Statistical Shape Analysis of the Proximal Femur: Development of a Fully Automatic Segmentation System and its Applications

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Abstract

Osteoarthritis (OA) is the most common form of human joint disease causing significant pain and disability. Current treatment for hip OA is limited to pain management and joint replacement for end-stage disease. The development of methods for early diagnosis and new treatment options are urgently needed to minimise the impact of the disease.Studies of hip OA have shown that hip joint morphology correlates with susceptibility to hip OA and disease progression. Bone shape analyses play an important role in disease diagnosis, pre-operative planning, and treatment analysis as well as in epidemiological studies aimed at identifying risk factors for hip OA. Statistical Shape Models (SSMs) are being increasingly applied to imaging-based bone shape analyses as they provide a means of quantitatively describing the global shape of the bone. This is in contrast to conventional clinical and research practice where the analysis of bone shape is reduced to a series of measurements of lengths and angles.This thesis describes the development of a novel fully automatic software system that segments the proximal femur from anteroposterior (AP) pelvic radiographs by densely placing 65 points along its contour. These annotations can then be used for the detailed morphometric analysis of proximal femur shape. The performance of the system was evaluated on a large dataset of 839 radiographs of mixed quality. Achieving a mean point-to-curve error of less than 0.9mm for 99% of all 839 AP pelvic radiographs, this is the most accurate and robust automatic method for segmenting the proximal femur in two-dimensional radiographs yet published.The system was also applied to a number of morphometric analyses of the proximal femur, showing that SSM-based radiographic proximal femur shape significantly differs between males and females, and is highly symmetric between the left and right hip joint of an individual. In addition, the research described in this thesis demonstrates how the point annotations resulting from the system can be used for univariate and multivariate genetic association analyses, identifying three novel genetic variants that contribute to radiographic proximal femur shape while also showing an association with hip OA.The developed system will facilitate complex morphometric and genetic analyses of shape variation of the proximal femur across large datasets, paving the way for the development of new options to diagnose, treat and prevent hip OA.

Keyword(s)

Computer vision; Feature point detection; Image segmentation; Osteoarthritis; Proximal femur morphology; Statistical shape models

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