Automatic detection of osteoporotic vertebral fractures in routine thoracic and abdominal MDCT

To develop a prototype algorithm for automatic spine segmentation in MDCT images and use it to automatically detect osteoporotic vertebral fractures.

Cross-sectional routine thoracic and abdominal MDCT images of 71 patients including 8 males and 9 females with 25 osteoporotic vertebral fractures and longitudinal MDCT images of 9 patients with 18 incidental fractures in the follow-up MDCT were retrospectively selected. The spine segmentation algorithm localised and identified the vertebrae T5-L5. Each vertebra was automatically segmented by using corresponding vertebra surface shape models that were adapted to the original images. Anterior, middle, and posterior height of each vertebra was automatically determined; the anterior-posterior ratio (APR) and middle-posterior ratio (MPR) were computed. As the gold standard, radiologists graded vertebral fractures from T5 to L5 according to the Genant classification in consensus.

Using ROC analysis to differentiate vertebrae without versus with prevalent fracture, AUC values of 0.84 and 0.83 were obtained for APR and MPR, respectively (p < 0.001). Longitudinal changes in APR and MPR were significantly different between vertebrae without versus with incidental fracture (ΔAPR: -8.5 % ± 8.6 % versus -1.6 % ± 4.2 %, p = 0.002; ΔMPR: -11.4 % ± 7.7 % versus -1.2 % ± 1.6 %, p < 0.001).

This prototype algorithm may support radiologists in reporting currently underdiagnosed osteoporotic vertebral fractures so that appropriate therapy can be initiated.

• This spine segmentation algorithm automatically localised, identified, and segmented the vertebrae in MDCT images. • Osteoporotic vertebral fractures could be automatically detected using this prototype algorithm. • The prototype algorithm helps radiologists to report underdiagnosed osteoporotic vertebral fractures.