the otherwise lengthy process. These, however, rely on manual segmentations. Nonetheless, the repeatability of manual muscle volume segmentations performed on clinical MRI data has not been thoroughly assessed. When conducted, volumetric assessments often disregard the hip muscles. Therefore, one trained operator performed repeated manual segmentations (n = 3) of the iliopsoas (n = 34) and gluteus medius (n = 40) muscles on coronal T1-weighted MRI scans, acquired on 1.5 T scanners on a clinical population of patients elected for hip replacement surgery. Reconstructed muscle volumes were divided in sub-volumes and compared in terms of volume variance (normalized variance of volumes - nVV), shape (Jaccard Index-JI) and surface similarity (maximal Hausdorff distance-HD), to quantify intra-operator repeatability. One-way repeated measures ANOVA (or equivalent) tests with Bonferroni corrections for multiple comparisons were conducted to assess statistical significance. For both muscles, repeated manual segmentations were highly similar to one another (nVV: 2-6%, JI > 0.78, HD < 15 mm). However, shape and surface similarity were significantly lower when muscle extremities were included in the segmentations (e.g., iliopsoas: HD -12.06 to 14.42 mm, P < 0.05). Our findings show that the manual segmentation of hip muscle volumes on clinical MRI scans provides repeatable results over time. Nonetheless, extreme care should be taken in the segmentation of muscle extremities.
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Reliability and agreement of lumbar multifidus volume and fat fraction quantification using magnetic resonance imaging. Musculoskelet Sci Pract 2022; 59:102532. [PMID: 35245881 DOI: 10.1016/j.msksp.2022.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is the standard to quantify size and structure of lumbar muscles. Three-dimensional volumetric measures are expected to be more closely related to muscle function than two-dimensional measures such as cross-sectional area. Reliability and agreement of a standardized method should be established to enable the use of MRI to assess lumbar muscle characteristics. OBJECTIVES This study investigates the intra- and inter-processor reliability for the quantification of (1) muscle volume and (2) fat fraction based on chemical shift MRI images using axial 3D-volume measurements of the lumbar multifidus in patients with low back pain. METHODS Two processors manually segmented the lumbar multifidus on the MRI scans of 18 patients with low back pain using Mevislab software following a well-defined method. Fat fraction of the segmented volume was calculated. Reliability and agreement were determined using intra-class correlation coefficients (ICC), Bland-Altman plots and calculation of the standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS Excellent ICCs were found for both intra-processor and inter-processor analysis of lumbar multifidus volume measurement, with slightly better results for the intra-processor reliability. The SEMs for volume were lower than 4.1 cm³. Excellent reliability and agreement were also found for fat fraction measures, with ICCs of 0.985-0.998 and SEMs below 0.946%. CONCLUSION The proposed method to quantify muscle volume and fat fraction of the lumbar multifidus on MRI was highly reliable, and can be used in further research on lumbar multifidus structure.
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Forsting J, Rehmann R, Rohm M, Froeling M, Schlaffke L. Evaluation of interrater reliability of different muscle segmentation techniques in diffusion tensor imaging. NMR IN BIOMEDICINE 2021; 34:e4430. [PMID: 33217106 DOI: 10.1002/nbm.4430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Muscle diffusion tensor imaging (mDTI) is a quantitative MRI technique that can provide information about muscular microstructure and integrity. Ultrasound and DTI studies have shown intramuscular differences, and therefore separation of different muscles for analysis is essential. The commonly used methods to assess DTI metrics in muscles are manual segmentation and tract-based analysis. Recently methods such as volume-based tractography have been applied to optimize muscle architecture estimation, but can also be used to assess DTI metrics. PURPOSE To evaluate diffusion metrics obtained using three different methods-volume-based tractography, manual segmentation-based analysis and tract-based analysis-with respect to their interrater reliability and their ability to detect intramuscular variance. MATERIALS AND METHODS 30 volunteers underwent an MRI examination in a 3 T scanner using a 16-channel Torso XL coil. Diffusion-weighted images were acquired to obtain DTI metrics. These metrics were evaluated in six thigh muscles using volume-based tractography, manual segmentation and standard tractography. All three methods were performed by two independent raters to assess interrater reliability by ICC analysis and Bland-Altman plots. Ability to assess intramuscular variance was compared using an ANOVA with muscle as a between-subjects factor. RESULTS Interrater reliability for all methods was found to be excellent. The highest interrater reliability was found for volume-based tractography (ICC ≥ 0.967). Significant differences for the factor muscle in all examined diffusion parameters were shown in muscles using all methods (main effect p < 0.001). CONCLUSIONS Diffusion data can be assessed by volume tractography, standard tractography and manual segmentation with high interrater reliability. Each method produces different results for the investigated DTI parameters. Volume-based tractography was superior to conventional manual segmentation and tractography regarding interrater reliability and detection of intramuscular variance, while tract-based analysis showed the lowest coefficients of variation.
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Affiliation(s)
- Johannes Forsting
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Robert Rehmann
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Marlena Rohm
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Martijn Froeling
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lara Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
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Bao H, Moal B, Vira S, Bronsard N, Amabile C, Errico T, Schwab F, Skalli W, Dubousset J, Lafage V. Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2998-3005. [PMID: 32529524 DOI: 10.1007/s00586-020-06488-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/09/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To quantify muscle characteristics (volumes and fat infiltration) and identify their relationship to sagittal malalignment and compensatory mechanism recruitment. METHODS Female adult spinal deformity patients underwent T1-weighted MRI with a 2-point Dixon protocol from the proximal tibia up to the T12 vertebra. 3D reconstructions of 17 muscles, including extensors and flexors of spine, hip and knee, were obtained. Muscle volume standardized by bone volume and percentage of fat infiltration (Pfat) were calculated. Correlations and regressions were performed. RESULTS A total of 22 patients were included. Significant correlations were observed between sagittal alignment and muscle parameters. Fat infiltration of the hip and knee flexors and extensors correlated with larger C7-S1 SVA. Smaller spinal flexor/extensor volumes correlated with greater PI-LL mismatch (r = - 0.45 and - 0.51). Linear regression identified volume of biceps femoris as only predictor for PT (R2 = 0.34, p = 0.005) and Pfat of gluteus minimus as only predictor for SVA (R2 = 0.45, p = 0.001). Sagittally malaligned patients with larger PT (26.8° vs. 17.2°) had significantly smaller volume and larger Pfat of gluteus medius, gluteus minimus and biceps femoris, but similar values for gluteus maximus, the hip extensor. CONCLUSION This study is the first to quantify the relationship between degeneration of spino-femoral muscles and sagittal malalignment. This pathoanatomical study identifies the close relationship between gluteal, hamstring muscles and PT, SVA, which deepens our understanding of the underlying etiology that contributes to adult spinal deformity.
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Affiliation(s)
- Hongda Bao
- Hospital for Special Surgery, 535 East 70th Street, New York, 10021, USA.,Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Bertrand Moal
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Shaleen Vira
- Hospital for Joint Diseases at NYU Langone Medical Center, New York, USA
| | - Nicolas Bronsard
- Institut Universitaire de l'Appareil Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Celia Amabile
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Thomas Errico
- Hospital for Joint Diseases at NYU Langone Medical Center, New York, USA
| | - Frank Schwab
- Hospital for Special Surgery, 535 East 70th Street, New York, 10021, USA
| | - Wafa Skalli
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 rue Bonaparte, Paris, France
| | - Virginie Lafage
- Hospital for Special Surgery, 535 East 70th Street, New York, 10021, USA.
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Pons C, Borotikar B, Garetier M, Burdin V, Ben Salem D, Lempereur M, Brochard S. Quantifying skeletal muscle volume and shape in humans using MRI: A systematic review of validity and reliability. PLoS One 2018; 13:e0207847. [PMID: 30496308 PMCID: PMC6264864 DOI: 10.1371/journal.pone.0207847] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS The aim of this study was to report the metrological qualities of techniques currently used to quantify skeletal muscle volume and 3D shape in healthy and pathological muscles. METHODS A systematic review was conducted (Prospero CRD42018082708). PubMed, Web of Science, Cochrane and Scopus databases were searched using relevant keywords and inclusion/exclusion criteria. The quality of the articles was evaluated using a customized scale. RESULTS Thirty articles were included, 6 of which included pathological muscles. Most evaluated lower limb muscles. Partially or completely automatic and manual techniques were assessed in 10 and 24 articles, respectively. Manual slice-by-slice segmentation reliability was good-to-excellent (n = 8 articles) and validity against dissection was moderate to good(n = 1). Manual slice-by-slice segmentation was used as a gold-standard method in the other articles. Reduction of the number of manually segmented slices (n = 6) provided good to excellent validity if a sufficient number of appropriate slices was chosen. Segmentation on one slice (n = 11) increased volume errors. The Deformation of a Parametric Specific Object (DPSO) method (n = 5) decreased the number of manually-segmented slices required for any chosen level of error. Other automatic techniques combined with different statistical shape or atlas/images-based methods (n = 4) had good validity. Some particularities were highlighted for specific muscles. Except for manual slice by slice segmentation, reliability has rarely been reported. CONCLUSIONS The results of this systematic review help the choice of appropriate segmentation techniques, according to the purpose of the measurement. In healthy populations, techniques that greatly simplified the process of manual segmentation yielded greater errors in volume and shape estimations. Reduction of the number of manually segmented slices was possible with appropriately chosen segmented slices or with DPSO. Other automatic techniques showed promise, but data were insufficient for their validation. More data on the metrological quality of techniques used in the cases of muscle pathology are required.
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Affiliation(s)
- Christelle Pons
- Pediatric rehabilitation department, Fondation ILDYS, Brest, France
- Laboratoire de Traitement de l’Information Médicale, INSERM, Brest, France
| | - Bhushan Borotikar
- Laboratoire de Traitement de l’Information Médicale, INSERM, Brest, France
| | - Marc Garetier
- Laboratoire de Traitement de l’Information Médicale, INSERM, Brest, France
- Radiology department, hôpital d'Instruction des Armées Clermont-Tonnerre, Brest, France
| | - Valérie Burdin
- Laboratoire de Traitement de l’Information Médicale, INSERM, Brest, France
- IMT Atlantique, Brest, France
| | - Douraied Ben Salem
- Laboratoire de Traitement de l’Information Médicale, INSERM, Brest, France
- Université de Bretagne Occidentale, Brest, France
- Radiology department, CHRU de Brest, Brest, France
| | - Mathieu Lempereur
- Laboratoire de Traitement de l’Information Médicale, INSERM, Brest, France
- Université de Bretagne Occidentale, Brest, France
- PMR department, CHRU de Brest, Hopital Morvan, Brest, France
| | - Sylvain Brochard
- Pediatric rehabilitation department, Fondation ILDYS, Brest, France
- Laboratoire de Traitement de l’Information Médicale, INSERM, Brest, France
- Université de Bretagne Occidentale, Brest, France
- PMR department, CHRU de Brest, Hopital Morvan, Brest, France
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Amabile C, Moal B, Chtara OA, Pillet H, Raya JG, Iannessi A, Skalli W, Lafage V, Bronsard N. Estimation of spinopelvic muscles' volumes in young asymptomatic subjects: a quantitative analysis. Surg Radiol Anat 2016; 39:393-403. [PMID: 27637762 DOI: 10.1007/s00276-016-1742-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/06/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Muscles have been proved to be a major component in postural regulation during pathological evolution or aging. Particularly, spinopelvic muscles are recruited for compensatory mechanisms such as pelvic retroversion, or knee flexion. Change in muscles' volume could, therefore, be a marker of greater postural degradation. Yet, it is difficult to interpret spinopelvic muscular degradation as there are few reported values for young asymptomatic adults to compare to. The objective was to provide such reference values on spinopelvic muscles. A model predicting the muscular volume from reduced set of MRI segmented images was investigated. METHODS A total of 23 asymptomatic subjects younger than 24 years old underwent an MRI acquisition from T12 to the knee. Spinopelvic muscles were segmented to obtain an accurate 3D reconstruction, allowing precise computation of muscle's volume. A model computing the volume of muscular groups from less than six MRI segmented slices was investigated. RESULTS Baseline values have been reported in tables. For all muscles, invariance was found for the shape factor [ratio of volume over (area times length): SD < 0.04] and volume ratio over total volume (SD < 1.2 %). A model computing the muscular volume from a combination of two to five slices has been evaluated. The five-slices model prediction error (in % of the real volume from 3D reconstruction) ranged from 6 % (knee flexors and extensors and spine flexors) to 11 % (spine extensors). CONCLUSION Spinopelvic muscles' values for a reference population have been reported. A new model predicting the muscles' volumes from a reduced set of MRI slices is proposed. While this model still needs to be validated on other populations, the current study appears promising for clinical use to determine, quantitatively, the muscular degradation.
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Affiliation(s)
- Celia Amabile
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Boulevard de l'Hopital, 75013, Paris, France.
- Spine Service, Hospital for Special Surgery, 535 East 70th Street, Belaire 4-E, New York, NY, 10021, USA.
| | - Bertrand Moal
- Spine Service, Hospital for Special Surgery, 535 East 70th Street, Belaire 4-E, New York, NY, 10021, USA
| | - Oussama Arous Chtara
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Boulevard de l'Hopital, 75013, Paris, France
| | - Helene Pillet
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Boulevard de l'Hopital, 75013, Paris, France
| | - Jose G Raya
- Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Antoine Iannessi
- Department of Radiology, Centre Antoine Lacassagne, Nice, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Boulevard de l'Hopital, 75013, Paris, France.
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, 535 East 70th Street, Belaire 4-E, New York, NY, 10021, USA
| | - Nicolas Bronsard
- Department of Orthopaedic, Trauma, and Spine Surgery, Institut Universitaire de l'appareil Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, Nice, France
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Moal B, Bronsard N, Raya JG, Vital JM, Schwab F, Skalli W, Lafage V. Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity. World J Orthop 2015; 6:727-737. [PMID: 26495250 PMCID: PMC4610915 DOI: 10.5312/wjo.v6.i9.727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/20/2015] [Accepted: 08/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity (ASD) with magnetic resonance imaging (MRI) and 3D reconstructions.
METHODS: Nineteen female ASD patients (mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle (fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl’X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle’s contour on a limited number of axial images [Deformation of parametric specific objects (DPSO) Method]. Musclar volume (Vmuscle), infiltrated fat volume (Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 × (Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated.
RESULTS: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fat-water ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability (Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2nd in terms of Pfat (14% ± 8%), and were significantly greater than those of the knee extensor (P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat (12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat (r = -0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.
CONCLUSION: Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.
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Ferrero E, Vira S, Ames CP, Kebaish K, Obeid I, O’Brien MF, Gupta MC, Boachie-Adjei O, Smith JS, Mundis GM, Challier V, Protopsaltis TS, Schwab FJ, Lafage V. Analysis of an unexplored group of sagittal deformity patients: low pelvic tilt despite positive sagittal malalignment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:3568-3576. [DOI: 10.1007/s00586-015-4048-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/19/2015] [Accepted: 05/23/2015] [Indexed: 11/30/2022]
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