Reproducibility of a semi-automatic method for 6-point vertebral morphometry in a multi-centre trial.

PURPOSE To evaluate the reproducibility of a semi-automated system for vertebral morphometry (MorphoXpress) in a large multi-centre trial. MATERIALS AND METHODS The study involved 132 clinicians (no radiologist) with different levels of experience across 20 osteo-centres in Italy. All have received training in using MorphoXpress. An expert radiologist was also involved providing data used as standard of reference. The test image originate from normal clinical activity and represent a variety of normal, under and over exposed films, indicating both normal anatomy and vertebral deformities. The image was represented twice to the clinicians in a random order. Using the software, the clinicians initially marked the midpoints of the upper and lower vertebrae to include as many of the vertebrae (T5-L4) as practical within each given image. MorphoXpress performs the localisation of all morphometric points based on statistical model-based vision system. Intra-operator as well inter-operator measurement of agreement was calculated using the coefficient of variation and the mean and standard deviation of the difference of two measurements to check their agreement. RESULTS The overall intra-operator mean differences in vertebral heights is 1.61+/-4.27% (1 S.D.). The overall intra-operator coefficient of variation is 3.95%. The overall inter-operator mean differences in vertebral heights is 2.93+/-5.38% (1 S.D.). The overall inter-operator coefficient of variation is 6.89%. CONCLUSIONS The technology tested here can facilitate reproducible quantitative morphometry suitable for large studies of vertebral deformities.

[1]  Jill C. Gardner,et al.  Semiautomated computerized system for fracture assessment of spinal x-ray films , 1996, Medical Imaging.

[2]  H. Sari-Sarraf,et al.  Hierarchical segmentation of cervical and lumbar vertebrae using a customized generalized Hough transform and extensions to active appearance models , 2004, 6th IEEE Southwest Symposium on Image Analysis and Interpretation, 2004..

[3]  T. Spector,et al.  The assessment of vertebral deformity: A method for use in population studies and clinical trials , 1993, Osteoporosis International.

[4]  J. C. Gardner,et al.  An Interactive Tutorial-Based Training Technique for Vertebral Morphometry , 2001, Osteoporosis International.

[5]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[6]  Gilberto Zamora,et al.  Hierarchical segmentation of vertebrae from x-ray images , 2003, SPIE Medical Imaging.

[7]  G. Blake,et al.  Vertebral morphometry studies using dual-energy x-ray absorptiometry. , 1997, Seminars in nuclear medicine.

[8]  Martin Roberts,et al.  Vertebral Morphometry: Semiautomatic Determination of Detailed Shape From Dual-Energy X-ray Absorptiometry Images Using Active Appearance Models , 2006, Investigative radiology.

[9]  Timothy F. Cootes,et al.  Statistical models of appearance for medical image analysis and computer vision , 2001, SPIE Medical Imaging.

[10]  R. Parker,et al.  Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. , 2001, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[11]  Marleen de Bruijne,et al.  Image segmentation by shape particle filtering , 2004, ICPR 2004.

[12]  D W Hukins,et al.  Comparison of the precision of two vertebral morphometry programs for the lunar EXPERT-XL imaging densitometer. , 1998, The British journal of radiology.

[13]  J. Li,et al.  Morphometric X‐Ray Absorptiometry and Morphometric Radiography of the Spine: A Comparison of Prevalent Vertebral Deformity Identification , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[14]  C. Cooper,et al.  Prevalence and incidence of vertebral deformities , 1993, Osteoporosis International.

[15]  M. Nevitt,et al.  Vertebral fracture assessment using a semiquantitative technique , 1993, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[16]  C. Wu,et al.  Vertebral fractures in osteoporosis: a new method for clinical assessment. , 2000, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[17]  C. Roux,et al.  Comparison of Four Morphometric Definitions and a Semiquantitative Consensus Reading for Assessing Prevalent Vertebral Fractures , 2001, Osteoporosis International.

[18]  P P Smyth,et al.  Vertebral shape: automatic measurement with active shape models. , 1999, Radiology.

[19]  M. Jergas,et al.  Assessment of prevalent and incident vertebral fractures in osteoporosis research , 2003, Osteoporosis International.

[20]  C. Roux,et al.  The severity of vertebral fractures and health-related quality of life in osteoporotic postmenopausal women , 2005, Osteoporosis International.

[21]  Richard Eastell,et al.  Erratum: 1991 Classification of vertebral fractures (J Bone Miner Res 6:207-215) , 1991 .

[22]  R. Eastell,et al.  Classification of vertebral fractures , 1991, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.