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Wang J, Luo J, Liang J, Cao Y, Feng J, Tan L, Wang Z, Li J, Hounye AH, Hou M, He J. Lightweight Attentive Graph Neural Network with Conditional Random Field for Diagnosis of Anterior Cruciate Ligament Tear. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:688-705. [PMID: 38343260 PMCID: PMC11031558 DOI: 10.1007/s10278-023-00944-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/23/2023] [Accepted: 10/16/2023] [Indexed: 04/20/2024]
Abstract
Anterior cruciate ligament (ACL) tears are prevalent orthopedic sports injuries and are difficult to precisely classify. Previous works have demonstrated the ability of deep learning (DL) to provide support for clinicians in ACL tear classification scenarios, but it requires a large quantity of labeled samples and incurs a high computational expense. This study aims to overcome the challenges brought by small and imbalanced data and achieve fast and accurate ACL tear classification based on magnetic resonance imaging (MRI) of the knee. We propose a lightweight attentive graph neural network (GNN) with a conditional random field (CRF), named the ACGNN, to classify ACL ruptures in knee MR images. A metric-based meta-learning strategy is introduced to conduct independent testing through multiple node classification tasks. We design a lightweight feature embedding network using a feature-based knowledge distillation method to extract features from the given images. Then, GNN layers are used to find the dependencies between samples and complete the classification process. The CRF is incorporated into each GNN layer to refine the affinities. To mitigate oversmoothing and overfitting issues, we apply self-boosting attention, node attention, and memory attention for graph initialization, node updating, and correlation across graph layers, respectively. Experiments demonstrated that our model provided excellent performance on both oblique coronal data and sagittal data with accuracies of 92.94% and 91.92%, respectively. Notably, our proposed method exhibited comparable performance to that of orthopedic surgeons during an internal clinical validation. This work shows the potential of our method to advance ACL diagnosis and facilitates the development of computer-aided diagnosis methods for use in clinical practice.
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Affiliation(s)
- Jiaoju Wang
- School of Mathematics and Statistics, Central South University, Changsha, 410083, Hunan, China
| | - Jiewen Luo
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiehui Liang
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Yangbo Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jing Feng
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Lingjie Tan
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Zhengcheng Wang
- Department of Orthopaedic Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750021, Ningxia Hui Autonomous Region, China
| | - Jingming Li
- School of Civil Engineeringand Architecture, Nanyang Normal University, Nanyang, 473061, Henan, China
| | - Alphonse Houssou Hounye
- School of Mathematics and Statistics, Central South University, Changsha, 410083, Hunan, China
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha, 410083, Hunan, China.
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
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Xue Y, Yang S, Sun W, Tan H, Lin K, Peng L, Wang Z, Zhang J. Approaching expert-level accuracy for differentiating ACL tear types on MRI with deep learning. Sci Rep 2024; 14:938. [PMID: 38195977 PMCID: PMC10776725 DOI: 10.1038/s41598-024-51666-8] [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: 08/12/2023] [Accepted: 01/08/2024] [Indexed: 01/11/2024] Open
Abstract
Treatment for anterior cruciate ligament (ACL) tears depends on the condition of the ligament. We aimed to identify different tear statuses from preoperative MRI using deep learning-based radiomics with sex and age. We reviewed 862 patients with preoperative MRI scans reflecting ACL status from Hunan Provincial People's Hospital. Based on sagittal proton density-weighted images, a fully automated approach was developed that consisted of a deep learning model for segmenting ACL tissue (ACL-DNet) and a deep learning-based recognizer for ligament status classification (ACL-SNet). The efficacy of the proposed approach was evaluated by using the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) and compared with that of a group of three orthopedists in the holdout test set. The ACL-DNet model yielded a Dice coefficient of 98% ± 6% on the MRI datasets. Our proposed classification model yielded a sensitivity of 97% and a specificity of 97%. In comparison, the sensitivity of alternative models ranged from 84 to 90%, while the specificity was between 86 and 92%. The AUC of the ACL-SNet model was 99%, demonstrating high overall diagnostic accuracy. The diagnostic performance of the clinical experts as reflected in the AUC was 96%, 92% and 88%, respectively. The fully automated model shows potential as a highly reliable and reproducible tool that allows orthopedists to noninvasively identify the ACL status and may aid in optimizing different techniques, such as ACL remnant preservation, for ACL reconstruction.
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Affiliation(s)
- Yang Xue
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China
| | - Shu Yang
- Department of Orthopaedic, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410002, China
| | - Wenjie Sun
- Department of Radiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410002, China
| | - Hui Tan
- Department of Radiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410002, China
| | - Kaibin Lin
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China
| | - Li Peng
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China
| | - Zheng Wang
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China.
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China.
| | - Jianglin Zhang
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, 518020, Guangdong, China.
- Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
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Blanke F, Trinnes K, Oehler N, Prall WC, Lutter C, Tischer T, Vogt S. Spontaneous healing of acute ACL ruptures: rate, prognostic factors and short-term outcome. Arch Orthop Trauma Surg 2023; 143:4291-4298. [PMID: 36515708 PMCID: PMC10293391 DOI: 10.1007/s00402-022-04701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is considered the first line treatment in ACL rupture. However, some patients return to high intensity sport activities and show a normal knee function without ACL reconstruction. Therefore, aim of this study was to evaluate the rate and prognostic factors of spontaneous healing in patients with ACL rupture and the short-term functional outcome. METHODS The rate, prognostic factors and short-term functional results of spontaneous healing in patients with ACL rupture were evaluated in 381 patients. Morphology of ACL rupture and extent of posterior tibial slope (PTS) were classified by MR- and x-ray imaging. In patients with normal knee stability in anesthesia examination and healed ACL during the arthroscopy 6 weeks after trauma ACL reconstruction was canceled. IKDC -, Tegner Activity Score, KT 1000 testing and radiological characteristics were collected 12 months postoperatively in these patients. RESULTS 14.17% of the patients with ACL rupture showed a spontaneous healing after 6 weeks. Femoral ACL-rupture (p < 0.02) with integrity of ligament stump > 50% (p < 0.001), without bundle separation (p < 0.001) and decreased PTS (p < 0.001) was found significantly more often in patients with a spontaneous healed ACL. The average IKDC score was high at 84,63 in patients with healed ACL at 1 year follow-up, but KT 1000 testing was inferior compared to non-injured side. CONCLUSION Spontaneous healing of a ruptured ACL happened in 14% of the patients. Especially in low-demand patients with femoral single bundle lesions without increased posterior tibial slope delayed ACL surgery should be considered to await the possibility for potential spontaneous ACL healing.
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Affiliation(s)
- F Blanke
- Department of Knee-, Shoulder- and Hip-Surgery and Orthopedic Sports Medicine, Schön Klinik München-Harlaching, Munich, Germany.
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany.
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany.
| | - K Trinnes
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - N Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - W C Prall
- Department of Knee-, Shoulder- and Hip-Surgery and Orthopedic Sports Medicine, Schön Klinik München-Harlaching, Munich, Germany
- Department of Orthopedic Surgery, University Hospital of Ludwig Maximilian University (LMU), Munich, Germany
| | - C Lutter
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - T Tischer
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - S Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
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Griffith JF, Leung CTP, Lee JCH, Leung JCS, Yeung DKW, Yung PSH. Positional MR imaging of normal and injured knees. Eur Radiol 2023; 33:1553-1564. [PMID: 36348091 DOI: 10.1007/s00330-022-09198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/10/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study uses a practical positional MRI protocol to evaluate tibiofemoral translation and rotation in normal and injured knees. METHODS Following ethics approval, positional knee MRI of both knees was performed at 35° flexion, extension, and hyperextension in 34 normal subjects (mean age 31.1 ± 10 years) and 51 knee injury patients (mean age 36.4 ± 11.5 years, ACL tear n = 23, non-ACL injury n = 28). At each position, tibiofemoral translation and rotation were measured. RESULTS Normal knees showed 8.1 ± 3.3° external tibial rotation (i.e., compatible with physiological screw home mechanism) in hyperextension. The unaffected knee of ACL tear patients showed increased tibial anterior translation laterally (p = 0.005) and decreased external rotation (p = 0.002) in hyperextension compared to normal knees. ACL-tear knees had increased tibial anterior translation laterally (p < 0.001) and decreased external rotation (p < 0.001) compared to normal knees. Applying normal thresholds, fifteen (65%) of 23 ACL knees had excessive tibial anterior translation laterally while 17 (74%) had limited external rotation. None (0%) of 28 non-ACL-injured knees had excessive tibial anterior translation laterally while 13 (46%) had limited external rotation. Multidirectional malalignment was much more common in ACL-tear knees. CONCLUSIONS Positional MRI shows (a) physiological tibiofemoral movement in normal knees, (b) aberrant tibiofemoral alignment in the unaffected knee of ACL tear patients, and (c) a high frequency of abnormal tibiofemoral malalignment in injured knees which was more frequent, more pronounced, more multidirectional, and of a different pattern in ACL-tear knees than non-ACL-injured knees. KEY POINTS • Positional MRI shows physiological tibiofemoral translation and rotation in normal knees. • Positional MRI shows a different pattern of tibiofemoral alignment in the unaffected knee of ACL tear patients compared to normal control knees. • Positional MRI shows a high prevalence of abnormal tibiofemoral alignment in injured knees, which is more frequent and pronounced in ACL-tear knees than in ACL-intact injured knees.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
| | - Cynthia T P Leung
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremiah C H Lee
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick S H Yung
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
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Qu C, Yang H, Wang C, Wang C, Ying M, Chen Z, Yang K, Zhang J, Li K, Dimitriou D, Tsai TY, Liu X. A deep learning approach for anterior cruciate ligament rupture localization on knee MR images. Front Bioeng Biotechnol 2022; 10:1024527. [PMID: 36246358 PMCID: PMC9561886 DOI: 10.3389/fbioe.2022.1024527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To develop and evaluate a deep learning-based method to localize and classify anterior cruciate ligament (ACL) ruptures on knee MR images by using arthroscopy as the reference standard. Methods: We proposed a fully automated ACL rupture localization system to localize and classify ACL ruptures. The classification of ACL ruptures was based on the projection coordinates of the ACL rupture point on the line connecting the center coordinates of the femoral and tibial footprints. The line was divided into three equal parts and the position of the projection coordinates indicated the classification of the ACL ruptures (femoral side, middle and tibial side). In total, 85 patients (mean age: 27; male: 56) who underwent ACL reconstruction surgery under arthroscopy were included. Three clinical readers evaluated the datasets separately and their diagnostic performances were compared with those of the model. The performance metrics included the accuracy, error rate, sensitivity, specificity, precision, and F1-score. A one-way ANOVA was used to evaluate the performance of the convolutional neural networks (CNNs) and clinical readers. Intraclass correlation coefficients (ICC) were used to assess interobserver agreement between the clinical readers. Results: The accuracy of ACL localization was 3.77 ± 2.74 and 4.68 ± 3.92 (mm) for three-dimensional (3D) and two-dimensional (2D) CNNs, respectively. There was no significant difference in the ACL rupture location performance between the 3D and 2D CNNs or among the clinical readers (Accuracy, p < 0.01). The 3D CNNs performed best among the five evaluators in classifying the femoral side (sensitivity of 0.86 and specificity of 0.79), middle side (sensitivity of 0.71 and specificity of 0.84) and tibial side ACL rupture (sensitivity of 0.71 and specificity of 0.99), and the overall accuracy for sides classifying of ACL rupture achieved 0.79. Conclusion: The proposed deep learning-based model achieved high diagnostic performances in locating and classifying ACL fractures on knee MR images.
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Affiliation(s)
- Cheng Qu
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Yang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Cong Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Chongyang Wang
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengjie Ying
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheyi Chen
- Department of Radiology, Shanghai Municipal Eighth People’s Hospital, Shanghai, China
| | - Kai Yang
- Department of Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Kang Li
- West China Hospital, Sichuan University, Chengdu, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zurich, Switzerland
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Tsung-Yuan Tsai, ; Xudong Liu,
| | - Xudong Liu
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Tsung-Yuan Tsai, ; Xudong Liu,
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