The Feasibility of Texture-based Quantification for Evaluating Lumbar Intervertebral Disc Degeneration in Adolescent Idiopathic Scoliosis from Conventional T2-weighted Magnetic Resonance Imaging
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Abstract:
Objective: To investigate the utility of texture data based on T2-weighted magnetic resonance imaging (MRI) in determining intervertebral disc degeneration in adolescent idiopathic scoliosis (AIS). Materials and Methods: From October 2016 and March 2020, 122 patients with AIS and 40 volunteers who underwent 3.0T MRI were prospectively included. The following MRI texture data were generated: (1) mean, (2) standard deviation, (3) max, (4) min, (5) the fifth, 10th, 25th, 50th, 75th and 90th percentiles; (6) skewness; (7) kurtosis; and (8) entropy. The Pfirrmann system was used to evaluate the intervertebral discs of all participants. Patients with Pm I were divided into groups 1 and 2. Volunteers were classified into 0. Differences and correlations between the groups were analyzed. Results: The mean, standard deviation, max, entropy and the 5th, 10th, 25th, 50th, 75th, and 90th percentiles in group 2 were significantly lower than those in group 1 and group 0; the min in group 2 was significantly lower than in group 0; the skewness in group 2 was significantly higher than in group 1 and group 0; the kurtosis in group 2 was significantly lower than in group 1; the skewness in group 1 was significantly higher than in group 0 and the standard deviation, min, kurtosis and 5th, 10th, 25th, and 50th percentiles in group 1 were significantly lower than those in group 0. Conclusion: Texture analysis can be used to assess early degenerative changes in the intervertebral discs of patients with AIS.
摘要:目的：探讨MRI T2加权成像纹理分析在青少年脊柱侧弯患者椎间盘退变中的应用价值。材料和方法：从2016年10月至2020年3月，前瞻性纳入122例AIS患者和40名志愿者行3.0 T磁共振成像（MRI）检查并得到患者图像MRI纹理参数值：①平均值，②标准差，③最大值，④最小值，⑤第5、10、25、50、75和90百分位数，⑥偏度，⑦峰度，⑧熵。采用Pfirrmann评分对所有参与者的椎间盘进行评估并分组，AIS患者中，评分为Pm I的患者纳入1组，其余患者纳入2组，志愿者纳入0组；分析组间差异性和相关性。结果：2组的均值、标准差、最大值、熵和第5、10、25、50、75、90百分位均显著低于1组和0组；2组min显著低于0组；2组偏度显著高于1组和0组；2组峰度显著低于1组；1组偏度显著高于0组，1组标准差、最小值、峰度和第5、10、25、50百分位显著低于0组。结论：纹理分析可用于评估AIS患者椎间盘早期退行性改变，且优于常规MRI T2加权成像。
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Figure 1. (a) Image of an 18-year-old female volunteer classified as group 0with a mean value of 150.19 ms; (b) Image of a 15-year-old female AIS patients classified as group 1with a mean value of 139.27 ms; (c) Images of a 17-year-old female AIS patients classified as group 2with a mean value of 93.72 ms; (d) Image of the histogram of the three participants in three different groups
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Figure 2. Boxplots of the 5th, 10th, and 25th percentiles. The three parameters can distinguish the differences between the three groups and have a strong negative correlation with g (r=–0.665, –0.652, –0.610)
Table 1 Kruskal-Wallis one-way ANOVA (K sample) test between group 0 and group 1
Paramter Group P 0 1 mean 202.103±74.038 180.604±47.484 1.000 standard-deviation 62.857±22.634 77.961±25.300 0.012* min 28.325±18.993 9.819±6.796 <0.001* max 301.825±97.987 326.010±97.248 0.336 5th percentile 86.000±32.214 48.521±18.381 <0.001* 10th percentile 106.150±36.778 68.202±23.571 <0.001* 25th percentile 156.250±61.812 116.617±35.037 0.001* 50th percentile 217.700±84.736 190.276±51.065 0.450* 75th percentile 249.500±88.844 246.914±67.077 1.000 90th percentile 272.250±93.633 275.617±77.267 1.000 skewness −0.538±0.246 −0.324±0.302 0.004* kurtosis 2.470±0.456 2.080±0.335 <0.001* entropy 5.264±0.216 5.410±0.354 0.136 NOTE: Mean and percentile values are in units of ms. Mean=mean T2 relaxation time; standard deviation=spread of distribution; min=minimum T2 relaxation time; max=maximum T2 relaxation time; the 5th, 10th, 25th, 50th, 75th, and 90th percentiles=nth percentile T2 relaxation time of a cumulative histogram; skewness=histogram asymmetry degree around the mean; kurtosis=measurement of the histogram sharpness; entropy=the distribution of T2 relaxation time levels over the ROI. *−Statistically significant. P<0.05 was considered statistically significant in differentiating the groups 0 ~ 1. 
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Table 2 Kruskal-Wallis one-way ANOVA (K sample) test between group 0 and group 2
Paramter Group P 0 2 mean 202.103±74.038 78.691±44.100 <0.001* standard-deviation 62.857±22.634 34.065±16.268 <0.001* min 28.325±18.993 11.142±17.504 <0.001* max 301.825±97.987 163.821±71.492 <0.001* 5th percentile 86.000±32.214 29.178±28.686 <0.001* 10th percentile 106.150±36.778 36.178±31.232 <0.001* 25th percentile 156.250±61.812 51.928±38.613 <0.001* 50th percentile 217.700±84.736 75.357±44.333 <0.001* 75th percentile 249.500±88.844 103.892±53.918 <0.001* 90th percentile 272.250±93.633 126.500±62.421 <0.001* skewness −0.538±0.246 0.233±0.406 <0.001* kurtosis 2.470±0.456 2.499±0.552 1.000 entropy 5.264±0.216 4.636±0.313 <0.001* NOTE: mean and all percentile values are in units of ms. Mean=mean T2 relaxation time; standard deviation=spread of distribution; min=minimum T2 relaxation time; max=maximum T2 relaxation time;the 5th, 10th, 25th, 50th, 75th, and 90th percentiles=nth percentile T2 relaxation time of a cumulative histogram; skewness=histogram asymmetry degree aroundthe mean; kurtosis=measurement ofthe histogram sharpness; entropy=the distribution of T2 relaxation time levels overthe ROI. *−Statistically significant. P<0.05 was considered statistically significant in differentiatingthe group 0 ~ 2.
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Table 3 Kruskal-Wallis one-way ANOVA (K sample) test between group 1 and group 2
Paramter Group P 1 2 mean 180.604±47.484 78.691±44.100 <0.001* standard-deviation 77.961±25.300 34.065±16.268 <0.001* min 9.819±6.796 11.142±17.504 0.280 max 326.010±97.248 163.821±71.492 <0.001* 5th percentile 48.521±18.381 29.1785±28.686 <0.001* 10th percentile 68.202±23.571 36.178±31.232 <0.001* 25th percentile 116.617±35.037 51.928±38.613 <0.001* 50th percentile 190.276±51.065 75.357±44.333 <0.001* 75th percentile 246.914±67.077 103.892±53.918 <0.001* 90th percentile 275.617±77.267 126.5±62.421 <0.001* skewness −0.324±0.302 0.233±0.406 <0.001* kurtosis 2.080±0.335 2.499±0.552 <0.001* entropy 5.410±0.354 4.636±0.313 <0.001* NOTE: Mean and all percentile values are in units of ms. Mean=mean T2 relaxation time; standard deviation=spread of distribution; min=minimum T2 relaxation time; max=maximum T2 relaxation time;the 5th, 10th, 25th, 50th, 75th, and 90th percentiles=nth percentile T2 relaxation time of a cumulative histogram; skewness=histogram asymmetry degree aroundthe mean; kurtosis=measurement ofthe histogram sharpness; entropy=the distribution of T2 relaxation time levels overthe ROI. *−Statistically significant. P<0.05 was considered statistically significant in differentiatingthe group 1 ~ 2.
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Table 4 Receiver operating characteristic curves of histogram parameters in distinguishing different groups
Parameter Cut-off Sensitivity/% Specificity/% Accuracy AUC P Group 0 vs. Group 1 mean 142.840 28.700 95.000 0.485 0.548 0.380 standard-deviation 63.500 64.900 80.000 0.694 0.679 <0.001* min 23.000 98.900 57.500 0.865 0.796 <0.001* max 345.000 44.700 87.500 0.574 0.599 0.064 5th percentile 61.000 73.400 90.000 0.783 0.865 <0.001* 10th percentile 70.000 60.600 95.000 0.708 0.823 <0.001* 25th percentile 100.000 48.900 95.000 0.626 0.727 <0.001* 50th percentile 160.000 38.300 95.000 0.552 0.594 0.072 75th percentile 199.000 70.200 50.000 0.641 0.530 0.591 90th percentile 286.000 41.500 80.000 0.529 0.540 0.475 skewness −0.300 52.100 100.000 0.664 0.695 <0.001* kurtosis 1.950 48.900 100.000 0.641 0.767 <0.001* entropy 5.450 53.200 90.000 0.641 0.637 0.005* Group 0 vs. Group 2 mean 139.300 92.900 95.000 0.941 0.954 <0.001* standard-deviation 40.360 78.600 100.0000 0.911 0.879 <0.001* min 9.000 82.100 80.000 0.808 0.809 <0.001* max 194.000 82.100 92.500 0.882 0.901 <0.001* 5th percentile 52.000 89.300 95.000 0.926 0.933 <0.001* 10th percentile 70.000 92.900 95.000 0.941 0.945 <0.001* 25th percentile 92.000 92.900 100.000 0.970 0.955 <0.001* 50th percentile 142.000 96.400 95.000 0.955 0.967 <0.001* 75th percentile 134.000 85.700 100.000 0.941 0.934 <0.001* 90th percentile 168.000 85.700 100.000 0.941 0.921 <0.001* skewness −0.300 89.300 100.000 0.955 0.937 <0.001* kurtosis 2.480 50.000 70.000 0.617 0.538 0.6111 entropy 5.020 92.900 90.000 0.911 0.962 <0.001* Group 1 vs. Group 2 mean 96.170 85.700 100.000 0.967 0.941 <0.001* Standard-deviation 41.780 82.100 95.700 0.926 0.936 <0.001* min 8.000 78.600 52.100 0.581 0.634 0.042* max 182.000 78.600 100.000 0.950 0.929 <0.001* 5th percentile 30.000 82.100 86.200 0.852 0.839 <0.001* 10th percentile 40.000 82.100 94.700 0.918 0.870 <0.001* 25th percentile 69.000 85.700 96.800 0.942 0.929 <0.001* 50th percentile 127.000 89.300 95.700 0.942 0.960 <0.001* 75th percentile 134.000 85.700 100.000 0.967 0.952 <0.001* 90th percentile 168.000 85.700 98.900 0.959 0.936 <0.001* skewness 0.010 75.000 88.300 0.852 0.863 <0.001* kurtosis 2.030 85.700 64.900 0.696 0.750 <0.001* entropy 4.890 82.100 90.400 0.885 0.937 <0.001* NOTE: Mean and all percentile values are in units of ms. Mean=mean T2 relaxation time; standard deviation=spread of distribution; min=minimum T2 relaxation time; max=maximum T2 relaxation time; 5th, 10th, 25th, 50th, 75th, and 90th percentiles=nth percentile T2 relaxation time of a cumulative histogram; skewness=degree of histogram asymmetry around the mean; kurtosis=measurement of histogram sharpness; entropy=distribution of T2 relaxation time levels over the ROI. AUC: area under the receiver operating characteristic (ROC) curve. *−P<0.05.
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Table 5 Intra- and Interobserver Agreement of All Parameters
Parameter Intraobserver agreement Interobserver agreement P ICC 95% CI ICC 95% CI mean 0.852 0.804, 0.890 0.819 0.761, 0.864 <0.001 standard deviation 0.869 0.826, 0.902 0.836 0.783, 0.877 <0.001 min 0.856 0.808, 0.892 0.806 0.745, 0.854 <0.001 max 0.881 0.841, 0.911 0.838 0.785, 0.879 <0.001 percentile 5 0.846 0.796, 0.885 0.809 0.748, 0.856 <0.001 percentile 10 0.866 0.822, 0.900 0.830 0.775, 0.872 <0.001 percentile 25 0.869 0.826, 0.902 0.810 0.749, 0.857 <0.001 percentile 50 0.900 0.865, 0.925 0.882 0.842, 0.912 <0.001 percentile 75 0.874 0.832, 0.906 0.836 0.783, 0.877 <0.001 percentile 90 0.900 0.865, 0.925 0.882 0.842, 0.912 <0.001 skewness 0.916 0.887, 0.938 0.899 0.865, 0.925 <0.001 kurtosis 0.887 0.849, 0.916 0.817 0.759, 0.863 <0.001 entropy 0.828 0.773, 0.871 0.803 0.741, 0.852 <0.001 NOTE: mean and all percentile values are in units of ms. Mean, mean T2 relaxation time; standard deviation, spread of distribution; min, minimum T2 relaxation time; max, maximum T2 relaxation time; the 5th, 10th, 25th, 50th, 75th, and 90th percentiles, nth percentile T2 relaxation time of a cumulative histogram; skewness, histogram asymmetry degree around the mean; kurtosis, measurement of the histogram sharpness; entropy the distribution of T2 relaxation time levels over the ROI. Abbreviations: ICC, intraclass correlation coefficient; CI, confidence interval. *-P<0.05.
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