Abstract：
BACKGROUND: Adolescent idiopathic scoliosis (AIS) necessitates accurate spinal curvature assessment for effective clinical management. Traditional two-dimensional (2D) Cobb angle measurements have been the standard, but the emergence of three-dimensional (3D) automatic measurement techniques, such as those using weight-bearing 3D imaging (WR3D), presents an opportunity to enhance the accuracy and comprehensiveness of AIS evaluation.
OBJECTIVE: This study aimed to compare traditional 2D Cobb angle measurements with 3D automatic measurements utilizing the WR3D imaging technique in patients with AIS.
METHODS: A cohort of 53 AIS patients was recruited, encompassing 88 spinal curves, for comparative analysis.
METHODS: The patient sample consisted of 53 individuals diagnosed with AIS.
METHODS: Cobb angles were calculated using the conventional 2D method and three different 3D methods: the Analytical Method (AM), the Plane Intersecting Method (PIM), and the Plane Projection Method (PPM).
METHODS: The 2D cobb angle was manually measured by 3 experienced clinicians with 2D frontal whole-spine radiographs. For 3D cobb angle measurements, the spine and femoral heads were segmented from the WR3D images using a 3D-UNet deep-learning model, and the automatic calculations of the angles were performed with the 3D slicer software.
RESULTS: AM and PIM estimates were found to be significantly larger than 2D measurements. Conversely, PPM results showed no statistical difference compared to the 2D method. These findings were consistent in a subgroup analysis based on 2D Cobb angles.
CONCLUSIONS: Each 3D measurement method provides a unique assessment of spinal curvature, with PPM offering values closely resembling 2D measurements, while AM and PIM yield larger estimations. The utilization of WR3D technology alongside deep learning segmentation ensures accuracy and efficiency in comparative analyses. However, additional studies, particularly involving patients with severe curves, are required to validate and expand on these results. This study emphasizes the importance of selecting an appropriate measurement method considering the imaging modality and clinical context when assessing AIS, and it also underlines the need for continuous refinement of these techniques for optimal use in clinical decision-making and patient management.
OBJECTIVE: This study aimed to compare traditional 2D Cobb angle measurements with 3D automatic measurements utilizing the WR3D imaging technique in patients with AIS.
METHODS: A cohort of 53 AIS patients was recruited, encompassing 88 spinal curves, for comparative analysis.
METHODS: The patient sample consisted of 53 individuals diagnosed with AIS.
METHODS: Cobb angles were calculated using the conventional 2D method and three different 3D methods: the Analytical Method (AM), the Plane Intersecting Method (PIM), and the Plane Projection Method (PPM).
METHODS: The 2D cobb angle was manually measured by 3 experienced clinicians with 2D frontal whole-spine radiographs. For 3D cobb angle measurements, the spine and femoral heads were segmented from the WR3D images using a 3D-UNet deep-learning model, and the automatic calculations of the angles were performed with the 3D slicer software.
RESULTS: AM and PIM estimates were found to be significantly larger than 2D measurements. Conversely, PPM results showed no statistical difference compared to the 2D method. These findings were consistent in a subgroup analysis based on 2D Cobb angles.
CONCLUSIONS: Each 3D measurement method provides a unique assessment of spinal curvature, with PPM offering values closely resembling 2D measurements, while AM and PIM yield larger estimations. The utilization of WR3D technology alongside deep learning segmentation ensures accuracy and efficiency in comparative analyses. However, additional studies, particularly involving patients with severe curves, are required to validate and expand on these results. This study emphasizes the importance of selecting an appropriate measurement method considering the imaging modality and clinical context when assessing AIS, and it also underlines the need for continuous refinement of these techniques for optimal use in clinical decision-making and patient management.
摘要：
背景：青少年特发性脊柱侧凸（AIS）需要准确的脊柱弯曲度评估以进行有效的临床治疗。传统的二维(2D)Cobb角测量已成为标准,但是三维（3D）自动测量技术的出现，例如那些使用负重3D成像(WR3D)的为提高AIS评估的准确性和全面性提供了机会。
目的：本研究旨在比较传统的2DCobb角测量与利用WR3D成像技术在AIS患者中的3D自动测量。
方法：招募了53名AIS患者，包括88条脊柱曲线，进行比较分析。
方法：患者样本由53名诊断为AIS的个体组成。
方法：使用常规2D方法和三种不同的3D方法计算Cobb角：分析方法（AM），平面相交法(PIM),和平面投影法(PPM)。
方法：由3名经验丰富的临床医生用2D额全脊柱X线片手动测量2Dcobb角。对于3Dcobb角测量，使用U-net深度学习模型从WR3D图像中分割出脊柱和股骨头，并且使用3D切片机软件进行角度的自动计算。
结果：发现AM和PIM估计值明显大于2D测量值。相反，PPM结果与2D方法相比没有统计学差异。这些发现在基于2DCobb角的亚组分析中是一致的。
结论：每种3D测量方法都提供了对脊柱弯曲度的独特评估，PPM提供的值与2D测量非常相似，而AM和PIM产生更大的估计。利用WR3D技术以及深度学习分割可确保比较分析的准确性和效率。然而,额外的研究，特别是严重曲线的患者，需要验证和扩展这些结果。本研究强调了在评估AIS时，考虑到成像模式和临床背景，选择合适的测量方法的重要性。它还强调了需要不断改进这些技术，以便在临床决策和患者管理中得到最佳使用。
目的：本研究旨在比较传统的2DCobb角测量与利用WR3D成像技术在AIS患者中的3D自动测量。
方法：招募了53名AIS患者，包括88条脊柱曲线，进行比较分析。
方法：患者样本由53名诊断为AIS的个体组成。
方法：使用常规2D方法和三种不同的3D方法计算Cobb角：分析方法（AM），平面相交法(PIM),和平面投影法(PPM)。
方法：由3名经验丰富的临床医生用2D额全脊柱X线片手动测量2Dcobb角。对于3Dcobb角测量，使用U-net深度学习模型从WR3D图像中分割出脊柱和股骨头，并且使用3D切片机软件进行角度的自动计算。
结果：发现AM和PIM估计值明显大于2D测量值。相反，PPM结果与2D方法相比没有统计学差异。这些发现在基于2DCobb角的亚组分析中是一致的。
结论：每种3D测量方法都提供了对脊柱弯曲度的独特评估，PPM提供的值与2D测量非常相似，而AM和PIM产生更大的估计。利用WR3D技术以及深度学习分割可确保比较分析的准确性和效率。然而,额外的研究，特别是严重曲线的患者，需要验证和扩展这些结果。本研究强调了在评估AIS时，考虑到成像模式和临床背景，选择合适的测量方法的重要性。它还强调了需要不断改进这些技术，以便在临床决策和患者管理中得到最佳使用。
