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Register a new userAccurately identifying vertebral levels in large datasets
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The vertebral levels of the spine provide a useful coordinate system when making measurements of plaque, muscle, fat, and bone mineral density. Correctly classifying vertebral levels with high accuracy is challenging due to the similar appearance of each vertebra, the curvature of the spine, and the possibility of anomalies such as fractured vertebrae, implants, lumbarization of the sacrum, and sacralization of L5. The goal of this work is to develop a system that can accurately and robustly identify the L1 level in large heterogeneous datasets. The first approach we study is using a 3D U-Net to segment the L1 vertebra directly using the entire scan volume to provide context. We also tested models for two class segmentation of L1 and T12 and a three class segmentation of L1, T12 and the rib attached to T12. By increasing the number of training examples to 249 scans using pseudo-segmentations from an in-house segmentation tool we were able to achieve 98% accuracy with respect to identifying the L1 vertebra, with an average error of 4.5 mm in the craniocaudal level. We next developed an algorithm which performs iterative instance segmentation and classification of the entire spine with a 3D U-Net. We found the instance based approach was able to yield better segmentations of nearly the entire spine, but had lower classification accuracy for L1.
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Rationale and Objectives: Medical artificial intelligence systems are dependent on well characterised large scale datasets. Recently released public datasets have been of great interest to the field, but pose specific challenges due to the disconnect they cause between data generation and data usage, potentially limiting the utility of these datasets. Materials and Methods: We visually explore two large public datasets, to determine how accurate the provided labels are and whether other subtle problems exist. The ChestXray14 dataset contains 112,120 frontal chest films, and the MURA dataset contains 40,561 upper limb radiographs. A subset of around 700 images from both datasets was reviewed by a board-certified radiologist, and the quality of the original labels was determined. Results: The ChestXray14 labels did not accurately reflect the visual content of the images, with positive predictive values mostly between 10% and 30% lower than the values presented in the original documentation. There were other significant problems, with examples of hidden stratification and label disambiguation failure. The MURA labels were more accurate, but the original normal/abnormal labels were inaccurate for the subset of cases with degenerative joint disease, with a sensitivity of 60% and a specificity of 82%. Conclusion: Visual inspection of images is a necessary component of understanding large image datasets. We recommend that teams producing public datasets should perform this important quality control procedure and include a thorough description of their findings, along with an explanation of the data generating procedures and labelling rules, in the documentation for their datasets.
We propose an auto-encoding network architecture for point clouds (PC) capable of extracting shape signatures without supervision. Building on this, we (i) design a loss function capable of modelling data variance on PCs which are unstructured, and (ii) regularise the latent space as in a variational auto-encoder, both of which increase the auto-encoders descriptive capacity while making them probabilistic. Evaluating the reconstruction quality of our architectures, we employ them for detecting vertebral fractures without any supervision. By learning to efficiently reconstruct only healthy vertebrae, fractures are detected as anomalous reconstructions. Evaluating on a dataset containing $sim$1500 vertebrae, we achieve area-under-ROC curve of $>$75%, without using intensity-based features.
An osteoporosis-related fracture occurs every three seconds worldwide, affecting one in three women and one in five men aged over 50. The early detection of at-risk patients facilitates effective and well-evidenced preventative interventions, reducing the incidence of major osteoporotic fractures. In this study, we present an automatic system for identification of vertebral compression fractures on Computed Tomography images, which are often an undiagnosed precursor to major osteoporosis-related fractures. The system integrates a compact 3D representation of the spine, utilizing a Convolutional Neural Network (CNN) for spinal cord detection and a novel end-to-end sequence to sequence 3D architecture. We evaluate several model variants that exploit different representation and classification approaches and present a framework combining an ensemble of models that achieves state of the art results, validated on a large data set, with a patient-level fracture identification of 0.955 Area Under the Curve (AUC). The system proposed has the potential to support osteoporosis clinical management, improve treatment pathways, and to change the course of one of the most burdensome diseases of our generation.
Differentiating Vertebral Compression Fractures (VCFs) associated with trauma and osteoporosis (benign VCFs) or those caused by metastatic cancer (malignant VCFs) are critically important for treatment decisions. So far, automatic VCFs diagnosis is solved in a two-step manner, i.e. first identify VCFs and then classify it into benign or malignant. In this paper, we explore to model VCFs diagnosis as a three-class classification problem, i.e. normal vertebrae, benign VCFs, and malignant VCFs. However, VCFs recognition and classification require very different features, and both tasks are characterized by high intra-class variation and high inter-class similarity. Moreover, the dataset is extremely class-imbalanced. To address the above challenges, we propose a novel Two-Stream Compare and Contrast Network (TSCCN) for VCFs diagnosis. This network consists of two streams, a recognition stream which learns to identify VCFs through comparing and contrasting between adjacent vertebra, and a classification stream which compares and contrasts between intra-class and inter-class to learn features for fine-grained classification. The two streams are integrated via a learnable weight control module which adaptively sets their contribution. The TSCCN is evaluated on a dataset consisting of 239 VCFs patients and achieves the average sensitivity and specificity of 92.56% and 96.29%, respectively.
Objective: The spinous process angle (SPA) is one of the essential parameters to denote three-dimensional (3-D) deformity of spine. We propose an automatic segmentation method based on Stacked Hourglass Network (SHN) to detect the spinous processes (SP) on ultrasound (US) spine images and to measure the SPAs of clinical scoliotic subjects. Methods: The network was trained to detect vertebral SP and laminae as five landmarks on 1200 ultrasound transverse images and validated on 100 images. All the processed transverse images with highlighted SP and laminae were reconstructed into a 3D image volume, and the SPAs were measured on the projected coronal images. The trained network was tested on 400 images by calculating the percentage of correct keypoints (PCK); and the SPA measurements were evaluated on 50 scoliotic subjects by comparing the results from US images and radiographs. Results: The trained network achieved a high average PCK (86.8%) on the test datasets, particularly the PCK of SP detection was 90.3%. The SPAs measured from US and radiographic methods showed good correlation (r>0.85), and the mean absolute differences (MAD) between two modalities were 3.3{deg}, which was less than the clinical acceptance error (5{deg}). Conclusion: The vertebral features can be accurately segmented on US spine images using SHN, and the measurement results of SPA from US data was comparable to the gold standard from radiography.
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