用AI自动读取无辐射MRI骨形态，精度接近专家水平
Measurements Automatically Extracted from Zero Echo Time MRI Using Deep Learning Image Segmentation and Geometric Modeling Agree with Expert Manual Readings
- 用深度学习分割骨骼和关键点，再通过几何算法自动算角度
- 多数角度与专家测量一致性高，误差范围比人与人之间还小
- 适合临床研究中快速、无辐射的髋关节形态评估
计算机断层扫描（CT）仍是股骨头髋臼撞击症（FAI）三维骨形态测量的金标准，但需电离辐射且依赖人工测量。零回波时间（ZTE）MRI可显示皮质骨，所得FAI角度与CT一致，但自动化测量仍受限。本研究在横断面研究（证据等级3）中开发并验证了从ZTE MRI自动计算FAI角度的方法。对73名参与者（平均年龄36.8±18.5岁；女性51人，男性22人）进行骨盆ZTE MRI扫描，共获得135个髋关节。使用100个手动标注的髋关节训练nnU-Net模型，实现股骨、骨盆及三个骨性标志的分割。定制几何算法基于分割结果计算α角、股骨颈干角、Tonnis角、冠状面和矢状面中心边缘角以及髋臼旋转角。在35个测试髋关节上，将模型测量结果与两位放射科医生平均手动测量值通过组内相关系数（ICC）和Bland-Altman分析比较。骨组织分割的Dice系数超过0.96，标志点分割的Dice系数为0.65至0.83。中位标志点误差为：股骨头0.38毫米，外侧髋臼0.82毫米，内侧髋臼及大转子均小于2.5毫米。双阅者间ICC在髋臼旋转角、冠状面中心边缘角和Tonnis角上表现优秀（≥0.82），但在α角和股骨颈干角上较差。模型与阅者均值的一致性在髋臼旋转角、冠状面中心边缘角和Tonnis角上优秀（0.92–0.96），中度（0.74）在中段冠状面矢状中心边缘角，α角（0.45）和股骨颈干角（0.55）为中等。模型的Bland-Altman一致性界限优于阅者间差异。完全自动化从ZTE MRI进行形态测量是可行的，且在多数覆盖和旋转角测量上表现可媲美专家。
原文摘要 · Abstract (English)
Computed tomography (CT) remains the reference for 3D osseous morphometry in femoroacetabular impingement (FAI) but requires ionizing radiation and manual measurement. Zero echo time (ZTE) MRI visualizes cortical bone and yields FAI angles that agree with CT, but automated angle extraction remains limited. We developed and validated automated FAI angle computation from ZTE MRI and assessed agreement with expert manual measurements in a cross-sectional study (level of evidence, 3). Pelvic ZTE MRI was acquired in 73 participants (mean age 36.8 +/- 18.5 years; 51 women, 22 men), yielding 135 hips. nnU-Net was trained on 100 manually curated hips to segment the femur, pelvis, and three osseous landmarks. Custom geometric algorithms computed alpha, femoral neck-shaft, Tonnis, coronal and sagittal center-edge, and acetabular version angles from inferred segmentations. Measurements on 35 test hips were compared with the mean of two radiologists' manual measures using intraclass correlation (ICC) and Bland-Altman analysis. Dice exceeded 0.96 for bone and ranged from 0.65 to 0.83 for landmarks. Median landmark error was 0.38 mm (femoral head), 0.82 mm (lateral acetabulum), and <2.5 mm (medial acetabulum, greater trochanter). Interrater ICC was excellent for acetabular version, coronal center-edge, and Tonnis (>=0.82) but poor for alpha and femoral neck-shaft. Model versus rater-mean agreement was excellent for acetabular version, coronal center-edge, and Tonnis (0.92-0.96), good for mid-acetabular sagittal center-edge (0.74), and fair for alpha (0.45) and femoral neck-shaft (0.55). Model Bland-Altman limits of agreement were narrower than interrater limits for most angles. Fully automated morphometric assessment from ZTE MRI is feasible and performs comparably to expert readers for most coverage and version angles.
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