Purpose
To investigate the noninvasive prediction model for new fractures after percutaneous
vertebral augmentation (PVA) based on radiomics signature and clinical parameters.
Methods
Data from patients who were diagnosed with osteoporotic vertebral compression fracture
(OVCF) and treated with PVA in our hospital between May 2014 and April 2019 were retrospectively
analyzed. Radiomics features were extracted from T1-weighted magnetic resonance imaging
(MRI) of the T11-L5 segments taken before PVA. Different radiomics models was developed
by using linear discriminant analysis (LDA), multilayer perceptron (MLP), and stochastic
gradient descent (SGD) classifiers. A nomogram was constructed by integrating clinical
parameters and Radscore that calculated by the best radiomics model. The model performance
was quantified in terms of discrimination, calibration and clinical usefulness.
Result
Four clinical parameters and 16 selected radiomics features were used for model development.
The clinical model showed poor discrimination capability with area under the curves
(AUCs) yielding of 0.522 in the training dataset and 0.517 in the validation dataset.
The LDA, MLP and SGD classifier-based radiomics model had achieved AUCs of 0.793,
0.810, and 0.797 in the training dataset, and 0.719, 0.704, and 0.725 in the validation
dataset, respectively. The nomogram showed the best performance with AUCs achieving
0.810 and 0.754 in the training and validation datasets, respectively. The decision
curve analysis demonstrated the net benefit of the nomogram was higher than that of
other models.
Conclusion
Our findings indicate that combining clinical features with radiomics features from
pre-augmentation T1-weighted MRI can be used to develop a nomogram that can predict
new fractures in patients after PVA.
Key Words
Abbreviations:
AUC (area under the receiver operating characteristic curves), BMI (body mass index), BMD (bone mineral density), DXA (Dual X-ray absorptiometry), LDA (linear discriminant analysis), MLP (multilayer perceptron), MRI (magnetic resonance imaging), NSF (new symptomatic fracture), OVCF (osteoporotic vertebral compression fracture), PKP (percutaneous kyphoplasty), PVP (percutaneous vertebroplasty), PVA (percutaneous vertebral augmentation), QCT (quantitative computed tomography), ROI (region of interest), SGD (stochastic gradient descent), TBS (trabecular bone score)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Fracture prediction, imaging and screening in osteoporosis.Nat Rev Endocrinol. 2019; 15: 535-547
- Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial.Lancet. 2016; 388: 1408-1416
- Safety and Clinical Effectiveness of Percutaneous Vertebroplasty in the Elderly (≥80 years).Eur Radiol. 2016; 26: 2352-2358
- Mortality outcomes of vertebral augmentation (vertebroplasty and/or balloon kyphoplasty) for osteoporotic vertebral compression fractures: a systematic review and meta-analysis.Radiology. 2020; 295: 96-103
- Morbidity and mortality after vertebral fractures: comparison of vertebral augmentation and nonoperative management in the medicare population.Spine (Phila Pa 1976). 2015; 40: 1228-1241
- Percutaneous vertebroplasty versus non-operative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials.Osteoporos Int. 2019; 30: 2369-2380
- Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures.J Bone Miner Res. 2013; 28: 372-382
- Is vertebroplasty a risk factor for subsequent vertebral fracture, meta-analysis of published evidence?.Osteoporos Int. 2015; 26: 113-122
- Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? A meta-analysis.Pain Physician. 2017; 20: E13-E28
- Quality improvement guidelines for percutaneous vertebroplasty.J Vasc Interv Radiol. 2014; 25: 165-170
- Radiomics: extracting more information from medical images using advanced feature analysis.Eur J Cancer. 2012; 48: 441‑446
- Decoding tumor phenotype by noninvasive imaging using a quantitative radiomics approach.Nat Commun. 2014; 5: 4006
- A new approach to predict progression-free survival in stage IV EGFR-mutant NSCLC patients with EGFR-TKI therapy.Clin Cancer Res. 2018; 24: 3583-3592
- Radiomics signature: a potential biomarker for the prediction of disease-free survival in early-stage (I or II) non-small cell lung cancer.Radiology. 2016; 281: 947-957
- Vertebral body insufficiency fractures: detection of vertebrae at risk on standard CT images using texture analysis and machine learning.Eur Radiol. 2019; 29: 2207-2217
- Computational techniques to segment and classify lumbar compression fractures.Radiol Med. 2020; 125: 551-560
- Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study.BMC Musculoskelet Disord. 2021; 22: 108
- Artificial intelligence, osteoporosis and fragility fractures.Curr Opin Rheumatol. 2019; 31: 368-375
- Fracture-free probability and predictors of new symptomatic fractures in sandwich, ordinary-adjacent, and non-adjacent vertebrae: a vertebra-specific survival analysis.J Neurointerv Surg. 2021; 13: 1058-1062
- Perinodular and intranodular radiomic features on lung CT images distinguish adenocarcinomas from granulomas.Radiology. 2019; 290: 783-792
- LASSO: a feature selection technique in predictive modeling for machine learning.in: 2016 IEEE International Conference on Advances in Computer Applications (ICACA). 2016: 18-20https://doi.org/10.1109/ICACA.2016.7887916
- Decision curve analysis: a novel method for evaluating prediction models.Med Decis Making. 2006; 26: 565-574
- Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects.Osteoporos Int. 2012; 23: 1489-1501
- TBS reflects trabecular microarchitecture in premenopausal women and men with idiopathic osteoporosis and low-traumatic fractures.Bone. 2015; 79: 259-266
- Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry.Osteoporos Int. 2018; 29: 751-758
- Trabecular bone score: a noninvasive analytical method based upon the DXA image.J Bone Miner Res. 2014; 29: 518-530
- TBS in early postmenopausal women with severe vertebral osteoporosis.Bone. 2021; 142115698
- Densitometer specific differences in the correlation between body mass index and lumbar spine trabecular bone score.J Clin Densitometry. 2017; 20: 233-238
- Radiographic texture analysis of densitometric calcaneal images: relationship to clinical characteristics and to bone fragility.J Bone Miner Res. 2010; 25 (26): 56-63
- External validation and comparison of three prediction tools for risk of osteoporotic fractures using data from population based electronic health records: retrospective cohort study.BMJ. 2017; 356: i6755
- Artificial intelligence applied to osteoporosis: a performance comparison of machine learning algorithms in predicting fragility fractures from MRI data.J Magn Reson Imaging. 2019; 49: 1029-1038
- Evaluation of radius microstructure and areal bone mineral density improves fracture prediction in postmenopausal women.J Bone Miner Res. 2018; 33: 328-337
- Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study.Lancet Diabetes Endocrinol. 2019; 7: 34-43
- The importance and possible clinical impact of measuring trabecular and cortical bone microstructure to improve fracture risk prediction.J Bone Miner Res. 2020; 35: 831-832
- Bone biopsy in patients with osteoporosis.Curr Osteoporos Rep. 2007; 5: 146-152
- Magnetic resonance imaging based assessment of bone microstructure as a non-invasive alternative to histomorphometry in patients with chronic kidney disease.Bone. 2018; 114: 14-21
- High resolution image in bone biology I. Review of the literature.Med Oral Patol Oral Cir Bucal. 2007; 12 (34): E454-E458
- Texture analysis of vertebral bone marrow using chemical shift encoding-based water-fat MRI: a feasibility study.Osteoporos Int. 2019; 30: 1265-1274
Article info
Publication history
Published online: July 29, 2022
Accepted:
June 26,
2022
Received in revised form:
June 25,
2022
Received:
April 6,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
