Wia-Spine: A CBIR environment with embedded radiomic features to assess fragility fractures

Osteoporosis is a systemic disorder that reduces the bone mineral density, increasing the vertebrae's fragility and proneness to fracture. Although the bone densitometry index t-Score is a solid marker for the osteoporosis diagnosis, its measure alone is insufficient to predict the future development of fragility fractures. A complementary approach to address vertebral bone characterization is the analysis of magnetic resonance imaging (MRI) by radiomic features, which model vertebral bodies' morphological properties after color and texture. Radiomic features have been employed for detecting fragility fractures in related work, but, to the best of our knowledge, no study has been conducted on their suitability to recover similar, diagnosed cases that could hint at future fractures. We fulfill this gap by designing a Content-based Image Retrieval (CBIR) tool with embedded radiomic features, which uses past cases recovered from an annotated database to (i) identify an existing fragility fracture in a query vertebra and (ii) predict a fracture to a query vertebra from an aging patient. The proposed CBIR was evaluated on a reference database of 273 vertebral bodies from sagittal T2-weighted MRIs. The results indicate our fine-tuned approach spotted fragility fractures accurately $(\mathrm{F}1-\text{Score} =0.83,\ \text{Precision} =0.83,\ \text{AUC} =0.81,\ \text{CI} =95\%)$. We also investigated the CBIR potential to predict fractures in a case study regarding three patients from the reference database (confirmed osteoporosis, MRI in [2012–2017]). The system correctly inferred the prediction of future fractures for query vertebrae, which were confirmed a few years later (MRI in [2018–2021]). Such empirical findings suggest CBIR can support a differential diagnosis in the assessment of local fragility fractures.