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569
Latifa Hamami1
1
Laboratoire Signal et Communications, Dpartement d'Electronique, Ecole Nationale Polytechnique, 16200 Alger, Algrie
Dpartement Maintenance Industrielle, Facult des Sciences de l'Ingnieur, Universit M'Hamed Bougara Boumerdes, 35000 Boumerdes, Algrie
Abstract
Osteoporosis is a condition that is characterized by low bone mass and microarchitectural deterioration of bone
tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. This paper develops an
interconnectivity index for trabecular bone microarchitecture characterization for the discrimination of patients with
different degrees of osteoporosis. A total of seventy one images of the calcaneus (heel bone) from subjects suffering
from osteoporosis at different stages were analyzed. A fractal-based method (lacunarity), which quantifies the porosity
of the bone, is used as a comparative tool to estimate correlations between interconnectivity indexes and the disease.
Bone features are used to classify the subjects using a support vector machine (SVM) classifier. The correlation
between the proposed interconnectivity index and the disease was found to better than that between an existing index
and the disease. Statistical analysis results suggest that the proposed parameter is efficient for monitoring bone strength
and predicting future fracture risk. Moreover, results obtained using SVM with features from the proposed index
provide better accuracy and smaller error for classifying patients compared to those obtained with an existing index.
Keywords: Osteoporosis, Texture analysis, Lacunarity, Interconnectivity index, Bone mineral density (BMD), Support
vector machine (SVM)
1. Introduction
Osteoporosis is a skeletal disease characterized by low
bone mass and deterioration of bone microarchitecture, leading
to increased risk of fracture. [1]. Bone microarchitecture is an
important factor to be taken into account in assessing bone
strength, and is a complementary risk factor to bone mineral
density (BMD) measurement [2]. Trabecular microarchitecture
characterization cannot be routinely obtained by noninvasive
methods and requires a bone biopsy with histomorphometric
analysis. For this reason, researchers have developed
noninvasive methods for characterizing trabecular bone
microarchitecture [3,4].
One of the most used methods for characterizing
trabecular bone is that based on fractals. Fractal models are
suited for describing medical image textures, with fractal
dimension often used as a descriptor in texture analysis [5-7].
Lacunarity, which is another descriptor of texture, was
introduced for measuring the distribution of voids in a
geometric object, with the object being more lacunar than
others if its void sizes are distributed over a wider range [8].
* Corresponding author: Khaled Harrar
Tel: +213-0-550446659; Fax: +213-0-21522973
E-mail: harrar_k@umbb.dz
570
(a)
(b)
(c)
(d)
(e)
(a)
(b)
(c)
(d)
Figure 2. Binary images related to the previous ROI. (a) Control case,
(b) osteopenic patient, (c) osteoporotic patient, and (d) severe
osteoporotic case.
p p 2Q( p, r )
Z ( 2 ) (r )
BG (r ) (1) 2
Z (r )
[ pQ( p, r )]2
(1)
571
(r )
2 (r )
2
(2)
(3)
The trabecular network, defined as connectivity, is a threedimensional property that describes the topology of the various
connections between the nodes and the connecting segments
(struts and termini). The struts refer to trabeculae. A link
between three or more struts constitutes a node. When one side
of a strut is not joined to a node, it is referred to as a free end or
termini, which represents an interruption in the trabecular
network [21].
2.4.2. New interconnectivity index (NDX)
2.4.2.1. Interconnectivity index (ICI)
The existing ICI was originally proposed by Le et al. [22]
to describe the connectivity of porous biomaterials. It is based
Nd NNd
T ( NNdTm 1)
(4)
(5)
(6)
2
BS / BV
(7)
TV
TV
BV / TV
TbTh
1
TbTh
TbN
(8)
(9)
(10)
br _ size
(11)
R NNd V TbTh
( NTm NNdTm) Dist TbSp
(12)
2
1
w i yi wT xi b 1
2
max
w , b ,
i 1
with
i 0
n
n
w i yi xi 0 and i yi 0
i 1
i 1
(13)
572
f ( x) i yi k ( xi , x)
i 1
(14)
3. Results
Linear correlation analysis was done using Pearsons r.
The ability of the parameters to discriminate the four groups is
given by the p-value obtained using the non-parametrical
Kruskal-Wallis test (a test is considered as statistically
significant if p < 0.05).
To evaluate the classification, the confusion matrix was
used. The following properties were defined: standard error
(SE), true positive (TP), false positive (FP) , true negative (TN),
false negative (FN), true positive rate (TPR %), sensitivity, or
recall = TP/(TP + FN), false positive rate (FPR %) = (1
specificity) = FP/(FP + TN), specificity (SPC) or true negative
rate = TN/(TN + FP), positive predictive value (PPV %) or
precision = TP/(TP + FP), and accuracy (Acc %) = (TP+TN)/
(TP + FP + TN + FN).
The confusion matrix for a k-class classification problem
is presented in Table 1, where Ci denotes the class label of the
ith class. From Table 1, for class i, the true positive TP(i) = nii
12
C1
C2
.
.
.
Ck
True
class
Ck
n1k
n2k
.
.
.
nkk
2.5
NO
OP
OS
SOS
10
8
6
4
2
0
20
ji
and the false positive FP(i) = j
.The true negative,
1, j i
denoted by TN(i), equals the sum of the elements of the
confusion matrix with the column and row corresponding to
j 1, j i
ij
. The
Acc
i 1 ij
k
12
y = -5.51 x + 8.03,
Pi
j 1
(17)
n ji
All these properties were calculated for ICI and NDX, and
were studied to evaluate classification performance.
The lacunarity scatter plots for the four subjects (binary
test images) are shown in Fig. 4. The sampling boxes (r) are up
to 25 pixels. The image of the patient suffering from
osteoporosis with risk of fracture is the most lacunar. The
image of the NO case has the lowest lacunarity.
0.6
NO
OP
OS
SOS
0.5
Lacunarity (r)
0.5
0
80
20
40
Subjects
60
80
r2 = 0.51
2.5
NO
OP
OS
SOS
8
6
2
0
0.2
0.4
0.6
Lacunarity
0.8
NO
OP
OS
SOS
1.5
0.5
0
(a)
0.2
0.4
0.6
Lacunarity
0.8
(b)
nii
(b)
10
(16)
j 1 ij
1.5
i , j 1 ij
nii
60
Figure 5. Classification of the four groups using (a) ICI and (b) NDX.
(15)
40
Subjects
NO
OP
OS
SOS
(a)
C1
n11
n21
.
.
.
nk1
Predicted class
C2
n12
n22
.
.
.
.
.
.
nk2
573
0.4
ICI
NDX
BV
BS
TV
TbN
TbTh
V
S
TbSp
T
Nd
Tm
R
NNd
NTm
NNdTm
Dist
0.3
0.2
0.1
0
0
10
15
Box size r
20
25
Ns : Not significant
1
-0.71
-0.95
-0.81
-0.02
Null
0.02
-0.55
-0.81
0.55
0.44
0.78
-0.64
0.39
-0.90
-0.86
0.71
0.16
0.47
ICI
-0.71
1
0.77
0.72
-0.03
Null
-0.03
0.49
0.72
-0.50
-0.37
-0.74
0.48
-0.43
0.80
0.68
-0.66
-0.22
-0.27
NDX
-0.95
0.77
1
0.85
0.04
Null
0.04
0.52
0.85
-0.52
-0.51
-0.80
0.67
-0.39
0.92
0.89
-0.73
-0.14
-0.50
p-value
0.0003
0.0007
< 0.0001
0.001
0.9
Ns*
0.89
0.04
0.001
0.04
0.05
0.001
0.003
0.02
0.0004
0.0009
0.73
0.004
0.0008
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
NO
NO
OP
OP
OS
OS
SOS
SOS
(a)
2.5
10
9
8
NDX
ICI
7
6
1.5
5
4
3
2
NO
NO
OP
OP
OS
OS
SOS
SOS
0.5
NO
NO
(b)
OP
OP
OS
OS
SOS
SOS
(c)
Figure 7. Mean SD values for (a) , (b) ICI, and (c) NDX. The boxes
represent 95% confidence intervals of the values.
Actual
Classes
NO
OP
OS
SOS
Classified as
NO OP OS SOS
5
6
0
0
4
9
5
1
0
3
26
2
0
0
3
7
ACC = 47/71 = 66.19 %
SE = 24/71 = 33.8 %
TPR
45.5
47.4
83.9
70
FPR
6.7
17.3
20
4.9
Precision
55.6
50
76.5
70
Actual
Classes
NO
OP
OS
SOS
Classified as
NO OP OS SOS
10
1
0
0
0
17
2
0
0
1
30
0
0
0
0
10
ACC = 67/71 = 94.36 %
SE = 4/71 = 5.63 %
TPR
90.9
89.5
96.8
100
FPR
0
3.8
5
0
Precision
90.9
89.5
96.8
100
4. Discussion
To monitor osteoporosis, hip and lumbar spine scans are
used since these locations are considered as preferential
measurement sites [29]. Measurements made at various sites
show differences due to variability in the bone tissue [29]. The
present study uses the calcaneus because of the limited soft
tissues surrounding this bone. Soft tissues could increase the
574
575
5. Conclusion
This study developed and validated a new interconnectivity
index that takes into account new architectural parameters to
discriminate subjects suffering from osteoporosis. The proposed
index had a higher correlation coefficient value (r = -0.95) and a
lower p-value (p < 0.0001) compared to those of an existing
index. To highlight the use of new parameters, multiclass SVMs
were used to classify subjects. The results show that the
proposed index achieved 94.36% correct classification, whereas
the existing index achieved just 66.19% correct classification. In
conclusion, histomorphometry and fractal analysis of bone
texture from calcaneus radiographs are considered as simple,
low-radiation, and reproducible techniques for assessing bone
fragility. Being independent of bone density, these methods
could be complementary to BMD measurements. Several
techniques (fractal analysis, structural methods) need to be used
in parallel to understand the pathophysiological mechanisms of
osteoporotic states.
Acknowledgment
The authors wish to thank Prof. R. Jennane for his help.
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