Int J Med Robot 2018 Dec 2;14(6):e1947. Epub 2018 Aug 2.
Orthopaedic and Trauma Department, "Luigi Sacco" Hospital, ASST FBF-Sacco, Milan, Italy.
Background: The quantitative morphological analysis of the trochlear region in the distal femur and the precise staging of the potential dysplastic condition constitute a key point for the use of personalized treatment options for the patella-femoral joint. In this paper, we integrated statistical shape models (SSM), able to represent the individual morphology of the trochlea by means of a set of parameters and stacked sparse autoencoder (SSPA) networks, which exploit the parameters to discriminate among different levels of abnormalities.
Methods: Two datasets of distal femur reconstructions were obtained from CT scans, including pathologic and physiologic shapes. Both of them were processed to compute SSM of healthy and dysplastic trochlear regions. The parameters obtained by the 3D-3D reconstruction of a femur shape were fed into a trained SSPA classifier to automatically establish the membership to one of three clinical conditions, namely, healthy, mild dysplasia, and severe dysplasia of the trochlea. The validation was performed on a subset of the shapes not used in the construction of the SSM, by verifying the occurrence of a correct classification.
Results: A major finding of the work is that SSM are able to represent anomalies of the trochlear geometry by means of specific eigenmodes of variation and to model the interplay between morphologic features related to dysplasia. Exploiting the patient-specific morphing parameters of SSM, computed by means of a 3D-3D reconstruction, SSPA is demonstrated to outperform traditional discriminant analysis in classifying healthy, mild, and severe trochlear dysplasia providing 99%, 97%, and 98% accuracy for each of the three classes, respectively (discriminant analysis accuracy: 85%, 89%, and 77%).
Conclusions: From a clinical point of view, this paper contributes to support the increasing role of SSM, integrated with deep learning techniques, in diagnostics and therapy definition as quantitative and advanced visualization tools.