1
|
Zhan H, Teng F, Liu Z, Yi Z, He J, Chen Y, Geng B, Xia Y, Wu M, Jiang J. Artificial Intelligence Aids Detection of Rotator Cuff Pathology: A Systematic Review. Arthroscopy 2024; 40:567-578. [PMID: 37355191 DOI: 10.1016/j.arthro.2023.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To determine the model performance of artificial intelligence (AI) in detecting rotator cuff pathology using different imaging modalities and to compare capability with physicians in clinical scenarios. METHODS The review followed the PRISMA guidelines and was registered on PROSPERO. The criteria were as follows: 1) studies on the application of AI in detecting rotator cuff pathology using medical images, and 2) studies on smart devices for assisting in diagnosis were excluded. The following data were extracted and recorded: statistical characteristics, input features, AI algorithms used, sample sizes of training and testing sets, and model performance. The data extracted from the included studies were narratively reviewed. RESULTS A total of 14 articles, comprising 23,119 patients, met the inclusion and exclusion criteria. The pooled mean age of the patients was 56.7 years, and the female rate was 56.1%. The area under the curve (AUC) of the algorithmic model to detect rotator cuff pathology from ultrasound images, MRI images, and radiographic series ranged from 0.789 to 0.950, 0.844 to 0.943, and 0.820 to 0.830, respectively. Notably, 1 of the studies reported that AI models based on ultrasound images demonstrated a diagnostic performance similar to that of radiologists. Another comparative study demonstrated that AI models using MRI images exhibited greater accuracy and specificity compared to orthopedic surgeons in the diagnosis of rotator cuff pathology, albeit not in sensitivity. CONCLUSIONS The detection of rotator cuff pathology has been significantly aided by the exceptional performance of AI models. In particular, these models are equally adept as musculoskeletal radiologists in using ultrasound to diagnose rotator cuff pathology. Furthermore, AI models exhibit statistically superior levels of accuracy and specificity when using MRI to diagnose rotator cuff pathology, albeit with no marked difference in sensitivity, in comparison to orthopaedic surgeons. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.
Collapse
Affiliation(s)
- Hongwei Zhan
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Fei Teng
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Zhongcheng Liu
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Zhi Yi
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Jinwen He
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Yi Chen
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Bin Geng
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Yayi Xia
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China.
| | - Meng Wu
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Jin Jiang
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| |
Collapse
|
2
|
Esfandiari MA, Fallah Tafti M, Jafarnia Dabanloo N, Yousefirizi F. Detection of the rotator cuff tears using a novel convolutional neural network from magnetic resonance image (MRI). Heliyon 2023; 9:e15804. [PMID: 37206038 PMCID: PMC10189183 DOI: 10.1016/j.heliyon.2023.e15804] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
The rotator cuff tear is a common situation for basketballers, handballers, or other athletes that strongly use their shoulders. This injury can be diagnosed precisely from a magnetic resonance (MR) image. In this paper, a novel deep learning-based framework is proposed to diagnose rotator cuff tear from MRI images of patients suspected of the rotator cuff tear. First, we collected 150 shoulders MRI images from two classes of rotator cuff tear patients and healthy ones with the same numbers. These images were observed by an orthopedic specialist and then tagged and used as input in the various configurations of the Convolutional Neural Network (CNN). At this stage, five different configurations of convolutional networks have been examined. Then, in the next step, the selected network with the highest accuracy is used to extract the deep features and classify the two classes of rotator cuff tear and healthy. Also, MRI images are feed to two quick pre-trained CNNs (MobileNetv2 and SqueezeNet) to compare with the proposed CNN. Finally, the evaluation is performed using the 5-fold cross-validation method. Also, a specific Graphical User Interface (GUI) was designed in the MATLAB environment for simplicity, which allows for testing by detecting the image class. The proposed CNN achieved higher accuracy than the two mentioned pre-trained CNNs. The average accuracy, precision, sensitivity, and specificity achieved by the best selected CNN configuration are equal to 92.67%, 91.13%, 91.75%, and 92.22%, respectively. The deep learning algorithm could accurately rule out significant rotator cuff tear based on shoulder MRI.
Collapse
Affiliation(s)
- Mohammad Amin Esfandiari
- Department of Biomedical Engineering, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Fallah Tafti
- Department of Biomedical Engineering, South Tehran Branch, Islamic Azad University, Tehran, Iran
- Corresponding author.
| | - Nader Jafarnia Dabanloo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fereshteh Yousefirizi
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| |
Collapse
|
3
|
Bi D, Shi L, Liu C, Li B, Li Y, Le LH, Luo J, Wang S, Ta D. Ultrasonic Through-Transmission Measurements of Human Musculoskeletal and Fat Properties. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:347-355. [PMID: 36266143 DOI: 10.1016/j.ultrasmedbio.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
The study described here was aimed at investigating the feasibility of using the ultrasonic through-transmission technique to estimate human musculoskeletal and fat properties. Five hundred eighty-two volunteers were assessed by dual-energy X-ray absorptiometry (DXA) and ultrasonic transmission techniques. Bone mineral density (BMD), muscle and fat mass were measured for both legs and the whole body. Hip BMD and spine BMD were also measured. Ultrasonic transmission measurements were performed on the heel, and the measured parameters were broadband ultrasound attenuation (BUA), speed of sound (SOS), ultrasonic stiffness index (SI), T-score and Z-score, which were significantly correlated with all measured BMDs. The optimal correlation was observed between SI and left-leg BMD (p < 0.001) before and after adjustment for age, sex and body mass index (BMI). The linear and partial correlation analyses revealed that BUA and SOS were closely associated with muscle and fat mass, respectively. Multiple regressions revealed that muscle and fat mass significantly contributed to the prediction of transmission parameters, explaining up to 17.83% (p < 0.001) variance independently of BMD. The results suggest that the ultrasonic through-transmission technique could help in the clinical diagnosis of skeletal and muscular system diseases.
Collapse
Affiliation(s)
- Dongsheng Bi
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Lingwei Shi
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chengcheng Liu
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Boyi Li
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Ying Li
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Jingchun Luo
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Sijia Wang
- Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
| | - Dean Ta
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China; Academy for Engineering and Technology, Fudan University, Shanghai, China; Human Phenome Institute, Fudan University, Shanghai, China.
| |
Collapse
|
4
|
Smerilli G, Cipolletta E, Sartini G, Moscioni E, Di Cosmo M, Fiorentino MC, Moccia S, Frontoni E, Grassi W, Filippucci E. Development of a convolutional neural network for the identification and the measurement of the median nerve on ultrasound images acquired at carpal tunnel level. Arthritis Res Ther 2022; 24:38. [PMID: 35135598 PMCID: PMC8822696 DOI: 10.1186/s13075-022-02729-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background Deep learning applied to ultrasound (US) can provide a feedback to the sonographer about the correct identification of scanned tissues and allows for faster and standardized measurements. The most frequently adopted parameter for US diagnosis of carpal tunnel syndrome is the increasing of the cross-sectional area (CSA) of the median nerve. Our aim was to develop a deep learning algorithm, relying on convolutional neural networks (CNNs), for the localization and segmentation of the median nerve and the automatic measurement of its CSA on US images acquired at the proximal inlet of the carpal tunnel. Methods Consecutive patients with rheumatic and musculoskeletal disorders were recruited. Transverse US images were acquired at the carpal tunnel inlet, and the CSA was manually measured. Anatomical variants were registered. The dataset consisted of 246 images (157 for training, 40 for validation, and 49 for testing) from 103 patients each associated with manual annotations of the nerve boundary. A Mask R-CNN, state-of-the-art CNN for image semantic segmentation, was trained on this dataset to accurately localize and segment the median nerve section. To evaluate the performances on the testing set, precision (Prec), recall (Rec), mean average precision (mAP), and Dice similarity coefficient (DSC) were computed. A sub-analysis excluding anatomical variants was performed. The CSA was automatically measured by the algorithm. Results The algorithm correctly identified the median nerve in 41/49 images (83.7%) and in 41/43 images (95.3%) excluding anatomical variants. The following metrics were obtained (with and without anatomical variants, respectively): Prec 0.86 ± 0.33 and 0.96 ± 0.18, Rec 0.88 ± 0.33 and 0.98 ± 0.15, mAP 0.88 ± 0.33 and 0.98 ± 0.15, and DSC 0.86 ± 0.19 and 0.88 ± 0.19. The agreement between the algorithm and the sonographer CSA measurements was excellent [ICC 0.97 (0.94–0.98)]. Conclusions The developed algorithm has shown excellent performances, especially if excluding anatomical variants. Future research should aim at expanding the US image dataset including a wider spectrum of normal anatomy and pathology. This deep learning approach has shown very high potentiality for a fully automatic support for US assessment of carpal tunnel syndrome.
Collapse
Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, 60035, Jesi, Ancona, Italy.
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, 60035, Jesi, Ancona, Italy
| | - Gianmarco Sartini
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, 60035, Jesi, Ancona, Italy
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, 60035, Jesi, Ancona, Italy
| | - Mariachiara Di Cosmo
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| | | | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Emanuele Frontoni
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, 60035, Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, 60035, Jesi, Ancona, Italy
| |
Collapse
|
5
|
Xiu F, Rong G, Zhang T. Construction of a Computer-Aided Analysis System for Orthopedic Diseases Based on High-Frequency Ultrasound Images. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8754693. [PMID: 35035525 PMCID: PMC8754625 DOI: 10.1155/2022/8754693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
The area of medical diagnosis has been transformed by computer-aided diagnosis (CAD). With the advancement of technology and the widespread availability of medical data, CAD has gotten a lot of attention, and numerous methods for predicting different pathological diseases have been created. Ultrasound (US) is the safest clinical imaging method; therefore, it is widely utilized in medical and healthcare settings with computer-aided systems. However, owing to patient movement and equipment constraints, certain artefacts make identification of these US pictures challenging. To enhance the quality of pictures for classification and segmentation, certain preprocessing techniques are required. Hence, we proposed a three-stage image segmentation method using U-Net and Iterative Random Forest Classifier (IRFC) to detect orthopedic diseases in ultrasound images efficiently. Initially, the input dataset is preprocessed using Enhanced Wiener Filter for image denoising and image enhancement. Then, the proposed segmentation method is applied. Feature extraction is performed by transform-based analysis. Finally, obtained features are reduced to optimal subset using Principal Component Analysis (PCA). The classification is done using the proposed Iterative Random Forest Classifier. The proposed method is compared with the conventional performance measures like accuracy, specificity, sensitivity, and dice score. The proposed method is proved to be efficient for detecting orthopedic diseases in ultrasound images than the conventional methods.
Collapse
Affiliation(s)
- Feifei Xiu
- Ultrasound Department, The Fourth People's Hospital of Langfang, Langfang, Hebei, China
| | - Guishan Rong
- Second Department of Orthopedics, The Fourth People's Hospital of Langfang, Langfang, Hebei, China
| | - Tao Zhang
- Second Department of Orthopedics, The Fourth People's Hospital of Langfang, Langfang, Hebei, China
| |
Collapse
|
6
|
Wu CH, Chiu PH, Boudier-Revret M, Chang SW, Chen WS, zakar L. Deep learning for detecting supraspinatus calcific tendinopathy on ultrasound images. J Med Ultrasound 2022; 30:196-202. [DOI: 10.4103/jmu.jmu_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022] Open
|
7
|
Fehr S, Whealy G, Liu XC. Investigation of Ultrasound as a Diagnostic Imaging Modality for Little League Shoulder. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1735535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Objective Ultrasound (US) is an established imaging modality in adult sports medicine but is not commonly used in the diagnosis of pediatric sports conditions, such as Little League shoulder (LLS). This study was conducted to determine the reliability of US measurement of width of the physis at the proximal humerus in diagnosed LLS and to compare US to radiography (RA) in detecting a difference between the affected (dominant) (A) and unaffected (U) shoulders.
Materials and Methods Ten male baseball players diagnosed with LLS were enrolled in the study. US images of the proximal humeral physis at the greater tuberosity of both shoulders were obtained by an US-trained sports medicine physician, and the physeal width was measured. Blinded to prior measurements, a separate physician performed measurements on the stored US images. Measurements were compared with RA on the anteroposterior (AP) view for both A and U at the time of the initial visit and for A at follow-up.
Results The physeal width (mm) at A and U at the initial visit averaged 5.94 ± 1.69 and 4.36 ± 1.20 respectively on RA, and 4.15 ± 1.12 and 3.40 ± 0.85 on US. Median difference of averaged US measurements between A and U at initial evaluation was 0.75 mm (p = 0.00016). A linear model showed US measurements to be predictive of RA on A (R2 = 0.51) and U (R2 = 0.48).
Conclusion US was able to reliably measure the width of the proximal humeral physis and detect a difference between A and U. US correlated well with RA (standard for LLS). US should be considered by the US-trained physician for the diagnosis of LLS.
Collapse
Affiliation(s)
- Shayne Fehr
- Department of Orthopaedic Surgery, Children's Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Gunnar Whealy
- Department of Orthopaedic Surgery, Children's Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Xue-Cheng Liu
- Department of Orthopaedic Surgery, Children's Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| |
Collapse
|
8
|
Lee K, Kim JY, Lee MH, Choi CH, Hwang JY. Imbalanced Loss-Integrated Deep-Learning-Based Ultrasound Image Analysis for Diagnosis of Rotator-Cuff Tear. SENSORS 2021; 21:s21062214. [PMID: 33809972 PMCID: PMC8005102 DOI: 10.3390/s21062214] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 12/19/2022]
Abstract
A rotator cuff tear (RCT) is an injury in adults that causes difficulty in moving, weakness, and pain. Only limited diagnostic tools such as magnetic resonance imaging (MRI) and ultrasound Imaging (UI) systems can be utilized for an RCT diagnosis. Although UI offers comparable performance at a lower cost to other diagnostic instruments such as MRI, speckle noise can occur the degradation of the image resolution. Conventional vision-based algorithms exhibit inferior performance for the segmentation of diseased regions in UI. In order to achieve a better segmentation for diseased regions in UI, deep-learning-based diagnostic algorithms have been developed. However, it has not yet reached an acceptable level of performance for application in orthopedic surgeries. In this study, we developed a novel end-to-end fully convolutional neural network, denoted as Segmentation Model Adopting a pRe-trained Classification Architecture (SMART-CA), with a novel integrated on positive loss function (IPLF) to accurately diagnose the locations of RCT during an orthopedic examination using UI. Using the pre-trained network, SMART-CA can extract remarkably distinct features that cannot be extracted with a normal encoder. Therefore, it can improve the accuracy of segmentation. In addition, unlike other conventional loss functions, which are not suited for the optimization of deep learning models with an imbalanced dataset such as the RCT dataset, IPLF can efficiently optimize the SMART-CA. Experimental results have shown that SMART-CA offers an improved precision, recall, and dice coefficient of 0.604% (+38.4%), 0.942% (+14.0%) and 0.736% (+38.6%) respectively. The RCT segmentation from a normal ultrasound image offers the improved precision, recall, and dice coefficient of 0.337% (+22.5%), 0.860% (+15.8%) and 0.484% (+28.5%), respectively, in the RCT segmentation from an ultrasound image with severe speckle noise. The experimental results demonstrated the IPLF outperforms other conventional loss functions, and the proposed SMART-CA optimized with the IPLF showed better performance than other state-of-the-art networks for the RCT segmentation with high robustness to speckle noise.
Collapse
Affiliation(s)
- Kyungsu Lee
- Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu 42988, Korea; (K.L.); (M.H.L.)
| | - Jun Young Kim
- The Department of Orthopedic Surgery, School of Medicine, Catholic University, Daegu 42472, Korea;
| | - Moon Hwan Lee
- Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu 42988, Korea; (K.L.); (M.H.L.)
| | - Chang-Hyuk Choi
- The Department of Orthopedic Surgery, School of Medicine, Catholic University, Daegu 42472, Korea;
- Correspondence: (C.-H.C.); (J.Y.H.)
| | - Jae Youn Hwang
- The Department of Orthopedic Surgery, School of Medicine, Catholic University, Daegu 42472, Korea;
- Correspondence: (C.-H.C.); (J.Y.H.)
| |
Collapse
|
9
|
Cipolletta E, Fiorentino MC, Moccia S, Guidotti I, Grassi W, Filippucci E, Frontoni E. Artificial Intelligence for Ultrasound Informative Image Selection of Metacarpal Head Cartilage. A Pilot Study. Front Med (Lausanne) 2021; 8:589197. [PMID: 33732711 PMCID: PMC7956959 DOI: 10.3389/fmed.2021.589197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: This study aims to develop an automatic deep-learning algorithm, which is based on Convolutional Neural Networks (CNNs), for ultrasound informative-image selection of hyaline cartilage at metacarpal head level. The algorithm performance and that of three beginner sonographers were compared with an expert assessment, which was considered the gold standard. Methods: The study was divided into two steps. In the first one, an automatic deep-learning algorithm for image selection was developed using 1,600 ultrasound (US) images of the metacarpal head cartilage (MHC) acquired in 40 healthy subjects using a very high-frequency probe (up to 22 MHz). The algorithm task was to identify US images defined informative as they show enough information to fulfill the Outcome Measure in Rheumatology US definition of healthy hyaline cartilage. The algorithm relied on VGG16 CNN, which was fine-tuned to classify US images in informative and non-informative ones. A repeated leave-four-subject out cross-validation was performed using the expert sonographer assessment as gold-standard. In the second step, the expert assessed the algorithm and the beginner sonographers' ability to obtain US informative images of the MHC. Results: The VGG16 CNN showed excellent performance in the first step, with a mean area (AUC) under the receiver operating characteristic curve, computed among the 10 models obtained from cross-validation, of 0.99 ± 0.01. The model that reached the best AUC on the testing set, which we named “MHC identifier 1,” was then evaluated by the expert sonographer. The agreement between the algorithm, and the expert sonographer was almost perfect [Cohen's kappa: 0.84 (95% confidence interval: 0.71–0.98)], whereas the agreement between the expert and the beginner sonographers using conventional assessment was moderate [Cohen's kappa: 0.63 (95% confidence interval: 0.49–0.76)]. The conventional obtainment of US images by beginner sonographers required 6.0 ± 1.0 min, whereas US videoclip acquisition by a beginner sonographer lasted only 2.0 ± 0.8 min. Conclusion: This study paves the way for the automatic identification of informative US images for assessing MHC. This may redefine the US reliability in the evaluation of MHC integrity, especially in terms of intrareader reliability and may support beginner sonographers during US training.
Collapse
Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Sara Moccia
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy.,Department of Advanced Robotics, Italian Institute of Technology, Genoa, Italy
| | - Irene Guidotti
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Emanuele Frontoni
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
10
|
Xu D, Song R, Zhu T, Tu J, Zhang D. Quantitative Evaluation of Rotator Cuff Tears Based on Non-linear Statistical Analysis of Ultrasound Radiofrequency Signals. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:582-589. [PMID: 33317856 DOI: 10.1016/j.ultrasmedbio.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
There is increasing clinical requirement for early and accurate ultrasound diagnosis of rotator cuff tears (RCTs). A method based on non-linear statistical analysis was proposed for the detection of RCTs using ultrasound radiofrequency (RF) signals. One hundred fifty-two patients with shoulder pain were first examined with ultrasound and then diagnosed with magnetic resonance imaging (MRI) as the ground truth. By comparison of the region of interest (ROI) with a part of the supraspinatus with no pathologic change part in the same RF signal frame, the relative Pks value (viz., rPks value) was evaluated to quantify the pathophysiologic changes. The results indicated that the rPks values of all RCTs are <0.7, and the accuracy, sensitivity and specificity of the proposed method can reach 97.5%, 100% and 91.4%, respectively. This computer-aided method was found to perform better diagnostic than the results reported by an experienced radiologist (accuracy = 75.7%, sensitivity = 72.6%, and specificity = 85.7%). The high sensitivity advantage of this method indicates that the prospects for its application in the computer-aided diagnosis of RCTs are good.
Collapse
Affiliation(s)
- Dahua Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Renjie Song
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing, China
| | - Tianshu Zhu
- First Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Juan Tu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing, China.
| |
Collapse
|
11
|
Lo CM, Weng RC, Cheng SJ, Wang HJ, Hsieh KLC. Computer-aided diagnosis of isocitrate dehydrogenase genotypes in glioblastomas from radiomic patterns. Medicine (Baltimore) 2020; 99:e19123. [PMID: 32080088 PMCID: PMC7034690 DOI: 10.1097/md.0000000000019123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
World Health Organization tumor classifications of the central nervous system differentiate glioblastoma multiforme (GBM) into wild-type (WT) and mutant isocitrate dehydrogenase (IDH) genotypes. This study proposes a noninvasive computer-aided diagnosis to interpret the status of IDH in glioblastomas from transformed magnetic resonance imaging patterns. The collected image database was composed of 32 WT and 7 mutant IDH cases. For each image, a ranklet transformation which changed the original pixel values into relative coefficients was 1st applied to reduce the effects of different scanning parameters and machines on the underlying patterns. Extracting various textural features from the transformed ranklet images and combining them in a logistic regression classifier allowed an IDH prediction. We achieved an accuracy of 90%, a sensitivity of 57%, and a specificity of 97%. Four of the selected textural features in the classifier (homogeneity, difference entropy, information measure of correlation, and inverse difference normalized) were significant (P < .05), and the other 2 were close to being significant (P = .06). The proposed computer-aided diagnosis system based on radiomic textural features from ranklet-transformed images using relative rankings of pixel values as intensity-invariant coefficients is a promising noninvasive solution to provide recommendations about the IDH status in GBM across different healthcare institutions.
Collapse
Affiliation(s)
- Chung-Ming Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University
- Graduate Institute of Library, Information and Archival Studies, National Chengchi University
| | - Rui-Cian Weng
- Taiwan Instrument Research Institute, National Applied Research Laboratories
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital
| | - Hung-Jung Wang
- Department of Medical Imaging, Taipei Medical University Hospital
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
12
|
Liu F, Dong J, Shen WJ, Kang Q, Zhou D, Xiong F. Detecting Rotator Cuff Tears: A Network Meta-analysis of 144 Diagnostic Studies. Orthop J Sports Med 2020; 8:2325967119900356. [PMID: 32076627 PMCID: PMC7003181 DOI: 10.1177/2325967119900356] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many imaging techniques have been developed for the detection of rotator cuff tears (RCTs). Despite numerous quantitative diagnostic studies, their relative accuracy remains inconclusive. PURPOSE To determine which of 3 commonly used imaging modalities is optimal for the diagnosis of RCTs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Studies evaluating the performance of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound (US) used in the detection of RCTs were retrieved from the PubMed/MEDLINE and Embase databases. Diagnostic data were extracted from articles that met the inclusion/exclusion criteria. A network meta-analysis was performed using an arm-based model to pool the absolute sensitivity and specificity, relative sensitivity and specificity, and diagnostic odds ratio as well as the superiority index for ranking the probability of these techniques. RESULTS A total of 144 studies involving 14,059 patients (14,212 shoulders) were included in this network meta-analysis. For the detection of full-thickness (FT) tears, partial-thickness (PT) tears, or any tear, MRA had the highest sensitivity, specificity, and superiority index. For the detection of any tear, MRI had better performance than US (sensitivity: 0.84 vs 0.81, specificity: 0.86 vs 0.82, and superiority index: 0.98 vs 0.22, respectively). With regard to FT tears, MRI had a higher sensitivity and superiority index than US (0.91 vs 0.87 and 0.67 vs 0.28, respectively) and a similar specificity (0.88 vs 0.88, respectively). The results for PT tears were similar to the detection of FT tears. A sensitivity analysis was performed by removing studies involving only 1 arm for FT tears, PT tears, or any tear, and the results remained stable. CONCLUSION This network meta-analysis of diagnostic tests revealed that high-field MRA had the highest diagnostic value for detecting any tear, followed by low-field MRA, high-field MRI, high-frequency US, low-field MRI, and low-frequency US. These findings can help guide clinicians in deciding on the appropriate imaging modality.
Collapse
Affiliation(s)
- Fanxiao Liu
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jinlei Dong
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Wun-Jer Shen
- Po Cheng Orthopedic Institute, Kaohsiung, Taiwan
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Fei Xiong
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Fei Xiong, MD, Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Yishan Road 600, Xuhui District, Shanghai 200233, China ()
| |
Collapse
|
13
|
Gutiérrez-Martínez J, Pineda C, Sandoval H, Bernal-González A. Computer-aided diagnosis in rheumatic diseases using ultrasound: an overview. Clin Rheumatol 2019; 39:993-1005. [DOI: 10.1007/s10067-019-04791-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/07/2019] [Accepted: 09/21/2019] [Indexed: 12/12/2022]
|
14
|
Kim KB, Song YS, Park HJ, Song DH, Choi BK. A fuzzy C-means quantization based automatic extraction of rotator cuff tendon tears from ultrasound images. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2018. [DOI: 10.3233/jifs-169576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kwang Baek Kim
- Department of Computer Engineering, Silla University, Busan, Korea
| | - Yu-Seon Song
- Department of Radiology, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun Jun Park
- Division of Software Convergence, Cheongju University, Cheongju, Korea
| | - Doo Heon Song
- Department of Computer Games, Yong-In SongDam College, Yongin, Korea
| | - Byung Kwan Choi
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| |
Collapse
|