Chest CT-based automated vertebral fracture assessment using artificial intelligence and morphologic features

Spinal degeneration and vertebral compression fractures are common among the elderly that adversely affect their mobility, quality of life, lung function, and mortality. Assessment of vertebral fractures in chronic obstructive pulmonary disease (COPD) is important due to the high prevalence of osteoporosis and associated vertebral fractures in COPD.

We present new automated methods for (1) segmentation and labelling of individual vertebrae in chest computed tomography (CT) images using deep learning (DL), multi-parametric freeze-and-grow (FG) algorithm, and separation of apparently fused vertebrae using intensity autocorrelation and (2) vertebral deformity fracture detection using computed vertebral height features and parametric computational modelling of an established protocol outlined for trained human experts.

A chest CT-based automated method was developed for quantitative deformity fracture assessment following the protocol by Genant et al. The computational method was accomplished in the following steps: (1) computation of a voxel-level vertebral body likelihood map from chest CT using a trained DL network; (2) delineation and labelling of individual vertebrae on the likelihood map using an iterative multi-parametric FG algorithm; (3) separation of apparently fused vertebrae in CT using intensity autocorrelation; (4) computation of vertebral heights using contour analysis on the central anterior-posterior (AP) plane of a vertebral body; (5) assessment of vertebral fracture status using ratio functions of vertebral heights and optimized thresholds. The method was applied to inspiratory or total lung capacity (TLC) chest scans from the multi-site Genetic Epidemiology of COPD (COPDGene) (ClinicalTrials.gov: NCT00608764) study, and the performance was examined (n = 3231). One hundred and twenty scans randomly selected from this dataset were partitioned into training (n = 80) and validation (n = 40) datasets for the DL-based vertebral body classifier. Also, generalizability of the method to low dose CT imaging (n = 236) was evaluated.

The vertebral segmentation module achieved a Dice score of .984 as compared to manual outlining results as reference (n = 100); the segmentation performance was consistent across images with the minimum and maximum of Dice scores among images being .980 and .989, respectively. The vertebral labelling module achieved 100% accuracy (n = 100). For low dose CT, the segmentation module produced image-level minimum and maximum Dice scores of .995 and .999, respectively, as compared to standard dose CT as the reference; vertebral labelling at low dose CT was fully consistent with standard dose CT (n = 236). The fracture assessment method achieved overall accuracy, sensitivity, and specificity of 98.3%, 94.8%, and 98.5%, respectively, for 40,050 vertebrae from 3231 COPDGene participants. For generalizability experiments, fracture assessment from low dose CT was consistent with the reference standard dose CT results across all participants.

Our CT-based automated method for vertebral fracture assessment is accurate, and it offers a feasible alternative to manual expert reading, especially for large population-based studies, where automation is important for high efficiency. Generalizability of the method to low dose CT imaging further extends the scope of application of the method, particularly since the usage of low dose CT imaging in large population-based studies has increased to reduce cumulative radiation exposure.