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Ong W, Lee A, Tan WC, Fong KTD, Lai DD, Tan YL, Low XZ, Ge S, Makmur A, Ong SJ, Ting YH, Tan JH, Kumar N, Hallinan JTPD. Oncologic Applications of Artificial Intelligence and Deep Learning Methods in CT Spine Imaging-A Systematic Review. Cancers (Basel) 2024; 16:2988. [PMID: 39272846 PMCID: PMC11394591 DOI: 10.3390/cancers16172988] [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: 07/10/2024] [Revised: 08/14/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
In spinal oncology, integrating deep learning with computed tomography (CT) imaging has shown promise in enhancing diagnostic accuracy, treatment planning, and patient outcomes. This systematic review synthesizes evidence on artificial intelligence (AI) applications in CT imaging for spinal tumors. A PRISMA-guided search identified 33 studies: 12 (36.4%) focused on detecting spinal malignancies, 11 (33.3%) on classification, 6 (18.2%) on prognostication, 3 (9.1%) on treatment planning, and 1 (3.0%) on both detection and classification. Of the classification studies, 7 (21.2%) used machine learning to distinguish between benign and malignant lesions, 3 (9.1%) evaluated tumor stage or grade, and 2 (6.1%) employed radiomics for biomarker classification. Prognostic studies included three (9.1%) that predicted complications such as pathological fractures and three (9.1%) that predicted treatment outcomes. AI's potential for improving workflow efficiency, aiding decision-making, and reducing complications is discussed, along with its limitations in generalizability, interpretability, and clinical integration. Future directions for AI in spinal oncology are also explored. In conclusion, while AI technologies in CT imaging are promising, further research is necessary to validate their clinical effectiveness and optimize their integration into routine practice.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Aric Lee
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Wei Chuan Tan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Kuan Ting Dominic Fong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Daoyong David Lai
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Yi Liang Tan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Shuliang Ge
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Shao Jin Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Yong Han Ting
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Jiong Hao Tan
- National University Spine Institute, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- National University Spine Institute, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Kalanjiyam GP, Chandramohan T, Raman M, Kalyanasundaram H. Artificial intelligence: a new cutting-edge tool in spine surgery. Asian Spine J 2024; 18:458-471. [PMID: 38917854 PMCID: PMC11222879 DOI: 10.31616/asj.2023.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 06/27/2024] Open
Abstract
The purpose of this narrative review was to comprehensively elaborate the various components of artificial intelligence (AI), their applications in spine surgery, practical concerns, and future directions. Over the years, spine surgery has been continuously transformed in various aspects, including diagnostic strategies, surgical approaches, procedures, and instrumentation, to provide better-quality patient care. Surgeons have also augmented their surgical expertise with rapidly growing technological advancements. AI is an advancing field that has the potential to revolutionize many aspects of spine surgery. We performed a comprehensive narrative review of the various aspects of AI and machine learning in spine surgery. To elaborate on the current role of AI in spine surgery, a review of the literature was performed using PubMed and Google Scholar databases for articles published in English in the last 20 years. The initial search using the keywords "artificial intelligence" AND "spine," "machine learning" AND "spine," and "deep learning" AND "spine" extracted a total of 78, 60, and 37 articles and 11,500, 4,610, and 2,270 articles on PubMed and Google Scholar. After the initial screening and exclusion of unrelated articles, duplicates, and non-English articles, 405 articles were identified. After the second stage of screening, 93 articles were included in the review. Studies have shown that AI can be used to analyze patient data and provide personalized treatment recommendations in spine care. It also provides valuable insights for planning surgeries and assisting with precise surgical maneuvers and decisionmaking during the procedures. As more data become available and with further advancements, AI is likely to improve patient outcomes.
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Affiliation(s)
- Guna Pratheep Kalanjiyam
- Spine Surgery Unit, Department of Orthopaedics, Meenakshi Mission Hospital and Research Centre, Madurai,
India
| | - Thiyagarajan Chandramohan
- Department of Orthopaedics, Government Stanley Medical College, Chennai,
India
- Department of Emergency Medicine, Government Stanley Medical College, Chennai,
India
| | - Muthu Raman
- Department of Orthopaedics, Tenkasi Government Hospital, Tenkasi,
India
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Caloro E, Gnocchi G, Quarrella C, Ce M, Carrafiello G, Cellina M. Artificial Intelligence in Bone Metastasis Imaging: Recent Progresses from Diagnosis to Treatment - A Narrative Review. Crit Rev Oncog 2024; 29:77-90. [PMID: 38505883 DOI: 10.1615/critrevoncog.2023050470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
The introduction of artificial intelligence (AI) represents an actual revolution in the radiological field, including bone lesion imaging. Bone lesions are often detected both in healthy and oncological patients and the differential diagnosis can be challenging but decisive, because it affects the diagnostic and therapeutic process, especially in case of metastases. Several studies have already demonstrated how the integration of AI-based tools in the current clinical workflow could bring benefits to patients and to healthcare workers. AI technologies could help radiologists in early bone metastases detection, increasing the diagnostic accuracy and reducing the overdiagnosis and the number of unnecessary deeper investigations. In addition, radiomics and radiogenomics approaches could go beyond the qualitative features, visible to the human eyes, extrapolating cancer genomic and behavior information from imaging, in order to plan a targeted and personalized treatment. In this article, we want to provide a comprehensive summary of the most promising AI applications in bone metastasis imaging and their role from diagnosis to treatment and prognosis, including the analysis of future challenges and new perspectives.
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Affiliation(s)
- Elena Caloro
- Università degli studi di Milano, via Festa del Perdono, 7, 20122 Milan, Italy
| | - Giulia Gnocchi
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Cettina Quarrella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Maurizio Ce
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy; Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Università di Milano, 20122 Milan, Italy
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Piazza Principessa Clotilde 3, 20121, Milan, Italy
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Bi L, Buehner U, Fu X, Williamson T, Choong P, Kim J. Hybrid CNN-transformer network for interactive learning of challenging musculoskeletal images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107875. [PMID: 37871450 DOI: 10.1016/j.cmpb.2023.107875] [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: 08/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND OBJECTIVES Segmentation of regions of interest (ROIs) such as tumors and bones plays an essential role in the analysis of musculoskeletal (MSK) images. Segmentation results can help with orthopaedic surgeons in surgical outcomes assessment and patient's gait cycle simulation. Deep learning-based automatic segmentation methods, particularly those using fully convolutional networks (FCNs), are considered as the state-of-the-art. However, in scenarios where the training data is insufficient to account for all the variations in ROIs, these methods struggle to segment the challenging ROIs that with less common image characteristics. Such characteristics might include low contrast to the background, inhomogeneous textures, and fuzzy boundaries. METHODS we propose a hybrid convolutional neural network - transformer network (HCTN) for semi-automatic segmentation to overcome the limitations of segmenting challenging MSK images. Specifically, we propose to fuse user-inputs (manual, e.g., mouse clicks) with high-level semantic image features derived from the neural network (automatic) where the user-inputs are used in an interactive training for uncommon image characteristics. In addition, we propose to leverage the transformer network (TN) - a deep learning model designed for handling sequence data, in together with features derived from FCNs for segmentation; this addresses the limitation of FCNs that can only operate on small kernels, which tends to dismiss global context and only focus on local patterns. RESULTS We purposely selected three MSK imaging datasets covering a variety of structures to evaluate the generalizability of the proposed method. Our semi-automatic HCTN method achieved a dice coefficient score (DSC) of 88.46 ± 9.41 for segmenting the soft-tissue sarcoma tumors from magnetic resonance (MR) images, 73.32 ± 11.97 for segmenting the osteosarcoma tumors from MR images and 93.93 ± 1.84 for segmenting the clavicle bones from chest radiographs. When compared to the current state-of-the-art automatic segmentation method, our HCTN method is 11.7%, 19.11% and 7.36% higher in DSC on the three datasets, respectively. CONCLUSION Our experimental results demonstrate that HCTN achieved more generalizable results than the current methods, especially with challenging MSK studies.
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Affiliation(s)
- Lei Bi
- Institute of Translational Medicine, National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Computer Science, University of Sydney, NSW, Australia
| | | | - Xiaohang Fu
- School of Computer Science, University of Sydney, NSW, Australia
| | - Tom Williamson
- Stryker Corporation, Kalamazoo, Michigan, USA; Centre for Additive Manufacturing, School of Engineering, RMIT University, VIC, Australia
| | - Peter Choong
- Department of Surgery, University of Melbourne, VIC, Australia
| | - Jinman Kim
- School of Computer Science, University of Sydney, NSW, Australia.
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Koike Y, Yui M, Nakamura S, Yoshida A, Takegawa H, Anetai Y, Hirota K, Tanigawa N. Artificial intelligence-aided lytic spinal bone metastasis classification on CT scans. Int J Comput Assist Radiol Surg 2023; 18:1867-1874. [PMID: 36991276 DOI: 10.1007/s11548-023-02880-8] [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: 09/19/2022] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Spinal bone metastases directly affect quality of life, and patients with lytic-dominant lesions are at high risk for neurological symptoms and fractures. To detect and classify lytic spinal bone metastasis using routine computed tomography (CT) scans, we developed a deep learning (DL)-based computer-aided detection (CAD) system. METHODS We retrospectively analyzed 2125 diagnostic and radiotherapeutic CT images of 79 patients. Images annotated as tumor (positive) or not (negative) were randomized into training (1782 images) and test (343 images) datasets. YOLOv5m architecture was used to detect vertebra on whole CT scans. InceptionV3 architecture with the transfer-learning technique was used to classify the presence/absence of lytic lesions on CT images showing the presence of vertebra. The DL models were evaluated via fivefold cross-validation. For vertebra detection, bounding box accuracy was estimated using intersection over union (IoU). We evaluated the area under the curve (AUC) of a receiver operating characteristic curve to classify lesions. Moreover, we determined the accuracy, precision, recall, and F1 score. We used the gradient-weighted class activation mapping (Grad-CAM) technique for visual interpretation. RESULTS The computation time was 0.44 s per image. The average IoU value of the predicted vertebra was 0.923 ± 0.052 (0.684-1.000) for test datasets. In the binary classification task, the accuracy, precision, recall, F1-score, and AUC value for test datasets were 0.872, 0.948, 0.741, 0.832, and 0.941, respectively. Heat maps constructed using the Grad-CAM technique were consistent with the location of lytic lesions. CONCLUSION Our artificial intelligence-aided CAD system using two DL models could rapidly identify vertebra bone from whole CT images and detect lytic spinal bone metastasis, although further evaluation of diagnostic accuracy is required with a larger sample size.
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Affiliation(s)
- Yuhei Koike
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Midori Yui
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Asami Yoshida
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hideki Takegawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Yusuke Anetai
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Kazuki Hirota
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
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Qin GB, Wu YH, Chen HS, Huang YT, Yi JF, Xiao Y. Correlation analysis between morphologic characteristics of the thoracolumbar basivertebral foramen and Kummell's disease in patients with osteoporosis using imaging techniques. BMC Musculoskelet Disord 2023; 24:513. [PMID: 37353769 DOI: 10.1186/s12891-023-06609-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The aging of the population is a social problem faced by many countries in the world. With the increase in the elderly population, the number of patients with Kummell's disease is also gradually increasing. No study has demonstrated that Kummell's disease has a clear correlation with the foramen of a vertebrobasilar vein. OBJECTIVES The research was conducted to describe and evaluate the morphological characteristics of a basivertebral foramen in patients with osteoporosis and Kummell's disease by CT; to infer whether the specific morphological characteristics of basivertebral foramen may be one of the risk factors of Kummell's disease; to provide clinical suggestions for the treatment of Kummell's disease. DESIGN Retrospective analysis from January 2020 to December 2021 on 83 patients with 83 vertebral bodies (T8-L5) diagnosed with senile osteoporosis and Kummell's disease hospitalized in our hospital due to chronic low back pain, including 57 women and 23 men. Group A was assigned for the following patients: the age ranged from 59 to 86 years old, with the average age of 67.30 ± 7.32 years old; the body mass index ranged from 20.01 to 29.46 kg/m2, with the average body mass index of 23.51 ± 3.03 kg/m2.Group B was assigned for the following patients: 83 patients diagnosed with senile osteoporosis in our outpatient department from January 2020 to December 2021, including 41 males and 42 females; the age ranged from 60 to 85 years, with an average age of 68.52 ± 4.68 years old; the height to weight ratio met the normal reference standard (except 20% above or 10% below the standard weight). Through the lanwon PACS imaging system, the related parameters of the vertebrobasilar foramen in patients with osteoporosis and Kummell's disease were measured to evaluate and analyze the correlation between the morphological characteristics of the vertebrobasilar foramen in patients with osteoporosis and Kummell's disease. RESULTS In patients with osteoporosis, the distribution of incidence rate of Kummell's disease in the spine was consistent with that of osteoporotic compression fractures. Sagittal view of the vertebral body on CT scan and the triangular-shaped, trapezoidal-shaped, and irregular-shaped basivertebral foramen in group A accounted for 18%,57%,and 36%,respectively. In group B, triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen accounted for 51%,17%,and 26%,respectively.The distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen was compared between groups A and B, and the difference was recorded as statistically significant (P < 0.05). Additionally, the difference in the distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen in group A was found statistically significant (P < 0.05),while that of Group B was found statistically insignificant (P > 0.05).On a horizontal CT scan of the vertebra of group A, triangles, trapezoids, and irregularities accounted for 28%, 26%, and 47%, respectively. In group B, triangles,trapezoids,and irregularities accounted for 31%, 37%, and 30%, respectively. The difference in the distribution of the triangular-shaped and trapezoidal-shaped foramen in groups A and B was statistically insignificant (P > 0.05), while that of irregular-shaped was statistically significant (P < 0.05). Additionally, there was no statistical significance (P > 0.05) in the difference in the morphological distribution of triangular-shaped and trapezoidal-shaped foramen in group A, while that of irregular-shaped was found to be statistically significant (P < 0.05). Further, the difference in the morphological distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen in group B was not statistically significant (P > 0.05).In general, about 8% of the vertebral body of BF has an osseous septum. In group A, 97% are single-holed while the remaining 3% are porous; in group B, those with single holes accounted for 76%, while the remaining 24% are porous. In groups A and B, the difference in the morphological distribution of single-holed and multi-holed T8, T11, T12, L1, L2, L4, and L5 vertebral bodies was statistically significant (P < 0.05). In group A, the difference in the distribution of single-holed and multi-holed L1 and L5 vertebral bodies was statistically significant (P < 0.05). Similarly, the difference in the distribution of single-holed and multi-holed T8, T11, T12, L1, L2, and L4 basivertebral foramen was statistically significant (P < 0.05). CONCLUSIONS In patients with osteoporosis, the incidence of vertebral Kummell's disease can be associated with the morphological characteristics of the basivertebral foramen, as observed in the CT scan. Furthermore, the vertebral body with trapezoidal-shaped and irregular-shaped basivertebral foramen and boneless septum in the foramen is highly susceptible to Kummell's disease.
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Affiliation(s)
- Guang Bing Qin
- Department of Orthopaedic Surgery, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Yi Hua Wu
- Department of Orthopaedic Surgery, Hechi People's Hospital, Guangxi Province, Hechi, China
| | - Huan Shi Chen
- Department of Orthopaedic Surgery, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Yu Ting Huang
- Department of Radiological Diagnosis, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Jun Fei Yi
- Department of Orthopaedic Surgery, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Ying Xiao
- Department of Orthopaedic Surgery, Affiliated Hospital of Guilin Medical University, Guangxi Province, GuiLin, China.
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Chang CY, Huber FA, Yeh KJ, Buckless C, Torriani M. Original research: utilization of a convolutional neural network for automated detection of lytic spinal lesions on body CTs. Skeletal Radiol 2023; 52:1377-1384. [PMID: 36651936 DOI: 10.1007/s00256-023-04283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To develop, train, and test a convolutional neural network (CNN) for detection of spinal lytic lesions in chest, abdomen, and pelvis CT scans. MATERIALS AND METHODS Cases of malignant spinal lytic lesions in CT scans were identified. Images were manually segmented for the following classes: (i) lesion, (ii) normal bone, (iii) background. If more than one lesion was on a single slice, all lesions were segmented. Images were stored as 128×128 pixel grayscale, with 10% segregated for testing. The training pipeline of the dataset included histogram equalization and data augmentation. A model was trained on Keras/Tensorflow using an 80/20 training/validation split, based on U-Net architecture. Additional testing of the model was performed on 1106 images of healthy controls. Global sensitivity measured detection of any lesion on a single image. Local sensitivity and positive predictive value (PPV) measured detection of all lesions on an image. Global specificity measured false positive rate in non-pathologic bone. RESULTS Six hundred images were obtained for model creation. The training set consisted of 540 images, which was augmented to 20,000. The test set consisted of 60 images. Model training was performed in triplicate. Mean Dice scores were 0.61 for lytic lesion, 0.95 for normal bone, and 0.99 for background. Mean global sensitivity was 90.6%, local sensitivity was 74.0%, local PPV was 78.3%, and global specificity was 63.3%. At least one false positive lesion was noted in 28.8-44.9% of control images. CONCLUSION A task-trained CNN showed good sensitivity in detecting spinal lytic lesions in axial CT images.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street - YAW 6 -, Boston, MA, 02114, USA.
| | - Florian A Huber
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street - YAW 6 -, Boston, MA, 02114, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Kaitlyn J Yeh
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street - YAW 6 -, Boston, MA, 02114, USA
| | - Colleen Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street - YAW 6 -, Boston, MA, 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street - YAW 6 -, Boston, MA, 02114, USA
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D'Angelo T, Caudo D, Blandino A, Albrecht MH, Vogl TJ, Gruenewald LD, Gaeta M, Yel I, Koch V, Martin SS, Lenga L, Muscogiuri G, Sironi S, Mazziotti S, Booz C. Artificial intelligence, machine learning and deep learning in musculoskeletal imaging: Current applications. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1414-1431. [PMID: 36069404 DOI: 10.1002/jcu.23321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Artificial intelligence is rapidly expanding in all technological fields. The medical field, and especially diagnostic imaging, has been showing the highest developmental potential. Artificial intelligence aims at human intelligence simulation through the management of complex problems. This review describes the technical background of artificial intelligence, machine learning, and deep learning. The first section illustrates the general potential of artificial intelligence applications in the context of request management, data acquisition, image reconstruction, archiving, and communication systems. In the second section, the prospective of dedicated tools for segmentation, lesion detection, automatic diagnosis, and classification of musculoskeletal disorders is discussed.
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Affiliation(s)
- Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
- Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands
| | - Danilo Caudo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
- Department or Radiology, IRRCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michele Gaeta
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Lenga
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Ong W, Zhu L, Zhang W, Kuah T, Lim DSW, Low XZ, Thian YL, Teo EC, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A, Hallinan JTPD. Application of Artificial Intelligence Methods for Imaging of Spinal Metastasis. Cancers (Basel) 2022; 14:4025. [PMID: 36011018 PMCID: PMC9406500 DOI: 10.3390/cancers14164025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Spinal metastasis is the most common malignant disease of the spine. Recently, major advances in machine learning and artificial intelligence technology have led to their increased use in oncological imaging. The purpose of this study is to review and summarise the present evidence for artificial intelligence applications in the detection, classification and management of spinal metastasis, along with their potential integration into clinical practice. A systematic, detailed search of the main electronic medical databases was undertaken in concordance with the PRISMA guidelines. A total of 30 articles were retrieved from the database and reviewed. Key findings of current AI applications were compiled and summarised. The main clinical applications of AI techniques include image processing, diagnosis, decision support, treatment assistance and prognostic outcomes. In the realm of spinal oncology, artificial intelligence technologies have achieved relatively good performance and hold immense potential to aid clinicians, including enhancing work efficiency and reducing adverse events. Further research is required to validate the clinical performance of the AI tools and facilitate their integration into routine clinical practice.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Wenqiao Zhang
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Desmond Shi Wei Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Lee HM, Kim YJ, Cho JB, Jeon JY, Kim KG. Computer-Aided Diagnosis for Determining Sagittal Spinal Curvatures Using Deep Learning and Radiography. J Digit Imaging 2022; 35:846-859. [PMID: 35277750 PMCID: PMC9485333 DOI: 10.1007/s10278-022-00592-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Analyzing spinal curvatures manually is time-consuming and tedious for clinicians, and intra-observer and inter-observer variability can affect manual measurements. In this study, we developed and evaluated the performance of an automated deep learning-based computer-aided diagnosis (CAD) tool for measuring the sagittal alignment of the spine from X-ray images. The CAD system proposed here performs two functions: deep learning-based lateral spine segmentation and automatic analysis of thoracic kyphosis and lumbar lordosis angles. We utilized 322 datasets with data augmentation for learning and fivefold cross-validation. The segmentation model was based on U-Net, which has multiple applications in medical image processing. Here, we utilized parameter equations and trigonometric functions to design spinal angle measurement algorithms. The kyphosis (T4-T12) and lordosis angle (L1-S1, L1-L5) were automatically measured to help diagnose kyphosis and lordosis. The segmentation model had precision, sensitivity, and dice similarity coefficient values of 90.53 ± 4.61%, 89.53 ± 1.8%, and 90.22 ± 0.62%, respectively. The performance of the CAD algorithm was also verified with the Pearson correlation, Bland-Altman, and intra-class correlation coefficient (ICC) analysis. The proposed angle measurement algorithm exhibited high similarity and reliability during verification. Therefore, CAD can help clinicians in reaching a diagnosis by analyzing the sagittal spinal curvatures while reducing observer-based variability and the required time or effort.
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Affiliation(s)
- Hyo Min Lee
- Department of Biomedical Engineering, College of Health Science, Gachon University, Seongnam, South Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, College of Health Science, Gachon University, Seongnam, South Korea
| | - Je Bok Cho
- Department of Medical Devices Convergence Center, Gachon University, Seongnam, South Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
| | - Kwang Gi Kim
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Seongnam, South Korea.
- Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
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Hoshiai S, Hanaoka S, Masumoto T, Nomura Y, Mori K, Okamoto Y, Saida T, Ishiguro T, Sakai M, Nakajima T. Effectiveness of temporal subtraction computed tomography images using deep learning in detecting vertebral bone metastases. Eur J Radiol 2022; 154:110445. [PMID: 35901601 DOI: 10.1016/j.ejrad.2022.110445] [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: 11/16/2021] [Revised: 05/28/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the clinical effectiveness of temporal subtraction computed tomography (TS CT) using deep learning to improve vertebral bone metastasis detection. METHOD This retrospective study used TS CT comprising bony landmark detection, bone segmentation with a multi-atlas-based method, and spatial registration of two images by a log-domain diffeomorphic Demons algorithm. Paired current and past CT images of 50 patients without vertebral metastasis, recorded during June 2011-September 2016, were included as training data. A deep learning-based method estimated registration errors and suppressed false positives. Thereafter, paired CT images of 40 cancer patients with newly developed vertebral metastases and 40 control patients without vertebral metastases were evaluated. Six board-certified radiologists and five radiology residents independently interpreted 80 paired CT images with and without TS CT. RESULTS Records of 40 patients in the metastasis group (median age: 64.5 years; 20 males) and 40 patients in the control group (median age: 64.0 years; 20 males) were evaluated. With TS CT, the overall figure of merit (FOM) of the board-certified radiologist and resident groups improved from 0.848 to 0.876 (p = 0.01) and from 0.752 to 0.799 (p = 0.02), respectively. The sub-analysis focusing on attenuation changes in lesions revealed that the FOM of osteoblastic lesions significantly improved in both the board-certified radiologist and resident groups using TS CT. The sub-analysis focusing on lesion location showed that the FOM of the resident group significantly improved in the vertebral arch (p = 0.04). CONCLUSIONS TS CT was effective in detecting bone metastasis by both board-certified radiologists and radiology residents.
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Affiliation(s)
- Sodai Hoshiai
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Shouhei Hanaoka
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tomohiko Masumoto
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yukihiro Nomura
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi, Inage-ku, Chiba 263-8522, Japan
| | - Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshikazu Okamoto
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tsukasa Saida
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshitaka Ishiguro
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masafumi Sakai
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takahito Nakajima
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Kuah T, Vellayappan BA, Makmur A, Nair S, Song J, Tan JH, Kumar N, Quek ST, Hallinan JTPD. State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression. Cancers (Basel) 2022; 14:3289. [PMID: 35805059 PMCID: PMC9265325 DOI: 10.3390/cancers14133289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/23/2022] Open
Abstract
Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes.
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Affiliation(s)
- Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore;
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (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
| | - Shalini Nair
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Junda Song
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - 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.)
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (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
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (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
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13
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Liu H, Jiao M, Yuan Y, Ouyang H, Liu J, Li Y, Wang C, Lang N, Qian Y, Jiang L, Yuan H, Wang X. Benign and malignant diagnosis of spinal tumors based on deep learning and weighted fusion framework on MRI. Insights Imaging 2022; 13:87. [PMID: 35536493 PMCID: PMC9091071 DOI: 10.1186/s13244-022-01227-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The application of deep learning has allowed significant progress in medical imaging. However, few studies have focused on the diagnosis of benign and malignant spinal tumors using medical imaging and age information at the patient level. This study proposes a multi-model weighted fusion framework (WFF) for benign and malignant diagnosis of spinal tumors based on magnetic resonance imaging (MRI) images and age information. METHODS The proposed WFF included a tumor detection model, sequence classification model, and age information statistic module based on sagittal MRI sequences obtained from 585 patients with spinal tumors (270 benign, 315 malignant) between January 2006 and December 2019 from the cooperative hospital. The experimental results of the WFF were compared with those of one radiologist (D1) and two spine surgeons (D2 and D3). RESULTS In the case of reference age information, the accuracy (ACC) (0.821) of WFF was higher than three doctors' ACC (D1: 0.686; D2: 0.736; D3: 0.636). Without age information, the ACC (0.800) of the WFF was also higher than that of the three doctors (D1: 0.750; D2: 0.664; D3:0.614). CONCLUSIONS The proposed WFF is effective in the diagnosis of benign and malignant spinal tumors with complex histological types on MRI.
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Affiliation(s)
- Hong Liu
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China.
| | - Menglei Jiao
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China
- University of Chinese Academy of Sciences, Beijing, 100086, China
| | - Yuan Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hanqiang Ouyang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Jianfang Liu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yuan Li
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Chunjie Wang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yueliang Qian
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China
| | - Liang Jiang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Xiangdong Wang
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China.
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Segmentation Performance Comparison Considering Regional Characteristics in Chest X-ray Using Deep Learning. SENSORS 2022; 22:s22093143. [PMID: 35590833 PMCID: PMC9104434 DOI: 10.3390/s22093143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 12/31/2022]
Abstract
Chest radiography is one of the most widely used diagnostic methods in hospitals, but it is difficult to read clearly because several human organ tissues and bones overlap. Therefore, various image processing and rib segmentation methods have been proposed to focus on the desired target. However, it is challenging to segment ribs elaborately using deep learning because they cannot reflect the characteristics of each region. Identifying which region has specific characteristics vulnerable to deep learning is an essential indicator of developing segmentation methods in medical imaging. Therefore, it is necessary to compare the deep learning performance differences based on regional characteristics. This study compares the differences in deep learning performance based on the rib region to verify whether deep learning reflects the characteristics of each part and to demonstrate why this regional performance difference has occurred. We utilized 195 normal chest X-ray datasets with data augmentation for learning and 5-fold cross-validation. To compare segmentation performance, the rib image was divided vertically and horizontally based on the spine, clavicle, heart, and lower organs, which are characteristic indicators of the baseline chest X-ray. Resultingly, we found that the deep learning model showed a 6-7% difference in the segmentation performance depending on the regional characteristics of the rib. We verified that the performance differences in each region cannot be ignored. This study will enable a more precise segmentation of the ribs and the development of practical deep learning algorithms.
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15
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Chang CY, Buckless C, Yeh KJ, Torriani M. Automated detection and segmentation of sclerotic spinal lesions on body CTs using a deep convolutional neural network. Skeletal Radiol 2022; 51:391-399. [PMID: 34291325 DOI: 10.1007/s00256-021-03873-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To develop a deep convolutional neural network capable of detecting spinal sclerotic metastases on body CTs. MATERIALS AND METHODS Our study was IRB-approved and HIPAA-compliant. Cases of confirmed sclerotic bone metastases in chest, abdomen, and pelvis CTs were identified. Images were manually segmented for 3 classes: background, normal bone, and sclerotic lesion(s). If multiple lesions were present on a slice, all lesions were segmented. A total of 600 images were obtained, with a 90/10 training/testing split. Images were stored as 128 × 128 pixel grayscale and the training dataset underwent a processing pipeline of histogram equalization and data augmentation. We trained our model from scratch on Keras/TensorFlow using an 80/20 training/validation split and a U-Net architecture (64 batch size, 100 epochs, dropout 0.25, initial learning rate 0.0001, sigmoid activation). We also tested our model's true negative and false positive rate with 1104 non-pathologic images. Global sensitivity measured model detection of any lesion on a single image, local sensitivity and positive predictive value (PPV) measured model detection of each lesion on a given image, and local specificity measured the false positive rate in non-pathologic bone. RESULTS Dice scores were 0.83 for lesion, 0.96 for non-pathologic bone, and 0.99 for background. Global sensitivity was 95% (57/60), local sensitivity was 92% (89/97), local PPV was 97% (89/92), and local specificity was 87% (958/1104). CONCLUSION A deep convolutional neural network has the potential to assist in detecting sclerotic spinal metastases.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, YAW 6, Boston, MA, 02114, USA.
| | - Colleen Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, YAW 6, Boston, MA, 02114, USA
| | - Kaitlyn J Yeh
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, YAW 6, Boston, MA, 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, YAW 6, Boston, MA, 02114, USA
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Musa Aguiar P, Zarantonello P, Aparisi Gómez MP. Differentiation Between Osteoporotic And Neoplastic Vertebral Fractures: State Of The Art And Future Perspectives. Curr Med Imaging 2021; 18:187-207. [PMID: 33845727 DOI: 10.2174/1573405617666210412142758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Abstract
Vertebral fractures are a common condition, occurring in the context of osteoporosis and malignancy. These entities affect a group of patients in the same age range; clinical features may be indistinct and symptoms non-existing, and thus present challenges to diagnosis. In this article, we review the use and accuracy of different imaging modalities available to characterize vertebral fracture etiology, from well-established classical techniques, to the role of new and advanced imaging techniques, and the prospective use of artificial intelligence. We also address the role of imaging on treatment. In the context of osteoporosis, the importance of opportunistic diagnosis is highlighted. In the near future, the use of automated computer-aided diagnostic algorithms applied to different imaging techniques may be really useful to aid on diagnosis.
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Affiliation(s)
- Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
| | - Paola Zarantonello
- Department of paediatric orthopedics and traumatology, IRCCS Istituto Ortopedico Rizzoli; Via G. C. Pupilli 1, 40136 Bologna. Italy
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Merali ZA, Colak E, Wilson JR. Applications of Machine Learning to Imaging of Spinal Disorders: Current Status and Future Directions. Global Spine J 2021; 11:23S-29S. [PMID: 33890805 PMCID: PMC8076811 DOI: 10.1177/2192568220961353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES We aim to describe current progress in the application of artificial intelligence and machine learning technology to provide automated analysis of imaging in patients with spinal disorders. METHODS A literature search utilizing the PubMed database was performed. Relevant studies from all the evidence levels have been included. RESULTS Within spine surgery, artificial intelligence and machine learning technologies have achieved near-human performance in narrow image classification tasks on specific datasets in spinal degenerative disease, spinal deformity, spine trauma, and spine oncology. CONCLUSION Although substantial challenges remain to be overcome it is clear that artificial intelligence and machine learning technology will influence the practice of spine surgery in the future.
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Affiliation(s)
- Zamir A. Merali
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Errol Colak
- Department of Medical Imaging, University of Toronto, St. Michael’s Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Jefferson R. Wilson
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
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18
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Sieren MM, Brenne F, Hering A, Kienapfel H, Gebauer N, Oechtering TH, Fürschke A, Wegner F, Stahlberg E, Heldmann S, Barkhausen J, Frydrychowicz A. Rapid study assessment in follow-up whole-body computed tomography in patients with multiple myeloma using a dedicated bone subtraction software. Eur Radiol 2020; 30:3198-3209. [DOI: 10.1007/s00330-019-06631-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/20/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
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19
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Tsuchiya M, Masui T, Katayama M, Hayashi Y, Yamada T, Terauchi K, Kawamura K, Ishikawa R, Mizobe H, Yamamichi J, Sakahara H, Goshima S. Temporal subtraction of low-dose and relatively thick-slice CT images with large deformation diffeomorphic metric mapping and adaptive voxel matching for detection of bone metastases: A STARD-compliant article. Medicine (Baltimore) 2020; 99:e19538. [PMID: 32195958 PMCID: PMC7220493 DOI: 10.1097/md.0000000000019538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate the improvement of radiologist performance in detecting bone metastases at follow up low-dose computed tomography (CT) by using a temporal subtraction (TS) technique based on an advanced nonrigid image registration algorithm.Twelve patients with bone metastases (males, 5; females, 7; mean age, 64.8 ± 7.6 years; range 51-81 years) and 12 control patients without bone metastases (males, 5; females, 7; mean age, 64.8 ± 7.6 years; 51-81 years) were included, who underwent initial and follow-up CT examinations between December 2005 and July 2016. Initial CT images were registered to follow-up CT images by the algorithm, and TS images were created. Three radiologists independently assessed the bone metastases with and without the TS images. The reader averaged jackknife alternative free-response receiver operating characteristics figure of merit was used to compare the diagnostic accuracy.The reader-averaged values of the jackknife alternative free-response receiver operating characteristics figures of merit (θ) significantly improved from 0.687 for the readout without TS and 0.803 for the readout with TS (P value = .031. F statistic = 5.24). The changes in the absolute value of CT attenuations in true-positive lesions were significantly larger than those in false-negative lesions (P < .001). Using TS, segment-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the readout with TS were 66.7%, 98.9%, 94.4%, 90.9%, and 94.8%, respectively.The TS images can significantly improve the radiologist's performance in the detection of bone metastases on low-dose and relatively thick-slice CT.
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Affiliation(s)
- Mitsuteru Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku
| | - Takayuki Masui
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu City, Shizuoka
| | - Motoyuki Katayama
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu City, Shizuoka
| | - Yuki Hayashi
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu City, Shizuoka
| | - Takahiro Yamada
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu City, Shizuoka
| | - Kazuma Terauchi
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu City, Shizuoka
| | - Kenshi Kawamura
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu City, Shizuoka
| | - Ryo Ishikawa
- Medical Imaging Information Technology Development Department Canon Inc.70-1, Yanagi-cho, Saiwai-ku, Kawasaki-shi, Kanagawa
| | - Hideaki Mizobe
- Medical Imaging Information Technology Development Department Canon Inc.70-1, Yanagi-cho, Saiwai-ku, Kawasaki-shi, Kanagawa
| | - Junta Yamamichi
- Medical Imaging Information Technology Development Department Canon Inc.70-1, Yanagi-cho, Saiwai-ku, Kawasaki-shi, Kanagawa
| | - Harumi Sakahara
- Department of Diagnostic Radiology and Nuclear Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka, Japan
| | - Satoshi Goshima
- Department of Diagnostic Radiology and Nuclear Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka, Japan
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Burns JE, Yao J, Summers RM. Artificial Intelligence in Musculoskeletal Imaging: A Paradigm Shift. J Bone Miner Res 2020; 35:28-35. [PMID: 31398274 DOI: 10.1002/jbmr.3849] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 01/22/2023]
Abstract
Artificial intelligence is upending many of our assumptions about the ability of computers to detect and diagnose diseases on medical images. Deep learning, a recent innovation in artificial intelligence, has shown the ability to interpret medical images with sensitivities and specificities at or near that of skilled clinicians for some applications. In this review, we summarize the history of artificial intelligence, present some recent research advances, and speculate about the potential revolutionary clinical impact of the latest computer techniques for bone and muscle imaging. © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Joseph E Burns
- Department of Radiological Sciences, University of California-Irvine School of Medicine, Orange, CA, USA
| | - Jianhua Yao
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Hoshiai S, Masumoto T, Hanaoka S, Nomura Y, Mori K, Hara T, Saida T, Okamoto Y, Minami M. Clinical usefulness of temporal subtraction CT in detecting vertebral bone metastases. Eur J Radiol 2019; 118:175-180. [PMID: 31439238 DOI: 10.1016/j.ejrad.2019.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/11/2019] [Accepted: 07/18/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine whether temporal subtraction (TS) computed tomography (CT) contributes to the detection of vertebral bone metastases. METHOD The calculation of TS CT was composed of bony landmark detection, bone segmentation with a multiatlas-based method, and spatial registration. Temporal increase and decrease of the CT values were visualized in blue and red, respectively. Paired CT images of 20 patients with cancer and newly-developed vertebral metastases were analyzed. Control CT examinations of 20 different patients were also included. The presence of vertebral metastases on the TS CT was evaluated by two board-certified radiologists. Five additional board-certified radiologists and five radiology residents independently interpreted the 40 paired CT images with and without TS CT. RESULTS In the lesion conspicuity evaluation, 96% of vertebral metastases were scored as excellent or good. In the image interpretation examination, according to free-response receiver operating characteristics analysis, the overall figure of merit (FOM) of the board-certified radiologist group was 0.892 and 0.898 with and without TS CT, respectively. The FOM of the resident group improved from 0.849 to 0.902 with viewing TS CT. In the sub-analysis focusing on the location of the lesion, the FOM of the resident group significantly improved from 0.75 to 0.92 in vertebral arch lesions (p = 0.001). CONCLUSIONS The TS CT may be useful to detect vertebral metastases because almost all the vertebral metastases were shown to be favorable visualization. The TS CT was proven to be especially helpful for radiology residents in detecting vertebral arch metastases.
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Affiliation(s)
- Sodai Hoshiai
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Tomohiko Masumoto
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shouhei Hanaoka
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukihiro Nomura
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tadashi Hara
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsukasa Saida
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoshikazu Okamoto
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Manabu Minami
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Summers RM. Are we at a crossroads or a plateau? Radiomics and machine learning in abdominal oncology imaging. Abdom Radiol (NY) 2019; 44:1985-1989. [PMID: 29730736 DOI: 10.1007/s00261-018-1613-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Advances in radiomics and machine learning have driven a technology boom in the automated analysis of radiology images. For the past several years, expectations have been nearly boundless for these new technologies to revolutionize radiology image analysis and interpretation. In this editorial, I compare the expectations with the realities with particular attention to applications in abdominal oncology imaging. I explore whether these technologies will leave us at a crossroads to an exciting future or to a sustained plateau and disillusionment.
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Affiliation(s)
- Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences Department, National Institutes of Health Clinical Center, Bldg. 10 Room 1C224D, MSC 1182, Bethesda, MD, 20892-1182, USA.
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Zhang Z, Sejdić E. Radiological images and machine learning: Trends, perspectives, and prospects. Comput Biol Med 2019; 108:354-370. [PMID: 31054502 PMCID: PMC6531364 DOI: 10.1016/j.compbiomed.2019.02.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 01/18/2023]
Abstract
The application of machine learning to radiological images is an increasingly active research area that is expected to grow in the next five to ten years. Recent advances in machine learning have the potential to recognize and classify complex patterns from different radiological imaging modalities such as x-rays, computed tomography, magnetic resonance imaging and positron emission tomography imaging. In many applications, machine learning based systems have shown comparable performance to human decision-making. The applications of machine learning are the key ingredients of future clinical decision making and monitoring systems. This review covers the fundamental concepts behind various machine learning techniques and their applications in several radiological imaging areas, such as medical image segmentation, brain function studies and neurological disease diagnosis, as well as computer-aided systems, image registration, and content-based image retrieval systems. Synchronistically, we will briefly discuss current challenges and future directions regarding the application of machine learning in radiological imaging. By giving insight on how take advantage of machine learning powered applications, we expect that clinicians can prevent and diagnose diseases more accurately and efficiently.
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Affiliation(s)
- Zhenwei Zhang
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
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Galbusera F, Casaroli G, Bassani T. Artificial intelligence and machine learning in spine research. JOR Spine 2019; 2:e1044. [PMID: 31463458 PMCID: PMC6686793 DOI: 10.1002/jsp2.1044] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022] Open
Abstract
Artificial intelligence (AI) and machine learning (ML) techniques are revolutionizing several industrial and research fields like computer vision, autonomous driving, natural language processing, and speech recognition. These novel tools are already having a major impact in radiology, diagnostics, and many other fields in which the availability of automated solution may benefit the accuracy and repeatability of the execution of critical tasks. In this narrative review, we first present a brief description of the various techniques that are being developed nowadays, with special focus on those used in spine research. Then, we describe the applications of AI and ML to problems related to the spine which have been published so far, including the localization of vertebrae and discs in radiological images, image segmentation, computer-aided diagnosis, prediction of clinical outcomes and complications, decision support systems, content-based image retrieval, biomechanics, and motion analysis. Finally, we briefly discuss major ethical issues related to the use of AI in healthcare, namely, accountability, risk of biased decisions as well as data privacy and security, which are nowadays being debated in the scientific community and by regulatory agencies.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Gloria Casaroli
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Tito Bassani
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
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25
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Kawagishi M, Kubo T, Sakamoto R, Yakami M, Fujimoto K, Aoyama G, Emoto Y, Sekiguchi H, Sakai K, Iizuka Y, Nishio M, Yamamoto H, Togashi K. Automatic inference model construction for computer-aided diagnosis of lung nodule: Explanation adequacy, inference accuracy, and experts' knowledge. PLoS One 2018; 13:e0207661. [PMID: 30444907 PMCID: PMC6239329 DOI: 10.1371/journal.pone.0207661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022] Open
Abstract
We aimed to describe the development of an inference model for computer-aided diagnosis of lung nodules that could provide valid reasoning for any inferences, thereby improving the interpretability and performance of the system. An automatic construction method was used that considered explanation adequacy and inference accuracy. In addition, we evaluated the usefulness of prior experts’ (radiologists’) knowledge while constructing the models. In total, 179 patients with lung nodules were included and divided into 79 and 100 cases for training and test data, respectively. F-measure and accuracy were used to assess explanation adequacy and inference accuracy, respectively. For F-measure, reasons were defined as proper subsets of Evidence that had a strong influence on the inference result. The inference models were automatically constructed using the Bayesian network and Markov chain Monte Carlo methods, selecting only those models that met the predefined criteria. During model constructions, we examined the effect of including radiologist’s knowledge in the initial Bayesian network models. Performance of the best models in terms of F-measure, accuracy, and evaluation metric were as follows: 0.411, 72.0%, and 0.566, respectively, with prior knowledge, and 0.274, 65.0%, and 0.462, respectively, without prior knowledge. The best models with prior knowledge were then subjectively and independently evaluated by two radiologists using a 5-point scale, with 5, 3, and 1 representing beneficial, appropriate, and detrimental, respectively. The average scores by the two radiologists were 3.97 and 3.76 for the test data, indicating that the proposed computer-aided diagnosis system was acceptable to them. In conclusion, the proposed method incorporating radiologists’ knowledge could help in eliminating radiologists’ distrust of computer-aided diagnosis and improving its performance.
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Affiliation(s)
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
- Preemptive Medicine and Lifestyle-related Disease Research Center, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
| | - Masahiro Yakami
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
- Preemptive Medicine and Lifestyle-related Disease Research Center, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
| | - Koji Fujimoto
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
| | | | - Yutaka Emoto
- Department of Medical Science, Kyoto College of Medical Science, Imakita, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan
| | - Hiroyuki Sekiguchi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
| | - Koji Sakai
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Kyoto, Japan
| | | | - Mizuho Nishio
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
- Preemptive Medicine and Lifestyle-related Disease Research Center, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
- * E-mail: ,
| | | | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan
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Ueno M, Aoki T, Murakami S, Kim H, Terasawa T, Fujisaki A, Hayashida Y, Korogi Y. CT temporal subtraction method for detection of sclerotic bone metastasis in the thoracolumbar spine. Eur J Radiol 2018; 107:54-59. [DOI: 10.1016/j.ejrad.2018.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
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Formation and Application of High Reflectivity Controllable Barium Sulfate Microspheres. CRYSTALS 2018. [DOI: 10.3390/cryst8090333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper investigated the influence of reaction conditions on particle morphology. X-ray powder diffraction (XRD), particle size distribution (PSD), and scanning electron microscopy (SEM) were used to characterize the morphology of barium sulfate. The barium sulfate microspheres were synthesized with BaCl2, Na2SO4, and ethylenediaminetetraacetic acid disodium (EDTA·2Na). The reflectivity of the synthesized barium sulfate microspheres was greater than 99% in the range of 400–700 nm, which was characterized by a reflectance spectrometer. The morphology of the barium sulfate particles and their cross-section were observed by SEM. The prepared microspheres were applied to high-density lipoprotein dry tablets due to their high reflectivity, and the results showed that the prepared tablets had high sensitivity and good repeatability.
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Chmelik J, Jakubicek R, Walek P, Jan J, Ourednicek P, Lambert L, Amadori E, Gavelli G. Deep convolutional neural network-based segmentation and classification of difficult to define metastatic spinal lesions in 3D CT data. Med Image Anal 2018; 49:76-88. [PMID: 30114549 DOI: 10.1016/j.media.2018.07.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 07/06/2018] [Accepted: 07/30/2018] [Indexed: 01/01/2023]
Abstract
This paper aims to address the segmentation and classification of lytic and sclerotic metastatic lesions that are difficult to define by using spinal 3D Computed Tomography (CT) images obtained from highly pathologically affected cases. As the lesions are ill-defined and consequently it is difficult to find relevant image features that would enable detection and classification of lesions by classical methods of texture and shape analysis, the problem is solved by automatic feature extraction provided by a deep Convolutional Neural Network (CNN). Our main contributions are: (i) individual CNN architecture, and pre-processing steps that are dependent on a patient data and a scan protocol - it enables work with different types of CT scans; (ii) medial axis transform (MAT) post-processing for shape simplification of segmented lesion candidates with Random Forest (RF) based meta-analysis; and (iii) usability of the proposed method on whole-spine CTs (cervical, thoracic, lumbar), which is not treated in other published methods (they work with thoracolumbar segments of spine only). Our proposed method has been tested on our own dataset annotated by two mutually independent radiologists and has been compared to other published methods. This work is part of the ongoing complex project dealing with spine analysis and spine lesion longitudinal studies.
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Affiliation(s)
- Jiri Chmelik
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Technicka 3082/12, 616 00, Czechia.
| | - Roman Jakubicek
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Technicka 3082/12, 616 00, Czechia
| | - Petr Walek
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Technicka 3082/12, 616 00, Czechia
| | - Jiri Jan
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Technicka 3082/12, 616 00, Czechia
| | - Petr Ourednicek
- Philips Healthcare, AE Eindhoven, High Tech Campus 34, 5656, Netherlands; Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine Masaryk University Brno, Brno, Pekarska 663/53, 656 91 Czechia
| | - Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, U Nemocnice 499/2, 128 08, Czechia
| | - Elena Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola FC, Via Piero Maroncelli 40, 470 14, Italy
| | - Giampaolo Gavelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola FC, Via Piero Maroncelli 40, 470 14, Italy
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Computer-aided detection in musculoskeletal projection radiography: A systematic review. Radiography (Lond) 2018; 24:165-174. [DOI: 10.1016/j.radi.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/31/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022]
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Zhang X, Li S, Zhao X, Christiansen BA, Chen J, Fan S, Zhao F. The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen. Spine J 2018; 18:472-481. [PMID: 28823938 DOI: 10.1016/j.spinee.2017.08.237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/04/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The basivertebral foramen (BF), located in the middle posterior wall of the vertebral body, may induce local weakness and contribute to the formation of a retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF). We hypothesize that the mechanism of TLBF is related to the BF. PURPOSE This study aimed to clarify the relationship between RBFs and the BF in TLBFs, and to explain the results using biomechanical experiments and micro-computed tomography (micro-CT). STUDY DESIGN A comprehensive research involving clinical radiology, micro-CT, and biomechanical experiments on cadaveric spines was carried out. PATIENT SAMPLE A total of 162 consecutive patients diagnosed with TLBF with RBFs, drawn from 256 patients who had reported accidents or injuries to their thoracolumbar spine, comprised the patient sample. OUTCOME MEASURES Dimensions and location of the RBFs in relation to the BF were the outcome measures. MATERIALS AND METHODS Computed tomography reconstruction imaging was used to measure the dimensions and location of RBFs in 162 patients (length, height, width of RBF and vertebral body). Furthermore, micro-CT scans were obtained of 10 cadaveric spines. Each vertebral body was divided into three layers (superior, middle, and inferior), and each layer was divided further into nine regions (R1-R9). Microarchitecture parameters were calculated from micro-CT scans, including bone volume fraction (BV/TV), connectivity (Conn.D), trabecular number (Tb.N), trabecular thickness (Tb.Th), and bone mineral density (BMD). Differences were analyzed between regions and layers. Burst fractures were simulated on cadaveric spines to explore the fracture line location and test the relationship between RBFs and BF. RESULTS Retropulsed bone fragment width was usually one-third of the width of the vertebral body, whereas RBF length and height were approximately half of the corresponding vertebral body dimensions. Measures of trabecular bone quality were generally lowest in those central and superior regions of the vertebral body which are adjacent to the BF and which are most affected by burst fracture. In simulated TLBFs, the fracture line went across the vertex or upper surface of the BF. CONCLUSIONS The most vulnerable regions in the vertebral body lie within or just superior to the BF. The central MR2 region in particular is at risk of fracture and RBF formation.
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Affiliation(s)
- Xuyang Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Rd East, Hangzhou 310016, China.
| | - Shengyun Li
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Rd East, Hangzhou 310016, China
| | - Xing Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Rd East, Hangzhou 310016, China
| | - Blaine A Christiansen
- Department of Orthopaedic Surgery, UC Davis Medical Center, 4635 2nd Ave, Suite 2000, Sacramento, CA 95817, USA
| | - Jian Chen
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Rd East, Hangzhou 310016, China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Rd East, Hangzhou 310016, China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Rd East, Hangzhou 310016, China
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Trabecular Microstructure and Damage Affect Cement Leakage From the Basivertebral Foramen During Vertebral Augmentation. Spine (Phila Pa 1976) 2017; 42:E939-E948. [PMID: 28098744 DOI: 10.1097/brs.0000000000002073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study on cadaver specimens. OBJECTIVE To explore why cement leakage from basivertebral foramen (BF) easily occurs during vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown. METHODS In this study, 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of intertrabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation, and imaging-based diagnosis were used to evaluate cement leakage. RESULTS Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P < 0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that intertrabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously in Wang et al. (Spine J 2014;14: 1551-1558). CONCLUSION The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest intervertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury. LEVEL OF EVIDENCE 4.
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Demirkaya O, AlQahtani M, Alsugair A, Aras O, Abouzied ME. Analysis of metastatic involvement in bone using anatomical and functional information from 18F-FDG PET/CT. Nucl Med Commun 2017; 38:780-787. [PMID: 28704338 DOI: 10.1097/mnm.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Although the overall incidence of bone metastasis is not known, over one-half of the people who die of cancer in the USA every year are thought to have bone involvement. In this study we have developed a method to quantify the metabolic and anatomic changes induced by different types of bone metastases in cancer patients using PET/CT images. PATIENTS AND MATERIALS Seventy-three cancer patients with no previous history of chemotherapy or radiotherapy who had definite bone metastases documented by PET/CT and other conventional modalities were selected for this study. PET and computed tomography (CT) images were resampled to the same pixel size. Thereafter, the bone structure was segmented using thresholding. The 50% of the maximum standardized uptake value within the bone mask was used to identify bone lesions in each slice. Using the final regions of interest defined at 70% of the maximum, the lesion characteristics including the mean Hounsfield Units were computed from the PET/CT images. The lesions were subjected to visual confirmation by an experienced physician who also categorized them on the basis of the appearances in CT as lytic, sclerotic, mixed, or no-change type. The lesion characteristics were compared using statistical methods. RESULTS In all, 340 bony lesions in 73 patients with different cancer types were analyzed. The lesions were further categorized into four groups on the basis of their anatomical location. The spine hosts the largest number of lesions. The lumbar bones are the most preferential sites within the spine. Statistical comparison of CT values indicated that the difference between no-change and lytic types was significant. Uptake period did not seem to have a significant impact on no-change and sclerotic types. Quantitatively, maximum standardized uptake value for lytic, no change, mixed, and sclerotic lesions were 7.4, 6.1, 8.2, and 7.2, respectively. CONCLUSION A quantitative method provides a convenient way that may serve as a useful tool in monitoring and assessing the response to therapy.
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Affiliation(s)
- Omer Demirkaya
- Departments of aBiomedical Physics bCyclotron and Radiopharmaceuticals cNuclear Medicine/Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia dDepartment of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
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Sakamoto R, Yakami M, Fujimoto K, Nakagomi K, Kubo T, Emoto Y, Akasaka T, Aoyama G, Yamamoto H, Miller MI, Mori S, Togashi K. Temporal Subtraction of Serial CT Images with Large Deformation Diffeomorphic Metric Mapping in the Identification of Bone Metastases. Radiology 2017; 285:629-639. [PMID: 28678671 DOI: 10.1148/radiol.2017161942] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the improvement of radiologist efficiency and performance in the detection of bone metastases at serial follow-up computed tomography (CT) by using a temporal subtraction (TS) technique based on an advanced nonrigid image registration algorithm. Materials and Methods This retrospective study was approved by the institutional review board, and informed consent was waived. CT image pairs (previous and current scans of the torso) in 60 patients with cancer (primary lesion location: prostate, n = 14; breast, n = 16; lung, n = 20; liver, n = 10) were included. These consisted of 30 positive cases with a total of 65 bone metastases depicted only on current images and confirmed by two radiologists who had access to additional imaging examinations and clinical courses and 30 matched negative control cases (no bone metastases). Previous CT images were semiautomatically registered to current CT images by the algorithm, and TS images were created. Seven radiologists independently interpreted CT image pairs to identify newly developed bone metastases without and with TS images with an interval of at least 30 days. Jackknife free-response receiver operating characteristics (JAFROC) analysis was conducted to assess observer performance. Reading time was recorded, and usefulness was evaluated with subjective scores of 1-5, with 5 being extremely useful and 1 being useless. Significance of these values was tested with the Wilcoxon signed-rank test. Results The subtraction images depicted various types of bone metastases (osteolytic, n = 28; osteoblastic, n = 26; mixed osteolytic and blastic, n = 11) as temporal changes. The average reading time was significantly reduced (384.3 vs 286.8 seconds; Wilcoxon signed rank test, P = .028). The average figure-of-merit value increased from 0.758 to 0.835; however, this difference was not significant (JAFROC analysis, P = .092). The subjective usefulness survey response showed a median score of 5 for use of the technique (range, 3-5). Conclusion TS images obtained from serial CT scans using nonrigid registration successfully depicted newly developed bone metastases and showed promise for their efficient detection. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Ryo Sakamoto
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Masahiro Yakami
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Koji Fujimoto
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Keita Nakagomi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Takeshi Kubo
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Yutaka Emoto
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Thai Akasaka
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Gakuto Aoyama
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Hiroyuki Yamamoto
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Michael I Miller
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Susumu Mori
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
| | - Kaori Togashi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (R.S., M.Y., K.F., T.K., T.A., K.T.); Advanced Information & Real-world Technology Development Center 1, Canon, Kyoto, Japan (K.N., G.A., H.Y.); Clinical Research Center for Medical Equipment Development, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan (K.N., G.A., H.Y.); Department of Medical Science, Kyoto College of Medical Science, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, Japan (Y.E.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (M.I.M.); Center for Imaging Science, Johns Hopkins University, Baltimore, Md (M.I.M.); Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (S.M.); and F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Md (S.M.)
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Yao J, Burns JE, Sanoria V, Summers RM. Mixed spine metastasis detection through positron emission tomography/computed tomography synthesis and multiclassifier. J Med Imaging (Bellingham) 2017; 4:024504. [PMID: 28612036 DOI: 10.1117/1.jmi.4.2.024504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/16/2017] [Indexed: 11/14/2022] Open
Abstract
Bone metastases are a frequent occurrence with cancer, and early detection can guide the patient's treatment regimen. Metastatic bone disease can present in density extremes as sclerotic (high density) and lytic (low density) or in a continuum with an admixture of both sclerotic and lytic components. We design a framework to detect and characterize the varying spectrum of presentation of spine metastasis on positron emission tomography/computed tomography (PET/CT) data. A technique is proposed to synthesize CT and PET images to enhance the lesion appearance for computer detection. A combination of watershed, graph cut, and level set algorithms is first run to obtain the initial detections. Detections are then sent to multiple classifiers for sclerotic, lytic, and mixed lesions. The system was tested on 44 cases with 225 sclerotic, 139 lytic, and 92 mixed lesions. The results showed that sensitivity (false positive per patient) was 0.81 (2.1), 0.81 (1.3), and 0.76 (2.1) for sclerotic, lytic, and mixed lesions, respectively. It also demonstrates that using PET/CT data significantly improves the computer aided detection performance over using CT alone.
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Affiliation(s)
- Jianhua Yao
- National Institutes of Health, Radiology and Imaging Sciences Department, Clinical Center, Bethesda, Maryland, United States
| | - Joseph E Burns
- University of California, Department of Radiological Sciences, Irvine School of Medicine, Orange, California, United States
| | - Vic Sanoria
- University of California, Department of Radiological Sciences, Irvine School of Medicine, Orange, California, United States
| | - Ronald M Summers
- National Institutes of Health, Radiology and Imaging Sciences Department, Clinical Center, Bethesda, Maryland, United States
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Horger M, Ditt H, Liao S, Weisel K, Fritz J, Thaiss WM, Kaufmann S, Nikolaou K, Kloth C. Automated "Bone Subtraction" Image Analysis Software Package for Improved and Faster CT Monitoring of Longitudinal Spine Involvement in Patients with Multiple Myeloma. Acad Radiol 2017; 24:623-632. [PMID: 28256439 DOI: 10.1016/j.acra.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/18/2016] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES The study aimed to assess the diagnostic benefit of a novel computed tomography (CT) post-processing software generating subtraction maps of longitudinal non-enhanced CT examinations for monitoring the course of myeloma bone disease in the spine. MATERIALS AND METHODS The local institutional review board approved the retrospective data evaluation. Included were 82 consecutive myeloma patients (46 male; mean age, 65.08 ± 9.76) who underwent 188 repeated whole-body reduced-dose Multislice Detector Computed Tomography (MDCT) at our institution between December 2013 and January 2016. Lytic bone lesions were categorized as new or enlarging versus stable. Bone subtraction maps were read in combination with corresponding 1-mm source images comparing results to those of standard image reading of 5-mm axial and 2-mm multiplanar reformat reconstructions (MPR) scans and hematologic markers, and classified as either progressive disease (PD) or stable disease (SD or remission). The standard of reference was 1-mm axial CT image reading + hematologic response both confirmed at follow-up. For statistical purposes, we subgrouped the hematologic response categories similarly to those applied for CT imaging (progression vs stable/response). RESULTS According to the standard of reference, 16 patients experienced PD and 66 SD at follow-up. Th sensitivity, specificity, and accuracy for axial 5 mm + 2 mm MPR image versus bone subtraction maps in a "lesion-by-lesion" reading were 97.6%, 92.3%, and 97.2% versus 97.8%, 96.7%, and 97.7%, respectively. The use of bone subtraction maps resulted in a change of response classification in 9.7% of the patients (n = 8) versus 5 mm + 2 mm MPR image reading from SD to PD. Bone sclerosis lesions were detected in 52 out of 82 patients (63.4%). The reading time was significantly lower with the software bone subtraction compared to standard reading (P < 0.01) and 1-mm image reading (P < 0.001). CONCLUSION Accuracy of bone subtraction maps reading for monitoring multiple myeloma is slightly increased over that of conventional axial + MPR image reading and significantly speeds up the reading time.
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Kawagishi M, Chen B, Furukawa D, Sekiguchi H, Sakai K, Kubo T, Yakami M, Fujimoto K, Sakamoto R, Emoto Y, Aoyama G, Iizuka Y, Nakagomi K, Yamamoto H, Togashi K. A study of computer-aided diagnosis for pulmonary nodule: comparison between classification accuracies using calculated image features and imaging findings annotated by radiologists. Int J Comput Assist Radiol Surg 2017; 12:767-776. [PMID: 28285338 DOI: 10.1007/s11548-017-1554-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE In our previous study, we developed a computer-aided diagnosis (CADx) system using imaging findings annotated by radiologists. The system, however, requires radiologists to input many imaging findings. In order to reduce such an interaction of radiologists, we further developed a CADx system using derived imaging findings based on calculated image features, in which the system only requires few user operations. The purpose of this study is to check whether calculated image features (CFT) or derived imaging findings (DFD) can represent information in imaging findings annotated by radiologists (AFD). METHODS We calculate 2282 image features and derive 39 imaging findings by using information on a nodule position and its type (solid or ground-glass). These image features are categorized into shape features, texture features and imaging findings-specific features. Each imaging finding is derived based on each corresponding classifier using random forest. To check whether CFT or DFD can represent information in AFD, under an assumption that the accuracies of classifiers are the same if information included in input is the same, we constructed classifiers by using various types of information (CTT, DFD and AFD) and compared accuracies on an inferred diagnosis of a nodule. We employ SVM with RBF kernel as classifier to infer a diagnosis name. RESULTS Accuracies of classifiers using DFD, CFT, AFD and CFT [Formula: see text] AFD were 0.613, 0.577, 0.773 and 0.790, respectively. Concordance rates between DFD and AFD of shape findings, texture findings and surrounding findings were 0.644, 0.871 and 0.768, respectively. CONCLUSIONS The results suggest that CFT and AFD are similar information and CFT represent only a portion of AFD. Particularly, CFT did not contain shape information in AFD. In order to decrease an interaction of radiologists, a development of a method which overcomes these problems is necessary.
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Affiliation(s)
- Masami Kawagishi
- Canon Inc., 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-8602, Japan.
| | - Bin Chen
- Canon Inc., 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-8602, Japan
| | - Daisuke Furukawa
- Canon Inc., 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-8602, Japan
| | - Hiroyuki Sekiguchi
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Sakai
- Human Health Science, Graduate School of Medicine, Kyoto University, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeshi Kubo
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masahiro Yakami
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Fujimoto
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ryo Sakamoto
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yutaka Emoto
- Department of Medical Science, Kyoto College of Medical Science, 1-3, Imakita, Oyama-Higashimachi, Sonobe-cho, Nantan, Kyoto, 622-0041, Japan
| | - Gakuto Aoyama
- Canon Inc., 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-8602, Japan
| | - Yoshio Iizuka
- Canon Inc., 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-8602, Japan
| | - Keita Nakagomi
- Canon Inc., 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-8602, Japan
| | - Hiroyuki Yamamoto
- Canon Inc., 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-8602, Japan
| | - Kaori Togashi
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Automatic detection of vertebral number abnormalities in body CT images. Int J Comput Assist Radiol Surg 2017; 12:719-732. [DOI: 10.1007/s11548-016-1516-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE Automated analysis of abdominal CT has advanced markedly over just the last few years. Fully automated assessment of organs, lymph nodes, adipose tissue, muscle, bowel, spine, and tumors are some examples where tremendous progress has been made. Computer-aided detection of lesions has also improved dramatically. CONCLUSION This article reviews the progress and provides insights into what is in store in the near future for automated analysis for abdominal CT, ultimately leading to fully automated interpretation.
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Fehr D, Schmidtlein C, Hwang S, Deasy JO, Veeraraghavan H. AUTOMATIC DETECTION AND TRACKING OF LONGITUDINAL CHANGES OF MULTIPLE BONE METASTASES FROM DUAL ENERGY CT. PROCEEDINGS. IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING 2016; 2016:168-171. [PMID: 31723375 PMCID: PMC6853027 DOI: 10.1109/isbi.2016.7493236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Early detection and the assessment of changes in bone metastatic cancers can enable clinicians to monitor disease progression and modify treatment to help achieve improved results for patients. However, poor contrast makes detection difficult, and multiple disease sites make tracking of their changes over time difficult. We present a method for automatically detecting and tracking the longitudinal changes in multiple sclerotic bone metastases from Dual Energy Computed Tomography (DECT) images. We employ a multi-stage approach involving (i) bone and marrow extraction, (ii) slice-wise lesion candidate detection and volumetric segmentation, and (iii) aggregation of these 3D candidates. The algorithm achieved 78% agreement with radiologist identified lesions from 10 patients. Longitudinal consistency in the lesion detection computed over 26 scans using Williams' index was 1.02 ± 0.23 using DICE and 1.03±0.30 using Hausdorff metrics. We also present preliminary results for analyzing lesion material composition changes by using a novel representation computed from the DECT images, where clear differences between bone metastases and normal marrow can be seen.
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Affiliation(s)
- Duc Fehr
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - C.Ross Schmidtlein
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sinchun Hwang
- Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph O. Deasy
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Harini Veeraraghavan
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J 2014; 14:1551-8. [PMID: 24314766 DOI: 10.1016/j.spinee.2013.09.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/24/2013] [Accepted: 09/19/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Among different types of cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fractures, leaks into the spinal canal are considered to be the most common complication. One potential structure causing this type of cement leakage is the potential connection between the basivertebral foramen and the intravertebral cleft, which is revealed clearly on magnetic resonance (MR) images, but is often ignored in the literature. PURPOSE The purpose of this study is to assess the incidence rate of different types of cement leakage in PKP with or without intravertebral clefts and to determine whether the basivertebral foramen could be connected to the intravertebral cleft. STUDY DESIGN This study is a retrospective assessment of the presence of an intravertebral cleft in osteoporotic vertebral bodies and the different types of cement leakage after PKP on radiographs, computed tomographic (CT) scans, and MR images. PATIENT SAMPLE A total of 164 consecutive patients underwent PKP to treat 204 osteoporotic vertebral compression fractures. OUTCOME MEASURES Outcome measures include the occurrence of different types of cement leakage in the groups with an intravertebral cleft and without intravertebral clefts. METHODS A total of 204 vertebrae in 164 consecutive patients who underwent PKP to treat osteoporotic vertebral compression fractures were classified into two patterns based on preoperative radiographs, CT scans, and/or MR images of the treated levels: cleft pattern (with an intravertebral cleft in the vertebral body) and trabecular pattern (without intravertebral clefts). When an intravertebral cleft was identified, the investigators examined the basivertebral foramen and looked for a communication between the two structures on three-dimensional CT scans and MR images. On direct postoperative images, the patterns of cement leakage were classified as five types: type A, through a cortical defect into the paraspinal soft tissues; type B, through the basivertebral foramen; type C, via the needle channel; type D, through a cortical defect into the disc space; and type E, via the paravertebral vein. The association of the distribution of the cement leakage and the presence of an intravertebral cleft was analyzed retrospectively. Moreover, the association of type B leakage with the communication between the basivertebral foramen and the intravertebral cleft was also assessed. RESULTS The average interobserver kappa values for determining the type of cement leakage and the presence of intravertebral cleft were 0.916 (range, 0.792-1) and 0.935, respectively. In 41 of 204 vertebrae (19.9%), an intravertebral cleft was confirmed on preoperative images. A communication between the intravertebral cleft and the basivertebral foramen was seen in 10 vertebrae (24.4%). Cement leakage was 36.2% in the group with a trabecular pattern and 41.5% in the group with a cleft pattern (p>.05). Leaks through the basivertebral foramen (type B; N=30, 14.7%) and through cortical defects into the disc space (type D; N=14, 6.9%) were more common than other types. Twenty of 163 vertebrae with the trabecular pattern (12.3%) and 10 of 41 vertebrae with the cleft pattern (24.4%) were identified as type B leaks, which reached statistical significance (p<.05). There was no statistical difference between the trabecular pattern and the cleft pattern on other types of leaks. CONCLUSIONS Type B leaks are more common in vertebrae with an intravertebral cleft, which supports the presence of a connection between an intravertebral cleft and the basivertebral foramen. Thus, care must be taken when PKP is performed in these patients to avoid direct cement leakage into the spinal canal through the basivertebral foramen.
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Differentiation of osteolytic metastases and Schmorl's nodes in cancer patients using dual-energy CT: Advantage of spectral CT imaging. Eur J Radiol 2014; 83:1216-1221. [DOI: 10.1016/j.ejrad.2014.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/14/2013] [Accepted: 02/03/2014] [Indexed: 11/21/2022]
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Yao J, Burns JE, Muñoz H, Summers RM. Cortical shell unwrapping for vertebral body abnormality detection on computed tomography. Comput Med Imaging Graph 2014; 38:628-38. [PMID: 24815367 DOI: 10.1016/j.compmedimag.2014.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/21/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
The vertebral body is the main axial load-bearing structure of the spinal vertebra. Assessment of acute injury and chronic deformity of the vertebral body is difficult to assess accurately and quantitatively by simple visual inspection. We propose a cortical shell unwrapping method to examine the vertebral body for injury such as fractures and degenerative osteophytes. The spine is first segmented and partitioned into vertebrae. Then the cortical shell of the vertebral body is extracted using deformable dual-surface models. The cortical shell is then unwrapped onto a 2D map and the complex 3D detection problem is effectively converted to a pattern recognition problem on a 2D plane. Characteristic features adapted for different applications are computed and sent to a committee of support vector machines for classification. The system was evaluated on two applications, one for fracture detection on trauma CT datasets and the other on degenerative osteophyte assessment on sodium fluoride PET/CT. The fracture CAD achieved 93.6% sensitivity at 3.2 false positive per patient and the degenerative osteophyte CAD achieved 82% sensitivity at 4.7 false positive per patient.
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Affiliation(s)
- Jianhua Yao
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, USA.
| | - Joseph E Burns
- Department of Radiological Sciences, University of California, Irvine, School of Medicine, CA 92868, USA
| | - Hector Muñoz
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, USA
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Toth DF, Töpker M, Mayerhöfer ME, Rubin GD, Furtner J, Asenbaum U, Karanikas G, Weber M, Czerny C, Herold CJ, Ringl H. Rapid detection of bone metastasis at thoracoabdominal CT: accuracy and efficiency of a new visualization algorithm. Radiology 2013; 270:825-33. [PMID: 24475821 DOI: 10.1148/radiol.13130789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To retrospectively assess the use of a combination of cancellous bone reconstructions (CBR) and multiplanar reconstructions (MPRs) for the detection of bone metastases at thoracoabdominal computed tomography (CT) compared with the use of MPRs alone. MATERIALS AND METHODS The study was approved by the local institutional review board. Included were 156 consecutive patients with confirmed cancer who underwent a whole-body positron emission tomography (PET)/CT examination for clinical purposes (93 male and 63 female patients; mean age ± standard deviation, 59.8 years ± 14.9; range, 11-85 years). Only the CT images were processed with the CBR algorithm, which segments the bones and removes the cortical layer from the images. The PET images served as part of the reference standard. Images from 15 patients were used as a training set. Four radiologists independently evaluated images of half of the remaining 141 patients by using CBRs and MPRs together, and the other half by using MPRs only. Radiologists were blinded to patient names, and patient order was randomized. Results for detection rates and reporting time were recorded and compared with a standard of reference for each patient that was created by one senior radiologist and one nuclear medicine specialist by using all available CT and PET data, CBRs, and follow-up examinations. General estimation equations were used for statistical analysis. RESULTS There were 349 lesions found in 103 patients, with 203 classified as malignant. Each patient was assessed by two readers per method, leading to a total of 698 lesions. The detection rate for all bone lesions was 35% (247 of 698) for MPRs and 74% (520 of 698) when CBRs and MPRs were used together, which was significantly higher (P < .001). The average reading time decreased from 85 to 43 seconds (P < .001) when both reconstructions were used. CONCLUSION Advanced visualization of cancellous bone significantly increased the detection of bone metastases and reduced the time for interpretation.
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Affiliation(s)
- Daniel F Toth
- From the Departments of Radiology (D.F.T., M.T., M.E.M., J.F., U.A., M.W., C.C., C.J.H., H.R.) and Nuclear Medicine (G.K.), Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; and Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.)
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Ramamurthy S, Bhatti P, Arepalli CD, Salama M, Provenzale JM, Tridandapani S. Integrating patient digital photographs with medical imaging examinations. J Digit Imaging 2013; 26:875-85. [PMID: 23408010 PMCID: PMC3782605 DOI: 10.1007/s10278-013-9579-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We introduce the concept, benefits, and general architecture for acquiring, storing, and displaying digital photographs along with medical imaging examinations. We also discuss a specific implementation built around an Android-based system for simultaneously acquiring digital photographs along with portable radiographs. By an innovative application of radiofrequency identification technology to radiographic cassettes, the system is able to maintain a tight relationship between these photographs and the radiographs within the picture archiving and communications system (PACS) environment. We provide a cost analysis demonstrating the economic feasibility of this technology. Since our architecture naturally integrates with patient identification methods, we also address patient privacy issues.
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Affiliation(s)
- Senthil Ramamurthy
- Department of Radiology and Imaging Sciences, Winship Cancer Institute, Emory University School of Medicine, 1701 Uppergate Drive NE, Suite 5018, Atlanta, GA 30322 USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, 777 Atlantic Drive NW, Atlanta, GA 30332 USA
| | - Pamela Bhatti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, 777 Atlantic Drive NW, Atlanta, GA 30332 USA
| | - Chesnal D. Arepalli
- Department of Radiology and Imaging Sciences, Winship Cancer Institute, Emory University School of Medicine, 1701 Uppergate Drive NE, Suite 5018, Atlanta, GA 30322 USA
| | - Mohamed Salama
- Department of Radiology and Imaging Sciences, Winship Cancer Institute, Emory University School of Medicine, 1701 Uppergate Drive NE, Suite 5018, Atlanta, GA 30322 USA
| | - James M. Provenzale
- Department of Radiology and Imaging Sciences, Winship Cancer Institute, Emory University School of Medicine, 1701 Uppergate Drive NE, Suite 5018, Atlanta, GA 30322 USA
- Department of Radiology, Duke University Medical Center, Durham, NC 27710 USA
| | - Srini Tridandapani
- Department of Radiology and Imaging Sciences, Winship Cancer Institute, Emory University School of Medicine, 1701 Uppergate Drive NE, Suite 5018, Atlanta, GA 30322 USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, 777 Atlantic Drive NW, Atlanta, GA 30332 USA
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Burns JE, Yao J, Wiese TS, Muñoz HE, Jones EC, Summers RM. Automated detection of sclerotic metastases in the thoracolumbar spine at CT. Radiology 2013; 268:69-78. [PMID: 23449957 DOI: 10.1148/radiol.13121351] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To design and validate a computer system for automated detection and quantitative characterization of sclerotic metastases of the thoracolumbar spine on computed tomography (CT) images. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and was HIPAA compliant; informed consent was waived. The data set consisted of CT examinations in 49 patients (14 female, 35 male patients; mean age, 57.0 years; range, 12-77 years), demonstrating a total of 532 sclerotic lesions of the spine of greater than 0.3 cm(3) in volume, and in 10 control case patients (four women, six men; mean age, 55.2 years; range, 19-70 years) without spinal lesions. CT examinations were divided into training and test sets, and images were analyzed according to prototypical fully-automated computer-aided detection (CAD) software. Free-response receiver operating characteristic analysis was performed. RESULTS Lesion detection sensitivity on images in the training set was 90%, relative to reference-standard marked lesions (95% confidence interval [CI]: 83%, 97%), at a false-positive rate (FPR) of 10.8 per patient (95% CI: 6.6, 15.0). For images in the testing set, sensitivity was 79% (95% CI: 74%, 84%), with an FPR of 10.9 per patient (95% CI: 8.5, 13.3). False-negative findings were most commonly (37 [40%] of 93) a result of endplate proximity, with 32 (34% of 93) caused by low CT attenuation. Marginal sclerosis caused by degenerative change (174 [28.1%] of 620 actual detections) was the most common cause of false-positive detections, followed by partial volume averaging with vertebral endplates (173 [27.9%] of 620) and pedicle cortex parallel to the axial imaging plane (121 [19.5%] 620). CONCLUSION This CAD system successfully identified and segmented sclerotic lesions in the thoracolumbar spine.
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Affiliation(s)
- Joseph E Burns
- Department of Radiological Sciences, University of California-Irvine, Orange, Calif, USA
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Hammon M, Dankerl P, Tsymbal A, Wels M, Kelm M, May M, Suehling M, Uder M, Cavallaro A. Automatic detection of lytic and blastic thoracolumbar spine metastases on computed tomography. Eur Radiol 2013; 23:1862-70. [PMID: 23397381 PMCID: PMC3674341 DOI: 10.1007/s00330-013-2774-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/06/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022]
Abstract
Objective To evaluate a computer-aided detection (CADe) system for lytic and blastic spinal metastases on computed tomography (CT). Methods We retrospectively evaluated the CADe system on 20 consecutive patients with 42 lytic and on 30 consecutive patients with 172 blastic metastases. The CADe system was trained using CT images of 114 subjects with 102 lytic and 308 blastic spinal metastases. Lesions were annotated by experienced radiologists. Detected benign lesions were considered false-positive findings. Detector sensitivity and the number of false-positive findings were calculated as the criteria for detector performance, and free-response receiver operating characteristic (FROC) analysis was conducted. Detailed analysis of false-positive and false-negative findings was performed. Results Algorithm runtime is 3 ± 0.5 min per patient. The system achieves a sensitivity of 83 % at 3.5 false positives per patient on average for blastic metastases and a sensitivity of 88 % at 3.7 false positives for lytic metastases. False positives appeared predominantly in the area of degenerative changes in the case of the blastic metastasis detector and in osteoporotic areas in the case of the lytic metastasis detector. Conclusion The CADe system reliably detects thoracolumbar spine metastases in real time. An additional study is planned to evaluate how the bone lesion CADe system improves radiologists’ accuracy and efficiency in a clinical setting. Key Points • Computer-aided detection (CADe) of bone metastases has been developed for spinal CT. • The CADe system exhibits high sensitivity with a tolerable false-positive rate. • Analysis of false-positive detection may further improve the system. • CADe may reduce the number of missed spinal metastases at CT interpretation.
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Affiliation(s)
- Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
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Summers RM. Evaluation of computer-aided detection devices: consensus is developing. Acad Radiol 2012; 19:377-9. [PMID: 22444672 DOI: 10.1016/j.acra.2012.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
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Automated segmentation method for spinal column based on a dual elliptic column model and its application for virtual spinal straightening. J Comput Assist Tomogr 2010; 34:156-62. [PMID: 20118740 DOI: 10.1097/rct.0b013e3181b12242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Segmentation of vertebral bones in computed tomographic data is important as a first stage of image-based radiological tasks. However, it is a challenging problem to segment an affected spine correctly. In this study, we propose a new method of segmentation of thoracic and lumbar vertebral bodies from thin-slice computed tomographic images. Especially, we focus on a deformable model-based segmentation scheme to confirm the feasibility in clinical data sets with various bone diseases, such as bone metastases and scoliosis. As an application of this algorithm, virtual straightening of the thoracolumbar spine is also performed. Results on a database of 16 patients indicate the applicability of our method to spines affected by scoliosis and multiple bone metastases.
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Quattrocchi CC, Santini D, Dell'aia P, Piciucchi S, Leoncini E, Vincenzi B, Grasso RF, Tonini G, Zobel BB. A prospective analysis of CT density measurements of bone metastases after treatment with zoledronic acid. Skeletal Radiol 2007; 36:1121-7. [PMID: 17912514 DOI: 10.1007/s00256-007-0388-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 08/28/2007] [Accepted: 09/04/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to prospectively determine CT density changes in bone metastases, before and after intravenous zoledronic acid for a maximum period of 12 months. PATIENTS AND METHODS Twenty-three consecutive patients presented with bone metastases and underwent therapy with zoledronic acid from December 2004. All patients underwent CT of the chest, abdomen, and pelvis. Bone density, measured in Hounsfield units (HU), was determined by segmenting lesions in the same anatomical area of the metastasis sites on the axial images of the sequential series of CT examinations. The effects of zoledronic acid were evaluated by calculating absolute and relative increases in bone density. RESULTS The patients presented with multiple metastases in 65% of the cases. When compared with the baseline, all groups demonstrated a significant increase in bone density, which significantly (p < 0.01) correlated with the number of zoledronic acid administrations. There was increased bone density of at least 100% in 57%, and an increase of at least 50% in 87% of the patients. This increase was significant in both lytic and sclerotic metastases after 3 months of therapy. No significant bone density difference was found in normal-appearing bone. CONCLUSION Bone density measured by CT increases at metastatic sites after zoledronic acid treatment, regardless of the type of metastasis, in contrast to apparently normal bone.
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Affiliation(s)
- Carlo C Quattrocchi
- Department of Radiology, Centro Interdisciplinare per la Ricerca Bio-Medica, Via Longoni 47, 00155, Rome, Italy.
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