Computer-assisted measurement of sagittal pelvic alignment parameters from radiographic images
Abstract
Background: Sagittal pelvic alignment is an important aspect of the sagittal balance that can be quantitatively assessed by measuring pelvic geometrical parameters, i.e. the sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). In this paper we present the results of a completely automated computer-assisted measurement of the parameters of sagittal pelvic alignment from radiographic images, and test the hypothesis stating that there are no statistically significant differences between the obtained and reference manual measurements.
Methods: Automated computer-assisted measurements of the sagittal pelvic alignment parameters are based on the latest technologies in the field of medical image processing and analysis, namely on the convolutional neural networks as a special group of deep learning techniques. In each sagittal radiographic image of the pelvis, regions of interest (sacral endplate and both femoral heads) are first automatically defined, and then distinctive points are detected within these regions, i.e. the anterior edge, the center and the posterior edge of the sacral endplate, to which a line is fitted at a later stage, and the centers of both femoral heads with the corresponding midpoint representing the hip axis. From the hip axis, and the line along the sacral endplate and its center point we can finally compute SS, PT and PI.
Results: Measurements were retrospectively performed on sagittal radiographic images of the pelvis from 38 subjects (15 males and 23 females; mean age 71.1 years). Statistical analysis of reference manual and automated computer-assisted measurements of the sagittal pelvic alignment parameters revealed a relatively good agreement and low variability. Respectively for SS, PT and PI, the mean absolute difference (standard deviation) was namely 5.2º (3.8º), 2.2º (2.0º) and 5.1º (4.4º), the correlation coefficient was 0.73, 0.94 and 0.82 (p < 10-6), and the paired t-test always confirmed the null hypothesis (p > 0.05).
Conclusion: The results showed that there are no statistically significant differences between the reference manual and automated computer-assisted measurements of the sagittal pelvic alignment parameters. Moreover, the deviation from reference manual measurements is within the repeatability and reliability of manual parameter measurements, and therefore the parameters of sagittal pelvic alignment can be accurately determined by the automated computer-assisted measurement. Nevertheless, verification and confirmation of measured values cannot be completely omitted, as the deviation can be for specific cases quite large, especially due to the natural biological variability of the human anatomy and properties of radiographic imaging.
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Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997 Dec;90(6):967–73. https://doi.org/10.1016/S0029-7844(97)00534-6 PMID:9397113
Sabry M, Al-Hendy A. Medical treatment of uterine leiomyoma. Reprod Sci. 2012 Apr;19(4):339–53. https://doi.org/10.1177/1933719111432867 PMID:22378865
Parker WH. Uterine myomas: management. Fertil Steril. 2007 Aug;88(2):255–71. https://doi.org/10.1016/j.fertnstert.2007.06.044 PMID:17658523
Talaulikar VS, Manyonda I. Progesterone and progesterone receptor modulators in the management of symptomatic uterine fibroids. Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):135–40. https://doi.org/10.1016/j.ejogrb.2012.07.023 PMID:22901974
Sankaran S, Manyonda IT. Medical management of fibroids. Best Pract Res Clin Obstet Gynaecol. 2008 Aug;22(4):655–76. https://doi.org/10.1016/j.bpobgyn.2008.03.001 PMID:18468953
Trefoux Bourdet A, Luton D, Koskas M. Clinical utility of ulipristal acetate for the treatment of uterine fibroids: current evidence. Int J Womens Health. 2015 Mar;7:321–30. PMID:25848323
Edifix has not found an issue number in the journal reference. Please check the volume/issue information. (Ref. 6 "Trefoux Bourdet, Luton, Koskas, 2015")
Ribič-Pucelj M. Tomaževič T. Vogler A. Laparoskopska miomektomija. In: Ribič- Pucelj M. Endoskopske operacije v ginekologiji. Radovljica: Didakta; 2007. p. 207–15.
Edifix Bibliographic Reference Processing failed to fully style this reference. Please check the copyediting. (Ref. 7 "Ribič-Pucelj, 2007")
Brun JL, Rajaonarison J, Froeliger A, Monseau-Thiburce AC, Randriamboavonjy R, Vogler A. Outcome of patients with uterine fibroids after 3-month ulipristal acetate therapy. Eur J Obstet Gynecol Reprod Biol. 2018 Mar;222:13–8. https://doi.org/10.1016/j.ejogrb.2017.12.033 PMID:29328939
Edifix has not found an issue number in the journal reference. Please check the volume/issue information. (Ref. 8 "Brun, Rajaonarison, Froeliger, Monseau-Thiburce, Randriamboavonjy, Vogler, 2018")
Sinai Talaulikar V, Belli AM, Manyonda I. GnRH agonists: do they have a place in the modern management of fibroid disease? J Obstet Gynaecol India. 2012 Oct;62(5):506–10. https://doi.org/10.1007/s13224-012-0206-0 PMID:24082548
Lethaby A, Vollenhoven B, Sowter M. Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review. BJOG. 2002 Oct;109(10):1097–108. https://doi.org/10.1111/j.1471-0528.2002.01225.x PMID:12387461
Mavrelos D, Ben-Nagi J, Davies A, Lee C, Salim R, Jurkovic D. The value of pre-operative treatment with GnRH analogues in women with submucous fibroids: a double-blind, placebo-controlled randomized trial. Hum Reprod. 2010 Sep;25(9):2264–9. https://doi.org/10.1093/humrep/deq188 PMID:20663795
Donnez J, Vázquez F, Tomaszewski J, Nouri K, Bouchard P, Fauser BC, et al.; PEARL III and PEARL III Extension Study Group. Long-term treatment of uterine fibroids with ulipristal acetate. Fertil Steril. 2014 Jun;101(6):1565–73.e1. https://doi.org/10.1016/j.fertnstert.2014.02.008 PMID:24630081
Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J, et al. Long-term medical management of uterine fibroids with ulipristal acetate. Fertil Steril. 2016 Jan;105(1):165–173.e4. https://doi.org/10.1016/j.fertnstert.2015.09.032 PMID:26477496
Powell M, Dutta D. Esmya® and the PEARL studies: A review. Womens Health (Lond). 2016 Nov;12(6):544–8. https://doi.org/10.1177/1745505717692591 PMID:29334010
Donnez J, Tomaszewski J, Vázquez F, Bouchard P, Lemieszczuk B, Baró F, et al.; PEARL II Study Group. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med. 2012 Feb;366(5):421–32. https://doi.org/10.1056/NEJMoa1103180 PMID:22296076
Biglia N, Carinelli S, Maiorana A, D’Alonzo M, Lo Monte G, Marci R. Ulipristal acetate: a novel pharmacological approach for the treatment of uterine fibroids. Drug Des Devel Ther. 2014 Feb;8:285–92. PMID:24591818
Edifix has not found an issue number in the journal reference. Please check the volume/issue information. (Ref. 16 "Biglia, Carinelli, Maiorana, D’Alonzo, Lo Monte, Marci, 2014")
Fiscella J, Bonfiglio T, Winters P, Eisinger SH, Fiscella K. Distinguishing features of endometrial pathology after exposure to the progesterone receptor modulator mifepristone. Hum Pathol. 2011 Jul;42(7):947–53. https://doi.org/10.1016/j.humpath.2010.11.003 PMID:21315422
Williams AR, Bergeron C, Barlow DH, Ferenczy A. Endometrial morphology after treatment of uterine fibroids with the selective progesterone receptor modulator, ulipristal acetate. Int J Gynecol Pathol. 2012 Nov;31(6):556–69. https://doi.org/10.1097/PGP.0b013e318251035b PMID:23018219
Donnez J, Tatarchuk TF, Bouchard P, Puscasiu L, Zakharenko NF, Ivanova T, et al.; PEARL I Study Group. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med. 2012 Feb;366(5):409–20. https://doi.org/10.1056/NEJMoa1103182 PMID:22296075
Sabry M, Al-Hendy A. Innovative oral treatments of uterine leiomyoma. Obstet Gynecol Int. 2012;2012:943635. https://doi.org/10.1155/2012/943635 PMID:22518167
Edifix has not found an issue number in the journal reference. Please check the volume/issue information. (Ref. 20 "Sabry, Al-Hendy, 2012")
Duhan N. Current and emerging treatments for uterine myoma - an update. Int J Womens Health. 2011;3(1):231–41. https://doi.org/10.2147/IJWH.S15710 PMID:21892334
Ginsburg ES, Benson CB, Garfield JM, Gleason RE, Friedman AJ. The effect of operative technique and uterine size on blood loss during myomectomy: a prospective randomized study. Fertil Steril. 1993 Dec;60(6):956–62. https://doi.org/10.1016/S0015-0282(16)56392-4 PMID:8243699
Leone Roberti Maggiore U, Scala C, Venturini PL, Ferrero S. Preoperative treatment with letrozole in patients undergoing laparoscopic myomectomy of large uterine myomas: a prospective non-randomized study. Eur J Obstet Gynecol Reprod Biol. 2014 Oct;181:157–62. https://doi.org/10.1016/j.ejogrb.2014.07.040 PMID:25150954
Edifix has not found an issue number in the journal reference. Please check the volume/issue information. (Ref. 23 "Maggiore, Scala, Venturini, Ferrero, 2014")
Donnez J, Hudecek R, Donnez O, Matule D, Arhendt HJ, Zatik J, et al. Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids. Fertil Steril. 2015 Feb;103(2):519–27.e3. https://doi.org/10.1016/j.fertnstert.2014.10.038 PMID:25542821
Rabe T, Ahrendt HJ, Albring C, Bitzer J, Bouchard P, Cirkel U, et al. Ulipristal acetate for symptomatic uterine fibroids and myoma-related hypermenorrhea: joint statement by the german society for gynecological endocrinology and reproductive medicine (DGGEF) and the german professional association of gynecologist (BVF). J Reproduktionsmed Endokrinol. 2013;10(1):82–101.
In the original reference, the issue number preceded the volume number: "(1);10:". Please check the reference carefully. (Ref. 25 "Rabe, Ahrendt, Albring, Bitzer, Bouchard, Cirkel, et al., 2013")
Edifix does not recognize the journal "J Reproduktionsmed Endokrinol.". If this is a valid journal title, please send this reference to journals@inera.com for addition to our journal database. (Ref. 25 "Rabe, Ahrendt, Albring, Bitzer, Bouchard, Cirkel, et al., 2013")
Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011 Oct;378(9800):1396–407. https://doi.org/10.1016/S0140-6736(11)61381-0 PMID:21982521
European medicines agency. Science medicines health, Esmya. Available from: http://www.ema.europa.eu/docs/sl_SI/document_library/EPAR_-_Summary_for_the_public/human/002041/WC500124089.pdf
European medicines agency. Science medicines health, Esmya. Available from: http://www.ema.europa.eu/docs/sl_SI/document_library/EPAR_-_Product_Information/human/002041/WC500124085.pdf
European medicines agency. Pharmacovigilance Assessment Committee (PRAC). Assessment report on provisional measures. EMA/97889/2018; 2018: 1–23.
Luyckx M, Squifflet JL, Jadoul P, Votino R, Dolmans MM, Donnez J. First series of 18 pregnancies after ulipristal acetate treatment for uterine fibroids. Fertil Steril. 2014 Nov;102(5):1404–9. https://doi.org/10.1016/j.fertnstert.2014.07.1253 PMID:25241376
Monleón J, Martínez-Varea A, Galliano D, Pellicer A. Successful pregnancy after treatment with ulipristal acetate for uterine fibroids. Case Rep Obstet Gynecol. 2014;2014:314587. https://doi.org/10.1155/2014/314587 PMID:25143845
The page range was updated but differs from the author's original: 1–3. (Ref. 31 "Monleón, Martínez-Varea, Galliano, Pellicer, 2014")
Edifix has not found an issue number in the journal reference. Please check the volume/issue information. (Ref. 31 "Javier Monleón, Martínez-Varea, Daniela Galliano, Pellicer, 2014")
Murad K. Spontaneous pregnancy following ulipristal acetate treatment in a woman with a symptomatic uterine fibroid. J Obstet Gynaecol Can. 2016 Jan;38(1):75–9. https://doi.org/10.1016/j.jogc.2015.11.004 PMID:26872760
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