Application of artificial intelligence in diagnosis of osteoporosis using medical images: a systematic review and meta-analysis

Diagnostic accuracy of chest X-ray and CT using artificial intelligence for osteoporosis: systematic review and meta-analysis

INTRODUCTION

Artificial intelligence (AI)-based systems using chest images are potentially reliable for diagnosing osteoporosis.

METHODS

We performed a systematic review and meta-analysis to assess the diagnostic accuracy of chest X-ray and computed tomography (CT) scans using AI for osteoporosis in accordance with the diagnostic test accuracy guidelines. We included any type of study investigating the diagnostic accuracy of index test for osteoporosis. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and IEEE Xplore Digital Library on November 8, 2023. The main outcome measures were the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for osteoporosis and osteopenia. We described forest plots for sensitivity, specificity, and AUC. The summary points were estimated from the bivariate random-effects models. We summarized the overall quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation approach.

RESULTS

Nine studies with 11,369 participants were included in this review. The pooled sensitivity, specificity, and AUC of chest X-rays for the diagnosis of osteoporosis were 0.83 (95% confidence interval [CI] 0.75, 0.89), 0.76 (95% CI 0.71, 0.80), and 0.86 (95% CI 0.83, 0.89), respectively (certainty of the evidence, low). The pooled sensitivity and specificity of chest CT for the diagnosis of osteoporosis and osteopenia were 0.83 (95% CI 0.69, 0.92) and 0.70 (95% CI 0.61, 0.77), respectively (certainty of the evidence, low and very low).

CONCLUSIONS

This review suggests that chest X-ray with AI has a high sensitivity for the diagnosis of osteoporosis, highlighting its potential for opportunistic screening. However, the risk of bias of patient selection in most studies were high. More research with adequate participants' selection criteria for screening tool will be needed in the future.

Diagnostic accuracy of artificial intelligence models in detecting osteoporosis using dental images: a systematic review and meta-analysis

The current study aimed to systematically review the literature on the accuracy of artificial intelligence (AI) models for osteoporosis (OP) diagnosis using dental images. A thorough literature search was executed in October 2022 and updated in November 2023 across multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar. The research targeted studies using AI models for OP diagnosis from dental radiographs. The main outcomes were the sensitivity and specificity of AI models regarding OP diagnosis. The "meta" package from the R Foundation was selected for statistical analysis. A random-effects model, along with 95% confidence intervals, was utilized to estimate pooled values. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was employed for risk of bias and applicability assessment. Among 640 records, 22 studies were included in the qualitative analysis and 12 in the meta-analysis. The overall sensitivity for AI-assisted OP diagnosis was 0.85 (95% CI, 0.70-0.93), while the pooled specificity equaled 0.95 (95% CI, 0.91-0.97). Conventional algorithms led to a pooled sensitivity of 0.82 (95% CI, 0.57-0.94) and a pooled specificity of 0.96 (95% CI, 0.93-0.97). Deep convolutional neural networks exhibited a pooled sensitivity of 0.87 (95% CI, 0.68-0.95) and a pooled specificity of 0.92 (95% CI, 0.83-0.96). This systematic review corroborates the accuracy of AI in OP diagnosis using dental images. Future research should expand sample sizes in test and training datasets and standardize imaging techniques to establish the reliability of AI-assisted methods in OP diagnosis through dental images.

Diagnostic Accuracy of Deep Learning for the Prediction of Osteoporosis Using Plain X-rays: A Systematic Review and Meta-Analysis

(1) Background: This meta-analysis assessed the diagnostic accuracy of deep learning model-based osteoporosis prediction using plain X-ray images. (2) Methods: We searched PubMed, Web of Science, SCOPUS, and Google Scholar from no set beginning date to 28 February 2023, for eligible studies that applied deep learning methods for diagnosing osteoporosis using X-ray images. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. The area under the receiver operating characteristic curve (AUROC) was used to quantify the predictive performance. Subgroup, meta-regression, and sensitivity analyses were performed to identify the potential sources of study heterogeneity. (3) Results: Six studies were included; the pooled AUROC, sensitivity, and specificity were 0.88 (95% confidence interval [CI] 0.85-0.91), 0.81 (95% CI 0.78-0.84), and 0.87 (95% CI 0.81-0.92), respectively, indicating good performance. Moderate heterogeneity was observed. Mega-regression and subgroup analyses were not performed due to the limited number of studies included. (4) Conclusion: Deep learning methods effectively extract bone density information from plain radiographs, highlighting their potential for opportunistic screening. Nevertheless, additional prospective multicenter studies involving diverse patient populations are required to confirm the applicability of this novel technique.

Artificial intelligence performance in detecting lymphoma from medical imaging: a systematic review and meta-analysis

BACKGROUND

Accurate diagnosis and early treatment are essential in the fight against lymphatic cancer. The application of artificial intelligence (AI) in the field of medical imaging shows great potential, but the diagnostic accuracy of lymphoma is unclear. This study was done to systematically review and meta-analyse researches concerning the diagnostic performance of AI in detecting lymphoma using medical imaging for the first time.

METHODS

Searches were conducted in Medline, Embase, IEEE and Cochrane up to December 2023. Data extraction and assessment of the included study quality were independently conducted by two investigators. Studies that reported the diagnostic performance of an AI model/s for the early detection of lymphoma using medical imaging were included in the systemic review. We extracted the binary diagnostic accuracy data to obtain the outcomes of interest: sensitivity (SE), specificity (SP), and Area Under the Curve (AUC). The study was registered with the PROSPERO, CRD42022383386.

RESULTS

Thirty studies were included in the systematic review, sixteen of which were meta-analyzed with a pooled sensitivity of 87% (95%CI 83-91%), specificity of 94% (92-96%), and AUC of 97% (95-98%). Satisfactory diagnostic performance was observed in subgroup analyses based on algorithms types (machine learning versus deep learning, and whether transfer learning was applied), sample size (≤ 200 or >  200), clinicians versus AI models and geographical distribution of institutions (Asia versus non-Asia).

CONCLUSIONS

Even if possible overestimation and further studies with a better standards for application of AI algorithms in lymphoma detection are needed, we suggest the AI may be useful in lymphoma diagnosis.

New Horizons: Artificial Intelligence Tools for Managing Osteoporosis

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.

Detection of sarcopenia using deep learning-based artificial intelligence body part measure system (AIBMS)

Background: Sarcopenia is an aging syndrome that increases the risks of various adverse outcomes, including falls, fractures, physical disability, and death. Sarcopenia can be diagnosed through medical images-based body part analysis, which requires laborious and time-consuming outlining of irregular contours of abdominal body parts. Therefore, it is critical to develop an efficient computational method for automatically segmenting body parts and predicting diseases. Methods: In this study, we designed an Artificial Intelligence Body Part Measure System (AIBMS) based on deep learning to automate body parts segmentation from abdominal CT scans and quantification of body part areas and volumes. The system was developed using three network models, including SEG-NET, U-NET, and Attention U-NET, and trained on abdominal CT plain scan data. Results: This segmentation model was evaluated using multi-device developmental and independent test datasets and demonstrated a high level of accuracy with over 0.9 DSC score in segment body parts. Based on the characteristics of the three network models, we gave recommendations for the appropriate model selection in various clinical scenarios. We constructed a sarcopenia classification model based on cutoff values (Auto SMI model), which demonstrated high accuracy in predicting sarcopenia with an AUC of 0.874. We used Youden index to optimize the Auto SMI model and found a better threshold of 40.69. Conclusion: We developed an AI system to segment body parts in abdominal CT images and constructed a model based on cutoff value to achieve the prediction of sarcopenia with high accuracy.

An End-to-End Data-Adaptive Pancreas Segmentation System with an Image Quality Control Toolbox

With the development of radiology and computer technology, diagnosis by medical imaging is heading toward precision and automation. Due to complex anatomy around the pancreatic tissue and high demands for clinical experience, the assisted pancreas segmentation system will greatly promote clinical efficiency. However, the existing segmentation model suffers from poor generalization among images from multiple hospitals. In this paper, we propose an end-to-end data-adaptive pancreas segmentation system to tackle the problems of lack of annotations and model generalizability. The system employs adversarial learning to transfer features from labeled domains to unlabeled domains, seeking a dynamic balance between domain discrimination and unsupervised segmentation. The image quality control toolbox is embedded in the system, which standardizes image quality in terms of intensity, field of view, and so on, to decrease heterogeneity among image domains. In addition, the system implements a data-adaptive process end-to-end without complex operations by doctors. The experiments are conducted on an annotated public dataset and an unannotated in-hospital dataset. The results indicate that after data adaptation, the segmentation performance measured by the dice similarity coefficient on unlabeled images improves from 58.79% to 75.43%, with a gain of 16.64%. Furthermore, the system preserves quantitatively structured information such as the pancreas’ size and volume, as well as objective and accurate visualized images, which assists clinicians in diagnosing and formulating treatment plans in a timely and accurate manner.

m2ABQ-a proposed refinement of the modified algorithm-based qualitative classification of osteoporotic vertebral fractures

Currently, there is no reproducible, widely accepted gold standard to classify osteoporotic vertebral body fractures (OVFs). The purpose of this study is to refine a method with clear rules to classify OVFs for machine learning purposes. The method was found to have moderate interobserver agreement that improved with training.

INTRODUCTION

The current methods to classify osteoporotic vertebral body fractures are considered ambiguous; there is no reproducible, accepted gold standard. The purpose of this study is to refine classification methodology by introducing clear, unambiguous rules and a refined flowchart to allow consistent classification of osteoporotic vertebral body fractures.

METHODS

We developed a set of rules and refinements that we called m2ABQ to classify vertebrae into five categories. A fracture-enriched database of thoracic and lumbar spine radiographs of patients 65 years of age and older was retrospectively obtained from clinical institutional radiology records using natural language processing. Five raters independently classified each vertebral body using the m2ABQ system. After each annotation round, consensus sessions that included all raters were held to discuss and finalize a consensus annotation for each vertebral body where individual raters' evaluations differed. This process led to further refinement and development of the rules.

RESULTS

Each annotation round showed increase in Fleiss kappa both for presence vs absence of fracture 0.62 (0.56-0.68) to 0.70 (0.65-0.75), as well as for the whole m2ABQ scale 0.29 (0.25-0.33) to 0.54 (0.51-0.58).

CONCLUSION

The m2ABQ system demonstrates moderate interobserver agreement and practical feasibility for classifying osteoporotic vertebral body fractures. Future studies to compare the method to existing studies are warranted, as well as further development of its use in machine learning purposes.

Application of a Remotely Controlled Artificial Intelligence Analgesic Pump Device in Painless Treatment of Children

In order to effectively improve the application of analgesic pump devices in the treatment of children, a method based on remote control artificial intelligence is proposed. 100 children with dental pulpitis who were treated in a hospital from December 2018 to December 2020 were selected as the research subjects; they were randomly divided into control group and observation group by an equidistant sampling method, with 50 cases in each group. Children in the control group were given articaine and adrenaline anesthesia, and the observation group was treated with articaine and adrenaline combined with a computer-controlled anesthesia system, the anesthesia pain degree and satisfaction degree of the two groups of children were observed and compared. The results showed that the pain score in anesthesia and intraoperative pain score in the observation group was significantly lower than that in the control group, and the differences were statistically significant (P < 0.05). The total satisfaction of 96.6% patients in the observation group was significantly higher than that in the control group (84.7%) and the difference was statistically significant (P < 0.05). There were no serious complications in both groups. The application of the computer anesthesia system combined with articaine adrenaline in the painless treatment of children's dental pulp proved to have better effects, the treatment compliance is higher, and it is worthy of clinical promotion.

Artificial Intelligence in Endodontics: Current Applications and Future Directions

INTRODUCTION

Artificial intelligence (AI) has the potential to replicate human intelligence to perform prediction and complex decision making in health care and has significantly increased its presence and relevance in various tasks and applications in dentistry, especially endodontics. The aim of this review was to discuss the current endodontic applications of AI and potential future directions.

METHODS

Articles that have addressed the applications of AI in endodontics were evaluated for information pertinent to include in this narrative review.

RESULTS

AI models (eg, convolutional neural networks and/or artificial neural networks) have demonstrated various applications in endodontics such as studying root canal system anatomy, detecting periapical lesions and root fractures, determining working length measurements, predicting the viability of dental pulp stem cells, and predicting the success of retreatment procedures. The future of this technology was discussed in light of helping with scheduling, treating patients, drug-drug interactions, diagnosis with prognostic values, and robotic-assisted endodontic surgery.

CONCLUSIONS

AI demonstrated accuracy and precision in terms of detection, determination, and disease prediction in endodontics. AI can contribute to the improvement of diagnosis and treatment that can lead to an increase in the success of endodontic treatment outcomes. However, it is still necessary to further verify the reliability, applicability, and cost-effectiveness of AI models before transferring these models into day-to-day clinical practice.