臨床整形外科57巻10号

2022年10月発行

特集 整形外科領域における人工知能の応用 各論

人工知能を用いた腰椎単純X線からの椎体骨折の診断

著者： 村田寿馬¹ 遠藤健司¹ 粟飯原孝人¹ 鈴木秀和¹ 松岡佑嗣¹ 西村浩輔¹ 髙松太一郎¹ 小西隆允¹ 山内英也¹ 長山恭平¹ 山本謙吾¹

所属機関： ¹東京医科大学整形外科学分野

ページ範囲：P.1241 - P.1245

椎体骨折の画像診断において単純X線側面像の読影は不可欠であるが，非専門医による読影は非常に精度が悪いことが知られる．臨床では必ずしも専門医による診察を受けられるわけではなく，需給のミスマッチが生じる．人工知能を用いた画像診断はこうしたミスマッチを是正する可能性のある新規医療技術であるが，診断精度は不明である．椎体骨折患者の単純X線を用いて，人工知能に骨折椎および非骨折椎の画像分類を学習させた．診断精度，感度・特異度，偽陽性率・偽陰性率はそれぞれ86.0％(95％CI：82.0〜90.0％)，84.7％(95％CI：78.8〜90.5％)，および87.3％(95％CI：81.9〜92.7％)，であり，椎体骨折の画像診断でも有効性が示唆される．

参考文献

1) Choi HG, Lee JK, Sim S, et al. Mortality and cause of death in patients with vertebral fractures:a longitudinal follow-up study using a national sample cohort. Spine (Phila Pa 1976) 2020;45(5):E280-7.

2) Hasserius R, Karlsson MK, Nilsson BE, et al. Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women:a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 2003;14(1):61-8.

3) Murata K, Matsuoka Y, Nishimura H, et al. The factors related to the poor ADL in the patients with osteoporotic vertebral fracture after instrumentation surgery. Eur Spine J 2020;29(7):1597-605.

4) Borges JL, Maia JL, Silva RF, et al. Diagnosing vertebral fractures:missed opportunities. Rev Bras Reumatol 2015;55(5):464-7.

5) Romero Lauro G, Cable W, Lesniak A, et al. Digital pathology consultations-a new era in digital imaging, challenges and practical applications. J Digit Imaging 2013;26(4):668-77.

6) Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993;8(9):1137-48.

7) Jung Y, Hu J. A K-fold averaging cross-validation procedure. J Nonparametr Stat 2015;27(2):167-79.

8) Sadat-Ali M, Gullenpet AH, Al-Turki HA, et al. Are we missing osteoporosis-related vertebral fractures in men? Asian Spine J 2011;5(2):107-10.

9) Bellabarba C, Fisher C, Chapman JR, et al. Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality? Spine (Phila pa 1976) 2010;35(9 Suppl):S138-45.

10) Ataka H, Tanno T, Yamazaki M. Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J 2009;18(1):69-76.

11) Chassagnon G, Vakalopoulou M, Paragios N, et al. Artificial intelligence applications for thoracic imaging. Eur J Radiol 2020;123:108774. doi:10.1016/j.ejrad.2019.108774

12) Cheng CT, Ho TY, Lee TY, et al. Application of a deep learning algorithm for detection and visualization of hip fractures on plain pelvic radiographs. Eur Radiol 2019;29(10):5469-77.

13) Ferizi U, Honig S, Chang G. Artificial intelligence, osteoporosis and fragility fractures. Curr Opin Rheumatol 2019;31(4):368-75.

14) Maki S, Furuya T, Horikoshi T, et al. A deep convolutional neural network with performance comparable to radiologists for differentiating between spinal schwannoma and meningioma. Spine (Phila Pa 1976) 2020;45(10):694-700.

15) Murata K, Endo K, Aihara T, et al. Use of residual neural network for the detection of ossification of the posterior longitudinal ligament on plain cervical radiography. Eur Spine J 2021;30(8):2185-90.

16) Miura M, Maki S, Miura K, et al. Automated detection of cervical ossification of the posterior longitudinal ligament in plain lateral radiographs of the cervical spine using a convolutional neural network. Sci Rep 2021;11(1):12702.

17) Simon JB, Schoenfeld AJ, Katz JN, et al. Are “normal” multidetector computed tomographic scans sufficient to allow collar removal in the trauma patient? J Trauma 2010;68(1):103-8.

18) Berry GE, Adams S, Harris MB, et al. Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. J Trauma 2005;59(6):1410-3.

19) Marongiu G, Congia S, Verona M, et al. The impact of magnetic resonance imaging in the diagnostic and classification process of osteoporotic vertebral fractures. Injury 2018;49(Suppl 3):S26-31.

20) Mettler FA Jr, Huda W, Yoshizumi TT, et al. Effective doses in radiology and diagnostic nuclear medicine:a catalog. Radiology 2008;248(1):254-63.

21) Wintermark M, Mouhsine E, Theumann N, et al. Thoracolumbar spine fractures in patients who have sustained severe trauma:depiction with multi-detector row CT. Radiology 2003;227(3):681-9.