Yang De, Lee Timothy Tin-Yan, Lai Kelly Ka-Lee, Lam Tsz-Ping, Chu Winnie Chiu-Wing, Castelein René Marten, Cheng Jack Chun-Yiu, Zheng Yong-Ping
Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
Spine Deform. 2022 Mar;10(2):351-359. doi: 10.1007/s43390-021-00421-4. Epub 2021 Nov 3.
Using X-ray to evaluate adolescent idiopathic scoliosis (AIS) conditions is the clinical gold standard, with potential radiation hazards. 3D ultrasound has demonstrated its validity and reliability of estimating X-ray Cobb angle (XCA) using spinous process angle (SPA), which can be automatically measured. While angle measurement with ultrasound using spine transverse process-related landmarks (UCA) shows better agreed with XCA, its automatic measurement is challenging and not available yet. This research aimed to analyze and measure scoliotic angles through a novel semi-automatic UCA method.
100 AIS subjects (age: 15.0 ± 1.9 years, gender: 19 M and 81 F, Cobb: 25.5 ± 9.6°) underwent both 3D ultrasound and X-ray scanning on the same day. Scoliotic angles with XCA and UCA methods were measured manually; and transverse process-related features were identified/drawn for the semi-automatic UCA method. The semi-automatic method measured the spinal curvature with pairs of thoracic transverse processes and lumbar lumps in respective regions.
The new semi-automatic UCA method showed excellent correlations with manual XCA (R = 0.815: thoracic angles R = 0.857, lumbar angles R = 0.787); and excellent correlations with manual UCA (R = 0.866: thoracic angles R = 0.921, lumbar angles R = 0.780). The Bland-Altman plot also showed a good agreement against manual UCA/XCA. The MADs of semi-automatic UCA against XCA were less than 5°, which is clinically insignificant.
The semi-automatic UCA method had demonstrated the possibilities of estimating manual XCA and UCA. Further advancement in image processing to detect the vertebral landmarks in ultrasound images could help building a fully automated measurement method.
Level III.
利用X射线评估青少年特发性脊柱侧凸（AIS）状况是临床金标准，但存在潜在辐射危害。三维超声已证明其通过棘突角（SPA）估算X射线Cobb角（XCA）的有效性和可靠性，且SPA可自动测量。虽然使用与脊柱横突相关标志的超声角度测量（UCA）与XCA的一致性更好，但其自动测量具有挑战性且尚未实现。本研究旨在通过一种新型半自动UCA方法分析和测量脊柱侧凸角度。
100例AIS受试者（年龄：15.0±1.9岁，性别：男19例，女81例，Cobb角：25.5±9.6°）在同一天接受三维超声和X射线扫描。采用XCA和UCA方法手动测量脊柱侧凸角度；并为半自动UCA方法识别/绘制与横突相关的特征。半自动方法通过各区域的成对胸段横突和腰段肿块测量脊柱曲率。
新的半自动UCA方法与手动XCA具有极好的相关性（R = 0.815：胸段角度R = 0.857，腰段角度R = 0.787）；与手动UCA也具有极好的相关性（R = 0.866：胸段角度R = 0.921，腰段角度R = 0.780）。Bland-Altman图也显示与手动UCA/XCA具有良好的一致性。半自动UCA相对于XCA的平均绝对偏差小于5°，在临床上无显著意义。
半自动UCA方法已证明估算手动XCA和UCA的可能性。进一步改进图像处理以检测超声图像中的椎体标志有助于建立全自动测量方法。
III级。
