Utilizing machine learning for opportunistic screening for low BMD using CT scans of the cervical spine - 20/04/23
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Abstract |
Background |
Computed Tomography (CT) scans of the cervical spine are often performed to evaluate patients for trauma and degenerative changes of the cervical spine. We hypothesized that the CT attenuation of the cervical vertebrae can be used to identify patients who should be screened for osteoporosis.
Methods |
A retrospective study of 253 patients (177 training/validation and 76 test) with unenhanced CT scans of the cervical spine and Dual-energy x-ray Absorbtiometry (DXA) studies within 12 months of each other was performed. Volumetric segmentation of C1-T1, clivus, and first ribs was performed to obtain the CT attenuation of each bone. The correlations of the CT attenuations between the bones and with DXA measurements were evaluated. Univariate receiver operator characteristic (ROC) analyses, and multivariate classifiers (Random Forest (RF), XGBoost, Naïve Bayes (NB), and Support Vector Machines (SVM)) analyzing the CT attenuation of all bones, were utilized to predict patients with osteopenia/osteoporosis and femoral neck bone mineral density (BMD) T-scores <-1.
Results |
There were positive correlations between the CT attenuation of each bone, and with the DXA measurements. A CT attenuation threshold of 305.2 Hounsfield Units (HU) at C3 had the highest accuracy (0.763, AUC=0.814) to detect femoral neck BMD T-scores ≤-1 and a CT attenuation threshold of 323.6 HU at C3 had the highest accuracy (0.774, AUC=0.843) to detect osteopenia/osteoporosis. The SVM classifier (AUC=0.756) had higher AUC than the RF (AUC=0.692, P=0.224), XGBoost (AUC=0.736; P=0.814), NB (AUC=0.622, P=0.133) and CT threshold of 305.2 HU at C3 (AUC=0.704, P=0.531) classifiers to identify patients with femoral neck BMD T-scores <-1. The SVM classifier (accuracy=0.816) was more accurate than using the CT threshold of 305.2 HU at C3 (accuracy=0.671) (McNemar's =7.55, P=0.006).
Conclusion |
Opportunistic screening for low BMD can be done using cervical spine CT scans. A SVM classifier was more accurate than using the CT threshold of 305.2 HU at C3.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | We show that C3 is the best bone for opportunistic screening for osteoporosis/osteopenia from cervical spine CT |
• | We use machine learning involving the CT attenuation data from multiple osseous sites to better identify patients with osteoporosis/osteopenia |
• | We include the CT attenuation of all bones routinely visible on CT scans of the cervical spine including clivus, T1 and the first rib |
• | We use three-dimensional (3D) volumetric segmentation of the vertebral bodies so that the entire trabecular bone is evaluated rather than sampling the trabecular bone on a single CT slice. |
Keywords : Computed tomography, CT attenuation, Cervical spine, Random forest, XGBoost, Naïve bayes, Support vector machine, Clivus
Plan
Vol 50 - N° 3
P. 293-301 - mai 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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