title: Automated Detection, Localization, and Classification of Traumatic Vertebral Body Fractures in the Thoracic and Lumbar Spine at CT.
abstract: OBJECTIVE
  To design and validate a fully automated computer system for the detection and anatomic localization of traumatic thoracic and lumbar vertebral body fractures at computed tomography (CT).
  
  
  METHODS
  This retrospective study was HIPAA compliant. Institutional review board approval was obtained, and informed consent was waived. CT examinations in 104 patients (mean age, 34.4 years; range, 14-88 years; 32 women, 72 men), consisting of 94 examinations with positive findings for fractures (59 with vertebral body fractures) and 10 control examinations (without vertebral fractures), were performed. There were 141 thoracic and lumbar vertebral body fractures in the case set. The locations of fractures were marked and classified by a radiologist according to Denis column involvement. The CT data set was divided into training and testing subsets (37 and 67 subsets, respectively) for analysis by means of prototype software for fully automated spinal segmentation and fracture detection. Free-response receiver operating characteristic analysis was performed.
  
  
  RESULTS
  Training set sensitivity for detection and localization of fractures within each vertebra was 0.82 (28 of 34 findings; 95% confidence interval [CI]: 0.68, 0.90), with a false-positive rate of 2.5 findings per patient. The sensitivity for fracture localization to the correct vertebra was 0.88 (23 of 26 findings; 95% CI: 0.72, 0.96), with a false-positive rate of 1.3. Testing set sensitivity for the detection and localization of fractures within each vertebra was 0.81 (87 of 107 findings; 95% CI: 0.75, 0.87), with a false-positive rate of 2.7. The sensitivity for fracture localization to the correct vertebra was 0.92 (55 of 60 findings; 95% CI: 0.79, 0.94), with a false-positive rate of 1.6. The most common cause of false-positive findings was nutrient foramina (106 of 272 findings [39%]).
  
  
  CONCLUSIONS
  The fully automated computer system detects and anatomically localizes vertebral body fractures in the thoracic and lumbar spine on CT images with a high sensitivity and a low false-positive rate.
authors.affiliation: From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (J.E.B.); and Imaging Biomarkers and Computer-Aided Detection Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Building 10, 1C224, MSC1182, Bethesda, MD 20892-1182 (J.Y., H.M., R.M.S.).
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Burns
authors.affiliation: From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (J.E.B.); and Imaging Biomarkers and Computer-Aided Detection Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Building 10, 1C224, MSC1182, Bethesda, MD 20892-1182 (J.Y., H.M., R.M.S.).
authors.forename: Jianhua
authors.initials: J
authors.lastname: Yao
authors.affiliation: From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (J.E.B.); and Imaging Biomarkers and Computer-Aided Detection Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Building 10, 1C224, MSC1182, Bethesda, MD 20892-1182 (J.Y., H.M., R.M.S.).
authors.forename: Hector
authors.initials: H
authors.lastname: Muñoz
authors.affiliation: From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (J.E.B.); and Imaging Biomarkers and Computer-Aided Detection Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Building 10, 1C224, MSC1182, Bethesda, MD 20892-1182 (J.Y., H.M., R.M.S.).
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Summers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010363:Pattern Recognition, Automated; D011857:Radiographic Image Interpretation, Computer-Assisted; D011873:Radiology Information Systems; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000145:classification* / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media