Using Artificial Intelligence to Diagnose Osteoporotic Vertebral Fractures on Plain Radiographs.

Researchers

Journal

Modalities

Models

Abstract

Osteoporotic vertebral fracture (OVF) is a risk factor for morbidity and mortality, and accurate diagnosis is important for improving treatment outcomes. OVF diagnosis suffers from high misdiagnosis and underdiagnosis rates, as well as high workload. Deep learning methods applied to lateral plain radiographs, a simple, fast and inexpensive examination, can potentially solve this problem. We developed and validated a deep-learning-based vertebral fracture diagnostic system using area loss ratio, which assisted a multitasking network to perform skeletal position detection and segmentation, and identify and grade vertebral fractures. 11,397 plain radiographs from six community centers in Shanghai were used as the training set and internal validation set. For the external validation set, 1,276 participants were recruited from the outpatient clinic of the Shanghai Sixth People’s Hospital (1,276 plain radiographs). Radiologists performed all X-ray images and used the Genant semi-quantitative tool (GSQ) for fracture diagnosis and grading as the ground truth data. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value were used to evaluate diagnostic performance. The AI_OVF_SH system demonstrated high accuracy and computational speed in skeletal position detection and segmentation. In the internal validation set, the accuracy, sensitivity and specificity with the AI_OVF_SH model were 97.41%, 84.08% and 97.25%, respectively, for all fractures. The sensitivity and specificity for moderate fractures were 88.55% and 99.74%, respectively, and for severe fractures, they were 92.30% and 99.92%. In the external validation set, the accuracy, sensitivity and specificity for all fractures were 96.85%, 83.35% and 94.70%, respectively. For moderate fractures, the sensitivity and specificity were 85.61% and 99.85%, respectively, and 93.46% and 99.92% for severe fractures. Therefore, the AI_OVF_SH system is an efficient tool to assist radiologists and clinicians to improve the diagnosing of vertebral fractures. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.