A Novel Method to Measure the Sagittal Curvature in Spinal Deformities: The Reliability and Feasibility of 3-D Ultrasound Imaging

Lee, Timothy Tin-Yan; Jiang, Wei; Cheng, Connie Lok Kan; Lai, Kelly Ka-Lee; To, Michael; Castelein, René M.; Zheng, Yongping

doi:10.1016/j.ultrasmedbio.2019.05.031

Cited by 21 publications

(20 citation statements)

References 51 publications

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“…Such a study, however, seems practically and ethically very difficult to perform, using radiographs in asymptomatic children. Nonionizing 3-D spinal ultrasound seems a promising technique for those research questions that require prospective follow-up of pediatric spinal morphology, this is the topic of an ongoing study [23]. Based on the heterogeneity of sagittal patterns in the population of Fruergaard et al and the present study, it would be recommended that also other factors that affect sagittal alignment, such as the individual changes of pelvic morphology during growth and BMI, are taken into account [17,24].…”

Section: Discussionmentioning

confidence: 85%

Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Schlösser

Castelein

Grobost³

et al. 2021

Eur Spine J

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Purpose The complex three-dimensional spinal deformity in AIS consists of rotated, lordotic apical areas and neutral junctional zones that modify the spine’s sagittal profile. Recently, three specific patterns of thoracic sagittal ‘malalignment’ were described for severe AIS. The aim of this study is to define whether specific patterns of pathological sagittal alignment are already present in mild AIS. Methods Lateral spinal radiographs of 192 mild (10°–20°) and 253 severe (> 45°) AIS patients and 156 controls were derived from an international consortium. Kyphosis characteristics (T4–T12 thoracic kyphosis, T10–L2 angle, C7 slope, location of the apex of kyphosis and of the inflection point) and sagittal curve types according to Abelin-Genevois were systematically compared between the three cohorts. Results Even in mild thoracic AIS, already 49% of the curves presented sagittal malalignment, mostly thoracic hypokyphosis, whereas only 13% of the (thoraco) lumbar curves and 6% of the nonscoliosis adolescents were hypokyphotic. In severe AIS, 63% had a sagittal malalignment. Hypokyphosis + thoracolumbar kyphosis occurred more frequently in high-PI and primary lumbar curves, whereas cervicothoracic kyphosis occurred more in double thoracic curves. Conclusions Pathological sagittal patterns are often already present in curves 10°–20°, whereas those are rare in non-scoliotic adolescents. This suggests that sagittal ‘malalignment’ patterns are an integral part of the early pathogenesis of AIS.

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Section: Discussionmentioning

confidence: 85%

Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Schlösser

Castelein

Grobost³

et al. 2021

Eur Spine J

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“…The ultrasonography system also contains adjustable supporters at the level of the anterior superior iliac spines and clavicles, facilitating subjects with different sizes to minimize the motion induced by the posterior pressure of the ultrasound transducer 21 . Detailed specification and the testing protocol of the 3D ultrasound imaging system and the testing protocol were reported in previousstudies 19,24 …”

Section: Methodsmentioning

confidence: 99%

Three‐dimensional ultrasonography could be a potential non‐ionizing tool to evaluate vertebral rotation of subjects with adolescent idiopathic scoliosis

et al. 2023

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BackgroundThree‐dimensional (3D) ultrasonography is nonionizing and has been demonstrated to be a reliable tool for scoliosis assessment, including coronal and sagittal curvatures. It shows a great potential for axial vertebral rotation (AVR) evaluation, yet its validity and reliability need to be further demonstrated.Materials and MethodsTwenty patients with adolescent idiopathic scoliosis (AIS) (coronal Cobb: 26.6 ± 9.1°) received 3D ultrasound scan for twice, 10 were scanned by the same operator, and the other 10 by different operators. EOS Bi‐planar x‐rays and 3D scan were conducted on another 29 patients on the same day. Two experienced 3D ultrasonographic researchers, with different experiences on AVR measurement, evaluated the 3D ultrasonographic AVR of the 29 patients (55 curves; coronal Cobb angle: 26.9 ± 11.3°). The gold standard AVR was determined from the 3D reconstruction of coronal and sagittal EOS radiographs. Intra‐class correlation coefficients (ICCs), mean absolute difference (MAD), standard error measurements (SEM), and Bland–Altman's bias were reported to evaluate the intra‐operator and inter‐operator/rater reliabilities of 3D ultrasonography. The reliability of 3D ultrasonographic AVR measurements was further validated using inter‐method with that of EOS.ResultsICCs for intra‐operator and inter‐operator/rater reliability assessment were all greater than 0.95. MAD, SEM, and bias for the 3D ultrasonographic AVRs were no more than 2.2°, 2.0°, and 0.5°, respectively. AVRs between both modalities were strongly correlated (R2 = 0.901) and not significantly different (p = 0.205). Bland–Altman plot also shows that the bias was less than 1°, with no proportional bias between the difference and mean of expected and radiographic Cobb angles.ConclusionThis study demonstrates that 3D ultrasonography is valid and reliable to evaluate AVR in AIS patients. 3D ultrasonography can be a potential tool for screening and following up subjects with AIS and evaluating the effectiveness of nonsurgical treatments.

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“…Further, Cheung et al [35,36] and Zheng et al [37] introduced a commercialised scoliosis assessment system Scolioscan for the three-dimensional (3D) spine reconstruction using freehand 2D T-US. Scolioscan was further used to study spinal curvatures in the coronal [38,39] and sagittal plane [40] and was recently equipped with a robotic arm for the automatic learningbased localisation of the spinous process [30]. Those studies have shown that 2D US measures of curvature are comparable with those obtained using X-ray and MRI based imaging methods, however, de Reuver et al [41] and Brink et al [42] showed that reconstructions based on 2D US typically underestimate the Cobb angle, indicating potentially relevant errors in the US image registration procedure.…”

Section: Introductionmentioning

confidence: 99%

Assessment of thoracic spinal curvatures in static postures using spatially tracked 3D ultrasound volumes: a proof-of-concept study

et al. 2023

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The assessment of spinal posture is a difficult endeavour given the lack of identifiable bony landmarks for placement of skin markers. Moreover, potentially significant soft tissue artefacts along the spine further affect the accuracy of marker-based approaches. The objective of this proof-of-concept study was to develop an experimental framework to assess spinal postures by using three-dimensional (3D) ultrasound (US) imaging. A phantom spine model immersed in water was scanned using 3D US in a neutral and two curved postures mimicking a forward flexion in the sagittal plane while the US probe was localised by three electromagnetic tracking sensors attached to the probe head. The obtained anatomical ‘coarse’ registrations were further refined using an automatic registration algorithm and validated by an experienced sonographer. Spinal landmarks were selected in the US images and validated against magnetic resonance imaging data of the same phantom through image registration. Their position was then related to the location of the tracking sensors identified in the acquired US volumes, enabling the localisation of landmarks in the global coordinate system of the tracking device. Results of this study show that localised 3D US enables US-based anatomical reconstructions comparable to clinical standards and the identification of spinal landmarks in different postures of the spine. The accuracy in sensor identification was 0.49 mm on average while the intra- and inter-observer reliability in sensor identification was strongly correlated with a maximum deviation of 0.8 mm. Mapping of landmarks had a small relative distance error of 0.21 mm (SD = ± 0.16) on average. This study implies that localised 3D US holds the potential for the assessment of full spinal posture by accurately and non-invasively localising vertebrae in space.

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A Novel Method to Measure the Sagittal Curvature in Spinal Deformities: The Reliability and Feasibility of 3-D Ultrasound Imaging

Cited by 21 publications

References 51 publications

Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Three‐dimensional ultrasonography could be a potential non‐ionizing tool to evaluate vertebral rotation of subjects with adolescent idiopathic scoliosis

Assessment of thoracic spinal curvatures in static postures using spatially tracked 3D ultrasound volumes: a proof-of-concept study

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