三维摄影对头形的定量分析在颅缝早闭的术前和术后评估中的应用。
Quantification of Head Shape from Three-Dimensional Photography for Presurgical and Postsurgical Evaluation of Craniosynostosis.
机构信息
From the Sheikh Zayed Institute for Pediatric Surgical Innovation and the Departments of Neurosurgery and Plastic and Reconstructive Surgery, Children's National Health System; Kitware, Inc.; and the Departments of Radiology, Pediatrics, and Biomedical Engineering, George Washington University.
出版信息
Plast Reconstr Surg. 2019 Dec;144(6):1051e-1060e. doi: 10.1097/PRS.0000000000006260.
BACKGROUND
Evaluation of surgical treatment for craniosynostosis is typically based on subjective visual assessment or simple clinical metrics of cranial shape that are prone to interobserver variability. Three-dimensional photography provides cheap and noninvasive information to assess surgical outcomes, but there are no clinical tools to analyze it. The authors aim to objectively and automatically quantify head shape from three-dimensional photography.
METHODS
The authors present an automatic method to quantify intuitive metrics of local head shape from three-dimensional photography using a normative statistical head shape model built from 201 subjects. The authors use these metrics together with a machine learning classifier to distinguish between patients with (n = 266) and without (n = 201) craniosynostosis (aged 0 to 6 years). The authors also use their algorithms to quantify objectively local surgical head shape improvements on 18 patients with presurgical and postsurgical three-dimensional photographs.
RESULTS
The authors' methods detected craniosynostosis automatically with 94.74 percent sensitivity and 96.02 percent specificity. Within the data set of patients with craniosynostosis, the authors identified correctly the fused sutures with 99.51 percent sensitivity and 99.13 percent specificity. When the authors compared quantitatively the presurgical and postsurgical head shapes of patients with craniosynostosis, they obtained a significant reduction of head shape abnormalities (p < 0.05), in agreement with the treatment approach and the clinical observations.
CONCLUSIONS
Quantitative head shape analysis and three-dimensional photography provide an accurate and objective tool to screen for head shape abnormalities at low cost and avoiding imaging with radiation and/or sedation. The authors' automatic quantitative framework allows for the evaluation of surgical outcomes and has the potential to detect relapses.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, I.
背景
颅缝早闭的手术治疗效果评估通常基于主观视觉评估或简单的颅骨形状临床指标，这些方法容易受到观察者间差异的影响。三维摄影提供了评估手术效果的廉价、非侵入性信息，但目前还没有用于分析这些信息的临床工具。作者旨在客观、自动地从三维摄影中量化头部形状。
方法
作者提出了一种自动方法，使用从 201 名受试者构建的正态统计头形模型，从三维摄影中量化直观的局部头形指标。作者使用这些指标和机器学习分类器来区分患有（n=266）和不患有（n=201）颅缝早闭的患者（年龄 0 至 6 岁）。作者还使用他们的算法对 18 名有术前和术后三维照片的患者进行客观的局部手术头形改善量化。
结果
作者的方法自动检测颅缝早闭的灵敏度为 94.74%，特异性为 96.02%。在颅缝早闭患者的数据集中，作者正确识别融合的缝线的灵敏度为 99.51%，特异性为 99.13%。当作者比较患有颅缝早闭的患者的术前和术后头部形状时，他们发现头部形状异常显著减少（p<0.05），这与治疗方法和临床观察一致。
结论
定量头部形状分析和三维摄影提供了一种准确、客观的工具，可在低成本的情况下筛查头部形状异常，避免使用放射性和/或镇静剂进行成像。作者的自动定量框架可用于评估手术效果，并有可能检测复发。
临床问题/证据水平：诊断，I。
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