1
|
Yuan X, Liang Y, Yang H, Feng L, Sun H, Li C, Qin J. Applying Machine Learning Analysis Based on Proximal Femur of Abdominal Computed Tomography to Screen for Abnormal Bone Mass in Femur. Acad Radiol 2024; 31:2003-2010. [PMID: 37973518 DOI: 10.1016/j.acra.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of machine learning analysis based on proximal femur of abdominal computed tomography (CT) scans in screening for abnormal bone mass in femur. MATERIALS AND METHODS 222 patients aged 50 years or older who underwent abdominal CT and dual-energy X-ray absorptiometry scans within 14 days were retrospectively enrolled. The patients were randomly assigned to a training cohort (n = 155) and a testing cohort (n = 67) in a ratio of 7:3. A total of 2288 candidate radiomic features were extracted from the volume region of interest - the left proximal femur of the abdominal CT scans. The most valuable radiomic features were selected using minimum-Redundancy Maximum-Relevancy and the least absolute shrinkage and selection operator to construct the radiomics model. The predictive performance was assessed with receiver operating characteristic curve. RESULTS 13 features were chosen to establish the radiomics model. The radiomics model using logistic regression displayed excellent prediction performance in distinguishing normal bone mass and abnormal bone mass, with the area under the curve (AUC), accuracy, sensitivity and specificity of 0.917 (95% CI, 0.867-0.967), 0.826, 0.935 and 0.780 in the training cohort. The testing cohort indicated a better performance with AUC, accuracy, sensitivity and specificity of 0.963 (95% CI, 0.919-0.999), 0.851, 0.923 and 0.889. CONCLUSION The radiomics model based on proximal femur of abdominal CT scans had a high predictive performance to identify abnormal bone mass in femur, which can be used as a tool for opportunistic osteoporosis screening.
Collapse
Affiliation(s)
- Xiaoqing Yuan
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Yanbo Liang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Hui Yang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Lingling Feng
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Hao Sun
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Changqin Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Jian Qin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China.
| |
Collapse
|
2
|
Liu D, Garrett JW, Perez AA, Zea R, Binkley NC, Summers RM, Pickhardt PJ. Fully automated CT imaging biomarkers for opportunistic prediction of future hip fractures. Br J Radiol 2024; 97:770-778. [PMID: 38379423 PMCID: PMC11027263 DOI: 10.1093/bjr/tqae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/27/2023] [Accepted: 02/19/2024] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE Assess automated CT imaging biomarkers in patients who went on to hip fracture, compared with controls. METHODS In this retrospective case-control study, 6926 total patients underwent initial abdominal CT over a 20-year interval at one institution. A total of 1308 patients (mean age at initial CT, 70.5 ± 12.0 years; 64.4% female) went on to hip fracture (mean time to fracture, 5.2 years); 5618 were controls (mean age 70.3 ± 12.0 years; 61.2% female; mean follow-up interval 7.6 years). Validated fully automated quantitative CT algorithms for trabecular bone attenuation (at L1), skeletal muscle attenuation (at L3), and subcutaneous adipose tissue area (SAT) (at L3) were applied to all scans. Hazard ratios (HRs) comparing highest to lowest risk quartiles and receiver operating characteristic (ROC) curve analysis including area under the curve (AUC) were derived. RESULTS Hip fracture HRs (95% CI) were 3.18 (2.69-3.76) for low trabecular bone HU, 1.50 (1.28-1.75) for low muscle HU, and 2.18 (1.86-2.56) for low SAT. 10-year ROC AUC values for predicting hip fracture were 0.702, 0.603, and 0.603 for these CT-based biomarkers, respectively. Multivariate combinations of these biomarkers further improved predictive value; the 10-year ROC AUC combining bone/muscle/SAT was 0.733, while combining muscle/SAT was 0.686. CONCLUSION Opportunistic use of automated CT bone, muscle, and fat measures can identify patients at higher risk for future hip fracture, regardless of the indication for CT imaging. ADVANCES IN KNOWLEDGE CT data can be leveraged opportunistically for further patient evaluation, with early intervention as needed. These novel AI tools analyse CT data to determine a patient's future hip fracture risk.
Collapse
Affiliation(s)
- Daniel Liu
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53792, United States
| | - John W Garrett
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53792, United States
| | - Alberto A Perez
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53792, United States
| | - Ryan Zea
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53792, United States
| | - Neil C Binkley
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53792, United States
| | - Ronald M Summers
- National Institutes of Health Clinical Center, Potomac, MD, 20892, United States
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53792, United States
| |
Collapse
|
3
|
Tsai DJ, Lin C, Lin CS, Lee CC, Wang CH, Fang WH. Artificial Intelligence-enabled Chest X-ray Classifies Osteoporosis and Identifies Mortality Risk. J Med Syst 2024; 48:12. [PMID: 38217829 DOI: 10.1007/s10916-023-02030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Abstract
A deep learning model was developed to identify osteoporosis from chest X-ray (CXR) features with high accuracy in internal and external validation. It has significant prognostic implications, identifying individuals at higher risk of all-cause mortality. This Artificial Intelligence (AI)-enabled CXR strategy may function as an early detection screening tool for osteoporosis. The aim of this study was to develop a deep learning model (DLM) to identify osteoporosis via CXR features and investigate the performance and clinical implications. This study collected 48,353 CXRs with the corresponding T score according to Dual energy X-ray Absorptiometry (DXA) from the academic medical center. Among these, 35,633 CXRs were used to identify CXR- Osteoporosis (CXR-OP). Another 12,720 CXRs were used to validate the performance, which was evaluated by the area under the receiver operating characteristic curve (AUC). Furthermore, CXR-OP was tested to assess the long-term risks of mortality, which were evaluated by Kaplan‒Meier survival analysis and the Cox proportional hazards model. The DLM utilizing CXR achieved AUCs of 0.930 and 0.892 during internal and external validation, respectively. The group that underwent DXA with CXR-OP had a higher risk of all-cause mortality (hazard ratio [HR] 2.59, 95% CI: 1.83-3.67), and those classified as CXR-OP in the group without DXA also had higher all-cause mortality (HR: 1.67, 95% CI: 1.61-1.72) in the internal validation set. The external validation set produced similar results. Our DLM uses CXRs for early detection of osteoporosis, aiding physicians to identify those at risk. It has significant prognostic implications, improving life quality and reducing mortality. AI-enabled CXR strategy may serve as a screening tool.
Collapse
Affiliation(s)
- Dung-Jang Tsai
- Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin Lin
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Wen-Hui Fang
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
- Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
| |
Collapse
|
4
|
Ong W, Liu RW, Makmur A, Low XZ, Sng WJ, Tan JH, Kumar N, Hallinan JTPD. Artificial Intelligence Applications for Osteoporosis Classification Using Computed Tomography. Bioengineering (Basel) 2023; 10:1364. [PMID: 38135954 PMCID: PMC10741220 DOI: 10.3390/bioengineering10121364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Osteoporosis, marked by low bone mineral density (BMD) and a high fracture risk, is a major health issue. Recent progress in medical imaging, especially CT scans, offers new ways of diagnosing and assessing osteoporosis. This review examines the use of AI analysis of CT scans to stratify BMD and diagnose osteoporosis. By summarizing the relevant studies, we aimed to assess the effectiveness, constraints, and potential impact of AI-based osteoporosis classification (severity) via CT. A systematic search of electronic databases (PubMed, MEDLINE, Web of Science, ClinicalTrials.gov) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 39 articles were retrieved from the databases, and the key findings were compiled and summarized, including the regions analyzed, the type of CT imaging, and their efficacy in predicting BMD compared with conventional DXA studies. Important considerations and limitations are also discussed. The overall reported accuracy, sensitivity, and specificity of AI in classifying osteoporosis using CT images ranged from 61.8% to 99.4%, 41.0% to 100.0%, and 31.0% to 100.0% respectively, with areas under the curve (AUCs) ranging from 0.582 to 0.994. While additional research is necessary to validate the clinical efficacy and reproducibility of these AI tools before incorporating them into routine clinical practice, these studies demonstrate the promising potential of using CT to opportunistically predict and classify osteoporosis without the need for DEXA.
Collapse
Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
| | - Ren Wei Liu
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Weizhong Jonathan Sng
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| |
Collapse
|
5
|
Xu TT, Huang XY, Jiang YW. Efficacy of two opportunistic methods for screening osteoporosis in lumbar spine surgery patients. 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 2023; 32:3912-3918. [PMID: 37715792 DOI: 10.1007/s00586-023-07938-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Hounsfield unit (HU) measurements and vertebral bone quality (VBQ) scores are opportunistic screening methods for evaluating bone quality. Since studies comparing the efficacies of the two methods are rare, this retrospective study aimed to examine the efficacy of VBQ scores compared with that of HU measurements for diagnosing osteoporosis in lumbar spine surgery patients. METHODS We selected patients who had undergone spinal surgery between January 2020 and May 2022 from our database. The VBQ scores based on magnetic resonance imaging (MRI) and HU measurements based on computed tomography (CT) were calculated. Correlation analysis of the dual-energy X-ray absorptiometry (DEXA) T score and study parameters was performed. The Delong test and decision curve analysis (DCA) were used to compare the efficacies of the two methods. RESULTS We included 118 consecutive patients who underwent selective spinal surgery. The VBQ score and HU measurement were significantly correlated with the DEXA T score. Based on the Delong test, HU measurement predicted osteoporosis more effectively than the VBQ score did. The DCA revealed that the VBQ score performed better than the HU measurement did. CONCLUSIONS The calculation of VBQ scores is a novel opportunistic screening method for diagnosing osteoporosis; however, CT-based HU measurements outperform MRI-based VBQ scores. HU measurements can be used as a screening method when pre-operative CT scans are available.
Collapse
Affiliation(s)
- Ting-Ting Xu
- Fujian Medical University, Fuzhou City, 350001, Fujian Province, China
| | - Xue-Ying Huang
- Fujian Medical University, Fuzhou City, 350001, Fujian Province, China
| | - Yan-Wei Jiang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No.29 Xinquan, Fuzhou City, 350001, Fujian Province, China.
- Fujian Medical University, Fuzhou City, 350001, Fujian Province, China.
| |
Collapse
|
6
|
Wu Y, Chen X, Dong F, He L, Cheng G, Zheng Y, Ma C, Yao H, Zhou S. Performance evaluation of a deep learning-based cascaded HRNet model for automatic measurement of X-ray imaging parameters of lumbar sagittal curvature. 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 2023:10.1007/s00586-023-07937-5. [PMID: 37787781 DOI: 10.1007/s00586-023-07937-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To develop a deep learning-based cascaded HRNet model, in order to automatically measure X-ray imaging parameters of lumbar sagittal curvature and to evaluate its prediction performance. METHODS A total of 3730 lumbar lateral digital radiography (DR) images were collected from picture archiving and communication system (PACS). Among them, 3150 images were randomly selected as the training dataset and validation dataset, and 580 images as the test dataset. The landmarks of the lumbar curve index (LCI), lumbar lordosis angle (LLA), sacral slope (SS), lumbar lordosis index (LLI), and the posterior edge tangent angle of the vertebral body (PTA) were identified and marked. The measured results of landmarks on the test dataset were compared with the mean values of manual measurement as the reference standard. Percentage of correct key-points (PCK), intra-class correlation coefficient (ICC), Pearson correlation coefficient (r), mean absolute error (MAE), mean square error (MSE), root-mean-square error (RMSE), and Bland-Altman plot were used to evaluate the performance of the cascade HRNet model. RESULTS The PCK of the cascaded HRNet model was 97.9-100% in the 3 mm distance threshold. The mean differences between the reference standard and the predicted values for LCI, LLA, SS, LLI, and PTA were 0.43 mm, 0.99°, 1.11°, 0.01 mm, and 0.23°, respectively. There were strong correlation and consistency of the five parameters between the cascaded HRNet model and manual measurements (ICC = 0.989-0.999, R = 0.991-0.999, MAE = 0.63-1.65, MSE = 0.61-4.06, RMSE = 0.78-2.01). CONCLUSION The cascaded HRNet model based on deep learning algorithm could accurately identify the sagittal curvature-related landmarks on lateral lumbar DR images and automatically measure the relevant parameters, which is of great significance in clinical application.
Collapse
Affiliation(s)
- Yuhua Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Xiaofei Chen
- Department of Radiology, Gansu Provincial Hospital of Traditional Chinese Medicine (The first affiliated hospital of Gansu University of Traditional Chinese Medicine), Lanzhou, 730050, Gansu, China
| | - Fuwen Dong
- Department of Radiology, Gansu Provincial Hospital of Traditional Chinese Medicine (The first affiliated hospital of Gansu University of Traditional Chinese Medicine), Lanzhou, 730050, Gansu, China
| | - Linyang He
- Hangzhou Jianpei Technology Company Ltd, Hangzhou, 311200, Zhejiang, China
| | - Guohua Cheng
- Hangzhou Jianpei Technology Company Ltd, Hangzhou, 311200, Zhejiang, China
| | - Yuwen Zheng
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Chunyu Ma
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Hongyan Yao
- Department of Radiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000, Gansu, China
| | - Sheng Zhou
- Department of Radiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000, Gansu, China.
| |
Collapse
|
7
|
Dimai HP. New Horizons: Artificial Intelligence Tools for Managing Osteoporosis. J Clin Endocrinol Metab 2023; 108:775-783. [PMID: 36477337 PMCID: PMC9999362 DOI: 10.1210/clinem/dgac702] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration leading to increased bone fragility and fracture risk. Typically, osteoporotic fractures occur at the spine, hip, distal forearm, and proximal humerus, but other skeletal sites may be affected as well. One of the major challenges in the management of osteoporosis lies in the fact that although the operational diagnosis is based on bone mineral density (BMD) as measured by dual x-ray absorptiometry, the majority of fractures occur at nonosteoporotic BMD values. Furthermore, osteoporosis often remains undiagnosed regardless of the low severity of the underlying trauma. Also, there is only weak consensus among the major guidelines worldwide, when to treat, whom to treat, and which drug to use. Against this background, increasing efforts have been undertaken in the past few years by artificial intelligence (AI) developers to support and improve the management of this disease. The performance of many of these newly developed AI algorithms have been shown to be at least comparable to that of physician experts, or even superior. However, even if study results appear promising at a first glance, they should always be interpreted with caution. Use of inadequate reference standards or selection of variables that are of little or no value in clinical practice are limitations not infrequently found. Consequently, there is a clear need for high-quality clinical research in this field of AI. This could, eg, be achieved by establishing an internationally consented "best practice framework" that considers all relevant stakeholders.
Collapse
Affiliation(s)
- Hans Peter Dimai
- Correspondence: Hans Peter Dimai, MD, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
| |
Collapse
|
8
|
Lei C, Song JH, Li S, Zhu YN, Liu MY, Wan MC, Mu Z, Tay FR, Niu LN. Advances in materials-based therapeutic strategies against osteoporosis. Biomaterials 2023; 296:122066. [PMID: 36842238 DOI: 10.1016/j.biomaterials.2023.122066] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023]
Abstract
Osteoporosis is caused by the disruption in homeostasis between bone formation and bone resorption. Conventional management of osteoporosis involves systematic drug administration and hormonal therapy. These treatment strategies have limited curative efficacy and multiple adverse effects. Biomaterials-based therapeutic strategies have recently emerged as promising alternatives for the treatment of osteoporosis. The present review summarizes the current status of biomaterials designed for managing osteoporosis. The advantages of biomaterials-based strategies over conventional systematic drug treatment are presented. Different anti-osteoporotic delivery systems are concisely addressed. These materials include injectable hydrogels and nanoparticles, as well as anti-osteoporotic bone tissue engineering materials. Fabrication techniques such as 3D printing, electrostatic spinning and artificial intelligence are appraised in the context of how the use of these adjunctive techniques may improve treatment efficacy. The limitations of existing biomaterials are critically analyzed, together with deliberation of the future directions in biomaterials-based therapies. The latter include discussion on the use of combination strategies to enhance therapeutic efficacy in the osteoporosis niche.
Collapse
Affiliation(s)
- Chen Lei
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Jing-Han Song
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Song Li
- School of Stomatology, Xinjiang Medical University. Urumqi 830011, China
| | - Yi-Na Zhu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Ming-Yi Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Mei-Chen Wan
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Zhao Mu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, 30912, USA.
| | - Li-Na Niu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| |
Collapse
|
9
|
Bonaldi L, Pretto A, Pirri C, Uccheddu F, Fontanella CG, Stecco C. Deep Learning-Based Medical Images Segmentation of Musculoskeletal Anatomical Structures: A Survey of Bottlenecks and Strategies. Bioengineering (Basel) 2023; 10:bioengineering10020137. [PMID: 36829631 PMCID: PMC9952222 DOI: 10.3390/bioengineering10020137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
By leveraging the recent development of artificial intelligence algorithms, several medical sectors have benefited from using automatic segmentation tools from bioimaging to segment anatomical structures. Segmentation of the musculoskeletal system is key for studying alterations in anatomical tissue and supporting medical interventions. The clinical use of such tools requires an understanding of the proper method for interpreting data and evaluating their performance. The current systematic review aims to present the common bottlenecks for musculoskeletal structures analysis (e.g., small sample size, data inhomogeneity) and the related strategies utilized by different authors. A search was performed using the PUBMED database with the following keywords: deep learning, musculoskeletal system, segmentation. A total of 140 articles published up until February 2022 were obtained and analyzed according to the PRISMA framework in terms of anatomical structures, bioimaging techniques, pre/post-processing operations, training/validation/testing subset creation, network architecture, loss functions, performance indicators and so on. Several common trends emerged from this survey; however, the different methods need to be compared and discussed based on each specific case study (anatomical region, medical imaging acquisition setting, study population, etc.). These findings can be used to guide clinicians (as end users) to better understand the potential benefits and limitations of these tools.
Collapse
Affiliation(s)
- Lorenza Bonaldi
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
| | - Andrea Pretto
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35121 Padova, Italy
| | - Carmelo Pirri
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy
| | - Francesca Uccheddu
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35121 Padova, Italy
- Centre for Mechanics of Biological Materials (CMBM), University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35121 Padova, Italy
- Centre for Mechanics of Biological Materials (CMBM), University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
- Correspondence: ; Tel.: +39-049-8276754
| | - Carla Stecco
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy
- Centre for Mechanics of Biological Materials (CMBM), University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
| |
Collapse
|
10
|
Medical optimization of osteoporosis for adult spinal deformity surgery: a state-of-the-art evidence-based review of current pharmacotherapy. Spine Deform 2022; 11:579-596. [PMID: 36454531 DOI: 10.1007/s43390-022-00621-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Osteoporosis is a common, but challenging phenomenon to overcome in adult spinal deformity (ASD) surgery. Several pharmacological agents are at the surgeon's disposal to optimize the osteoporotic patient prior to undergoing extensive reconstruction. Familiarity with these medications will allow the surgeon to make informed decisions on selecting the most appropriate adjuncts for each individual patient. METHODS A comprehensive literature review was conducted in PubMed from September 2021 to April 2022. Studies were selected that contained combinations of various terms including osteoporosis, specific medications, spine surgery, fusion, cage subsidence, screw loosening, pull-out, junctional kyphosis/failure. RESULTS Bisphosphonates, denosumab, selective estrogen receptor modulators, teriparatide, abaloparatide and romosozumab are all pharmacological agents currently available for adjunctive use. While these medications have been shown to have beneficial effects on improving bone mineral density in the osteoporotic patient, varying evidence is available on their specific effects in the context of extensive spine surgery. There is still a lack of human studies with use of the newer agents. CONCLUSION Bisphosphonates are first-line agents due to their low cost and robust evidence behind their utility. However, in the absence of contraindications, optimizing bone quality with anabolic medications should be strongly considered in preparation for spinal deformity surgeries due to their beneficial and favorable effects on fusion and hardware compared to the anti-resorptive medications.
Collapse
|
11
|
The Prevalence of Osteoporosis in the Thoracic Surgery Patient Population: An Opportunity Assessment from Thorax CT Scans. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2022. [DOI: 10.21673/anadoluklin.1145900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: To investigate the prevalence of osteoporosis in thoracic surgery patients and highlight the clinical significance for physicians.
Methods: Thoracic computed tomographies(CT) of 306 patients were examined for medullary density of T12 vertebra. Hounsfield units (HU) between men and women; under the age of 70 and those who are "70 years and older" groups were compared. To evaluate the diagnostic performance of the age parameter in predicting osteoporosis, ROC analysis, and logistic regression analysis were used. The rib cortical defects identified in this study group and their causes were explained.
Results: HUs of 51 subjects (or 16.7%) was less than 110 (osteoporosis); of 177 people (57.8%) was higher than 160 (normal). HU values ranged from 111 to 159 (borderline) for 78 individuals (25.5%). There was no significant difference between males and females. It was discovered that the difference between the population under 70 and the population over 70 was statistically significant (p
Collapse
|
12
|
Fleps I, Morgan EF. A Review of CT-Based Fracture Risk Assessment with Finite Element Modeling and Machine Learning. Curr Osteoporos Rep 2022; 20:309-319. [PMID: 36048316 PMCID: PMC10941185 DOI: 10.1007/s11914-022-00743-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW We reviewed advances over the past 3 years in assessment of fracture risk based on CT scans, considering methods that use finite element models, machine learning, or a combination of both. RECENT FINDINGS Several studies have demonstrated that CT-based assessment of fracture risk, using finite element modeling or biomarkers derived from machine learning, is equivalent to currently used clinical tools. Phantomless calibration of CT scans for bone mineral density enables accurate measurements from routinely taken scans. This opportunistic use of CT scans for fracture risk assessment is facilitated by high-quality automated segmentation with deep learning, enabling workflows that do not require user intervention. Modeling of more realistic and diverse loading conditions, as well as improved modeling of fracture mechanisms, has shown promise to enhance our understanding of fracture processes and improve the assessment of fracture risk beyond the performance of current clinical tools. CT-based screening for fracture risk is effective and, by analyzing scans that were taken for other indications, could be used to expand the pool of people screened, therefore improving fracture prevention. Finite element modeling and machine learning both provide valuable tools for fracture risk assessment. Future approaches should focus on including more loading-related aspects of fracture risk.
Collapse
Affiliation(s)
- Ingmar Fleps
- College of Mechanical Engineering, Boston University, Boston, USA.
| | - Elise F Morgan
- College of Mechanical Engineering, Boston University, Boston, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| |
Collapse
|
13
|
Ren G, Yu K, Xie Z, Wang P, Zhang W, Huang Y, Wang Y, Wu X. Current Applications of Machine Learning in Spine: From Clinical View. Global Spine J 2022; 12:1827-1840. [PMID: 34628966 PMCID: PMC9609532 DOI: 10.1177/21925682211035363] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES This review aims to present current applications of machine learning (ML) in spine domain to clinicians. METHODS We conducted a comprehensive PubMed search of peer-reviewed articles that were published between 2006 and 2020 using terms (spine, spinal, lumbar, cervical, thoracic, machine learning) to examine ML in spine. Then exclude research of other domain, case report, review or meta-analysis, and which without available abstract or full text. RESULTS Total 1738 articles were retrieved from database, and 292 studies were finally included. Key findings of current applications were compiled and summarized in this review. Main clinical applications of those techniques including image processing, diagnosis, decision supporting, operative assistance, rehabilitation, surgery outcomes, complications, hospitalization and cost. CONCLUSIONS ML had achieved excellent performance and hold immense potential in spine. ML could help clinical staff to improve medical level, enhance work efficiency, and reduce adverse events. However more randomized controlled trials and improvement of interpretability are essential to clinicians accepting models' assistance in real work.
Collapse
Affiliation(s)
- GuanRui Ren
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - Kun Yu
- Nanjing Jiangbei Hospital, Nanjing,
Jiangsu, China
| | - ZhiYang Xie
- Department of Spine Surgery, Zhongda
Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - PeiYang Wang
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - Wei Zhang
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - Yong Huang
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - YunTao Wang
- Department of Spine Surgery, Zhongda
Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China,YunTao Wang, Department of Spine Surgery,
Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao
Road, Nanjing, Jiangsu 210009, China.
| | - XiaoTao Wu
- Department of Spine Surgery, Zhongda
Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China,XiaoTao Wu, Department of Spine Surgery,
Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao
Road, Nanjing, Jiangsu 210009, China.
| |
Collapse
|
14
|
Wani IM, Arora S. Osteoporosis diagnosis in knee X-rays by transfer learning based on convolution neural network. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 82:14193-14217. [PMID: 36185321 PMCID: PMC9510281 DOI: 10.1007/s11042-022-13911-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/17/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Osteoporosis degrades the quality of bones and is the primary cause of fractures in the elderly and women after menopause. The high diagnostic and treatment costs urge the researchers to find a cost-effective diagnostic system to diagnose osteoporosis in the early stages. X-ray imaging is the cheapest and most common imaging technique to detect bone pathologies butmanual interpretation of x-rays for osteoporosis is difficult and extraction of required features and selection of high-performance classifiers is a very challenging task. Deep learning systems have gained the popularity in image analysis field over the last few decades. This paper proposes a convolution neural network (CNN) based approach to detect osteoporosis from x-rays. In our study, we have used the transfer learning of deep learning-based CNNs namely AlexNet, VggNet-16, ResNet, and VggNet -19 to classify the x-ray images of knee joints into normal, osteopenia, and osteoporosis disease groups. The main objectives of the current study are: (i) to present a dataset of 381 knee x-rays medically validated by the T-scores obtained from the Quantitative Ultrasound System, and (ii) to propose a deep learning approach using transfer learning to classify different stages of the disease. The performance of these classifiers is compared and the best accuracy of 91.1% is achieved by pretrained Alexnet architecture on the presented dataset with an error rate of 0.09 and validation loss of 0.54 as compared to the accuracy of 79%, an error rate of 0.21, and validation loss of 0.544 when pretrained network was not used.. The results of the study suggest that a deep learning system with transfer learning can help clinicians to detect osteoporosis in its early stages hence reducing the risk of fractures.
Collapse
Affiliation(s)
- Insha Majeed Wani
- School of Computer Science Engineering, Shri Mata Vaishno Devi University, Katra, India
| | - Sakshi Arora
- School of Computer Science Engineering, Shri Mata Vaishno Devi University, Katra, India
| |
Collapse
|
15
|
Jiang YW, Xu XJ, Wang R, Chen CM. Radiomics analysis based on lumbar spine CT to detect osteoporosis. Eur Radiol 2022; 32:8019-8026. [PMID: 35499565 PMCID: PMC9059457 DOI: 10.1007/s00330-022-08805-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Undiagnosed osteoporosis may lead to severe complications after spinal surgery. This study aimed to construct and validate a radiomic signature based on CT scans to screen for lumbar spine osteoporosis. METHODS Using a stratified random sample method, 386 vertebral bodies were randomly divided into a training set (n = 270) and a test set (n = 116). A total of 1040 radiomics features were automatically retracted from lumbar spine CT scans using the 3D slicer pyradiomics module, and a radiomic signature was created. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) of the Hounsfield and radiomics signature models were calculated. The AUCs of the two models were compared using the DeLong test. Their clinical usefulness was assessed using a decision curve analysis. RESULTS Twelve features were chosen to establish the radiomic signature. The AUCs of the radiomics signature and Hounsfield models were 0.96 and 0.88 in the training set and 0.92 and 0.84 in the test set, respectively. According to the DeLong test, the AUCs of the two models were significantly different (p < 0.05). The radiomics signature model indicated a higher overall net benefit than the Hounsfield model, as determined by decision curve analysis. CONCLUSIONS The CT-based radiomic signature can differentiate patients with/without osteoporosis prior to lumbar spinal surgery. Without additional medical cost and radiation exposure, the radiomics method may provide valuable information facilitating surgical decision-making. KEY POINTS • The goal of the study was to evaluate the efficacy of a radiomics signature model based on routine preoperative lumbar spine CT scans in screening osteoporosis. • The radiomics signature model demonstrated excellent prediction performance in both the training and test sets. • This radiomics method may provide valuable information and facilitate surgical decision-making without additional medical costs and radiation exposure.
Collapse
Affiliation(s)
- Yan-Wei Jiang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29, Xin Quan Road, Fuzhou City, 350001, Fujian Province, China
| | - Xiong-Jie Xu
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29, Xin Quan Road, Fuzhou City, 350001, Fujian Province, China
| | - Rui Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29, Xin Quan Road, Fuzhou City, 350001, Fujian Province, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29, Xin Quan Road, Fuzhou City, 350001, Fujian Province, China.
| |
Collapse
|
16
|
Roux C, Rozes A, Reizine D, Hajage D, Daniel C, Maire A, Bréant S, Taright N, Gordon R, Fechtenbaum J, Kolta S, Feydy A, Briot K, Tubach F. Fully automated opportunistic screening of vertebral fractures and osteoporosis on more than 150,000 routine computed tomography scans. Rheumatology (Oxford) 2021; 61:3269-3278. [PMID: 34850864 DOI: 10.1093/rheumatology/keab878] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Osteoporosis is underdiagnosed and undertreated, although severe complications of osteoporotic fractures, including vertebral fractures, are well known. This study sought to assess the feasibility and results of an opportunistic screening of vertebral fractures and osteoporosis in a large database of lumbar or abdominal CT scans. MATERIAL AND METHODS Data were analyzed from CT scans obtained in 35 hospitals from patients aged 60 years and more and stored in a Picture Archiving and Communication System in Assistance-Publique-Hôpitaux de Paris, from 2007 to 2013. Dedicated software analyzed the presence of at least 1 vertebral fracture (VF), and measured Hounsfield Units (HU) in lumbar vertebrae. A simulated T-score was calculated. RESULTS Data were analyzed from 152 268 patients (73.2 ± 9.07 years). Success rates for VF assessment and HU measurements were 82 and 87% respectively. Prevalence of VF was 24.5% and increased with age. Areas under the receiver operating characteristic curves for the detection of VF were 0.61 and 0.62 for mean HU of lumbar vertebrae and L1 HU, respectively. In patients without VF, HU decreased with age, similarly in males and females. The prevalence of osteoporosis (sT-score ≤ - 2.5) was 23.8% and 36.5% in patients without and with VFs respectively. CONCLUSION Opportunistic screening in patients 60 years and older having lumbar or abdominal CT scans is feasible at large scale to screen vertebral fractures and osteoporosis.
Collapse
Affiliation(s)
- Christian Roux
- Department of Rheumatology, INSERM UMR 1153, APHP. Centre-Université de Paris, Institut de Recherche des Maladies Ostéo-Articulaires de l'Université de Paris, Hôpital Cochin
| | - Antoine Rozes
- AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901
| | | | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901
| | - Christel Daniel
- AP-HP, Direction des Systèmes d'Information, Pôle Innovation et Données
- INSERM UMRS 1142
| | - Aurélien Maire
- AP-HP, Direction des Systèmes d'Information, Pôle Innovation et Données
| | - Stéphane Bréant
- AP-HP, Direction des Systèmes d'Information, Pôle Innovation et Données
| | - Namik Taright
- AP-HP, Direction de la Stratégie et de la Transformation, Pôle Sciences des données et Information médicale, Paris, France
| | | | - Jacques Fechtenbaum
- Department of Rheumatology, APHP, Centre-Université de Paris, Hôpital Cochin
| | - Sami Kolta
- Department of Rheumatology, APHP, Centre-Université de Paris, Hôpital Cochin
| | - Antoine Feydy
- Department of Rheumatology, INSERM UMR 1153, APHP. Centre-Université de Paris, Institut de Recherche des Maladies Ostéo-Articulaires de l'Université de Paris, Hôpital Cochin
- Service de Radiologie Ostéo-Articulaire, Hôpital Cochin, Collégiale de Radiologie, AP-HP, Paris, France
| | - Karine Briot
- Department of Rheumatology, INSERM UMR 1153, APHP. Centre-Université de Paris, Institut de Recherche des Maladies Ostéo-Articulaires de l'Université de Paris, Hôpital Cochin
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901
| |
Collapse
|
17
|
Kong SH, Shin CS. Applications of Machine Learning in Bone and Mineral Research. Endocrinol Metab (Seoul) 2021; 36:928-937. [PMID: 34674509 PMCID: PMC8566132 DOI: 10.3803/enm.2021.1111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/23/2021] [Accepted: 09/09/2021] [Indexed: 12/26/2022] Open
Abstract
In this unprecedented era of the overwhelming volume of medical data, machine learning can be a promising tool that may shed light on an individualized approach and a better understanding of the disease in the field of osteoporosis research, similar to that in other research fields. This review aimed to provide an overview of the latest studies using machine learning to address issues, mainly focusing on osteoporosis and fractures. Machine learning models for diagnosing and classifying osteoporosis and detecting fractures from images have shown promising performance. Fracture risk prediction is another promising field of research, and studies are being conducted using various data sources. However, these approaches may be biased due to the nature of the techniques or the quality of the data. Therefore, more studies based on the proposed guidelines are needed to improve the technical feasibility and generalizability of artificial intelligence algorithms.
Collapse
Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| |
Collapse
|
18
|
Hsieh CI, Zheng K, Lin C, Mei L, Lu L, Li W, Chen FP, Wang Y, Zhou X, Wang F, Xie G, Xiao J, Miao S, Kuo CF. Automated bone mineral density prediction and fracture risk assessment using plain radiographs via deep learning. Nat Commun 2021; 12:5472. [PMID: 34531406 PMCID: PMC8446034 DOI: 10.1038/s41467-021-25779-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) is underutilized to measure bone mineral density (BMD) and evaluate fracture risk. We present an automated tool to identify fractures, predict BMD, and evaluate fracture risk using plain radiographs. The tool performance is evaluated on 5164 and 18175 patients with pelvis/lumbar spine radiographs and Hologic DXA. The model is well calibrated with minimal bias in the hip (slope = 0.982, calibration-in-the-large = -0.003) and the lumbar spine BMD (slope = 0.978, calibration-in-the-large = 0.003). The area under the precision-recall curve and accuracy are 0.89 and 91.7% for hip osteoporosis, 0.89 and 86.2% for spine osteoporosis, 0.83 and 95.0% for high 10-year major fracture risk, and 0.96 and 90.0% for high hip fracture risk. The tool classifies 5206 (84.8%) patients with 95% positive or negative predictive value for osteoporosis, compared to 3008 DXA conducted at the same study period. This automated tool may help identify high-risk patients for osteoporosis.
Collapse
Affiliation(s)
- Chen-I Hsieh
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Chihung Lin
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ling Mei
- Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Le Lu
- PAII Inc., Bethesda, MD, USA
| | | | - Fang-Ping Chen
- Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | | | | | - Guotong Xie
- Ping An Insurance (Group) Company of China, Ltd., Shenzhen, Guangdong, China
| | - Jing Xiao
- Ping An Insurance (Group) Company of China, Ltd., Shenzhen, Guangdong, China
| | | | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- PAII Inc., Bethesda, MD, USA.
- Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
| |
Collapse
|
19
|
Aggarwal V, Maslen C, Abel RL, Bhattacharya P, Bromiley PA, Clark EM, Compston JE, Crabtree N, Gregory JS, Kariki EP, Harvey NC, Ward KA, Poole KES. Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation. Ther Adv Musculoskelet Dis 2021; 13:1759720X211024029. [PMID: 34290831 PMCID: PMC8274099 DOI: 10.1177/1759720x211024029] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Osteoporosis causes bones to become weak, porous and fracture more easily. While a vertebral fracture is the archetypal fracture of osteoporosis, it is also the most difficult to diagnose clinically. Patients often suffer further spine or other fractures, deformity, height loss and pain before diagnosis. There were an estimated 520,000 fragility fractures in the United Kingdom (UK) in 2017 (costing £4.5 billion), a figure set to increase 30% by 2030. One way to improve both vertebral fracture identification and the diagnosis of osteoporosis is to assess a patient's spine or hips during routine computed tomography (CT) scans. Patients attend routine CT for diagnosis and monitoring of various medical conditions, but the skeleton can be overlooked as radiologists concentrate on the primary reason for scanning. More than half a million CT scans done each year in the National Health Service (NHS) could potentially be screened for osteoporosis (increasing 5% annually). If CT-based screening became embedded in practice, then the technique could have a positive clinical impact in the identification of fragility fracture and/or low bone density. Several companies have developed software methods to diagnose osteoporosis/fragile bone strength and/or identify vertebral fractures in CT datasets, using various methods that include image processing, computational modelling, artificial intelligence and biomechanical engineering concepts. Technology to evaluate Hounsfield units is used to calculate bone density, but not necessarily bone strength. In this rapid evidence review, we summarise the current literature underpinning approved technologies for opportunistic screening of routine CT images to identify fractures, bone density or strength information. We highlight how other new software technologies have become embedded in NHS clinical practice (having overcome barriers to implementation) and highlight how the novel osteoporosis technologies could follow suit. We define the key unanswered questions where further research is needed to enable the adoption of these technologies for maximal patient benefit.
Collapse
Affiliation(s)
- Veena Aggarwal
- Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, UK
| | | | | | | | | | | | | | - Nicola Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Jennifer S. Gregory
- University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | | | | | - Kate A. Ward
- University of Southampton, Southampton, Hampshire, UK
| | - Kenneth E. S. Poole
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| |
Collapse
|
20
|
Smets J, Shevroja E, Hügle T, Leslie WD, Hans D. Machine Learning Solutions for Osteoporosis-A Review. J Bone Miner Res 2021; 36:833-851. [PMID: 33751686 DOI: 10.1002/jbmr.4292] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/04/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
Osteoporosis and its clinical consequence, bone fracture, is a multifactorial disease that has been the object of extensive research. Recent advances in machine learning (ML) have enabled the field of artificial intelligence (AI) to make impressive breakthroughs in complex data environments where human capacity to identify high-dimensional relationships is limited. The field of osteoporosis is one such domain, notwithstanding technical and clinical concerns regarding the application of ML methods. This qualitative review is intended to outline some of these concerns and to inform stakeholders interested in applying AI for improved management of osteoporosis. A systemic search in PubMed and Web of Science resulted in 89 studies for inclusion in the review. These covered one or more of four main areas in osteoporosis management: bone properties assessment (n = 13), osteoporosis classification (n = 34), fracture detection (n = 32), and risk prediction (n = 14). Reporting and methodological quality was determined by means of a 12-point checklist. In general, the studies were of moderate quality with a wide range (mode score 6, range 2 to 11). Major limitations were identified in a significant number of studies. Incomplete reporting, especially over model selection, inadequate splitting of data, and the low proportion of studies with external validation were among the most frequent problems. However, the use of images for opportunistic osteoporosis diagnosis or fracture detection emerged as a promising approach and one of the main contributions that ML could bring to the osteoporosis field. Efforts to develop ML-based models for identifying novel fracture risk factors and improving fracture prediction are additional promising lines of research. Some studies also offered insights into the potential for model-based decision-making. Finally, to avoid some of the common pitfalls, the use of standardized checklists in developing and sharing the results of ML models should be encouraged. © 2021 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Julien Smets
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Enisa Shevroja
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Didier Hans
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
21
|
Wani IM, Arora S. Computer-aided diagnosis systems for osteoporosis detection: a comprehensive survey. Med Biol Eng Comput 2020; 58:1873-1917. [PMID: 32583141 DOI: 10.1007/s11517-020-02171-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
Computer-aided diagnosis (CAD) has revolutionized the field of medical diagnosis. They assist in improving the treatment potentials and intensify the survival frequency by early diagnosing the diseases in an efficient, timely, and cost-effective way. The automatic segmentation has led the radiologist to successfully segment the region of interest to improve the diagnosis of diseases from medical images which is not so efficiently possible by manual segmentation. The aim of this paper is to survey the vision-based CAD systems especially focusing on the segmentation techniques for the pathological bone disease known as osteoporosis. Osteoporosis is the state of the bones where the mineral density of bones decreases and they become porous, making the bones easily susceptible to fractures by small injury or a fall. The article covers the image acquisition techniques for acquiring the medical images for osteoporosis diagnosis. The article also discusses the advanced machine learning paradigms employed in segmentation for osteoporosis disease. Other image processing steps in osteoporosis like feature extraction and classification are also briefly described. Finally, the paper gives the future directions to improve the osteoporosis diagnosis and presents the proposed architecture. Graphical abstract.
Collapse
Affiliation(s)
- Insha Majeed Wani
- School of Computer Science and Engineering, SMVDU, Katra, J&K, India
| | - Sakshi Arora
- School of Computer Science and Engineering, SMVDU, Katra, J&K, India.
| |
Collapse
|
22
|
Dagan N, Elnekave E, Barda N, Bregman-Amitai O, Bar A, Orlovsky M, Bachmat E, Balicer RD. Automated opportunistic osteoporotic fracture risk assessment using computed tomography scans to aid in FRAX underutilization. Nat Med 2020; 26:77-82. [PMID: 31932801 DOI: 10.1038/s41591-019-0720-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
Methods for identifying patients at high risk for osteoporotic fractures, including dual-energy X-ray absorptiometry (DXA)1,2 and risk predictors like the Fracture Risk Assessment Tool (FRAX)3-6, are underutilized. We assessed the feasibility of automatic, opportunistic fracture risk evaluation based on routine abdomen or chest computed tomography (CT) scans. A CT-based predictor was created using three automatically generated bone imaging biomarkers (vertebral compression fractures (VCFs), simulated DXA T-scores and lumbar trabecular density) and CT metadata of age and sex. A cohort of 48,227 individuals (51.8% women) aged 50-90 with available CTs before 2012 (index date) were assessed for 5-year fracture risk using FRAX with no bone mineral density (BMD) input (FRAXnb) and the CT-based predictor. Predictions were compared to outcomes of major osteoporotic fractures and hip fractures during 2012-2017 (follow-up period). Compared with FRAXnb, the major osteoporotic fracture CT-based predictor presented better receiver operating characteristic area under curve (AUC), sensitivity and positive predictive value (PPV) (+1.9%, +2.4% and +0.7%, respectively). The AUC, sensitivity and PPV measures of the hip fracture CT-based predictor were noninferior to FRAXnb at a noninferiority margin of 1%. When FRAXnb inputs are not available, the initial evaluation of fracture risk can be done completely automatically based on a single abdomen or chest CT, which is often available for screening candidates7,8.
Collapse
Affiliation(s)
- Noa Dagan
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel. .,Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel. .,School of Public Health, Ben-Gurion University, Beer Sheva, Israel.
| | - Eldad Elnekave
- Department of Diagnostic Radiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Zebra Medical Vision, Ltd, Shefayim, Israel
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel.,School of Public Health, Ben-Gurion University, Beer Sheva, Israel
| | | | - Amir Bar
- Zebra Medical Vision, Ltd, Shefayim, Israel
| | | | - Eitan Bachmat
- Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,School of Public Health, Ben-Gurion University, Beer Sheva, Israel
| |
Collapse
|
23
|
Czum JM. Simulated Lumbar Dual-Energy X-Ray Absorptiometry With Machine Learning Algorithms: Why Radiologists Who Interpret Abdominal CTs Should Care. J Am Coll Radiol 2019; 16:1471-1472. [DOI: 10.1016/j.jacr.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 10/25/2022]
|