Stuart J. Warden

Mohseu Rashid Subah, Mohammed Abdul Gani Zilani, Thomas L. Nickolas et al.

Osteoporosis is a skeletal disease typically diagnosed using dual-energy X-ray absorptiometry (DXA), which quantifies areal bone mineral density but overlooks bone microarchitecture and surrounding soft tissues. High-resolution peripheral quantitative computed tomography (HR-pQCT) enables three-dimensional microstructural imaging with minimal radiation. However, current analysis pipelines largely focus on mineralized bone compartments, leaving much of the acquired image data underutilized. We introduce a fully automated framework for binary osteoporosis classification using radiomics features extracted from anatomically segmented HR-pQCT images. To our knowledge, this work is the first to leverage a transformer-based segmentation architecture, i.e., the SegFormer, for fully automated multi-region HR-pQCT analysis. The SegFormer model simultaneously delineated the cortical and trabecular bone of the tibia and fibula along with surrounding soft tissues and achieved a mean F1 score of 95.36%. Soft tissues were further subdivided into skin, myotendinous, and adipose regions through post-processing. From each region, 939 radiomic features were extracted and dimensionally reduced to train six machine learning classifiers on an independent dataset comprising 20,496 images from 122 HR-pQCT scans. The best image level performance was achieved using myotendinous tissue features, yielding an accuracy of 80.08% and an area under the receiver operating characteristic curve (AUROC) of 0.85, outperforming bone-based models. At the patient level, replacing standard biological, DXA, and HR-pQCT parameters with soft tissue radiomics improved AUROC from 0.792 to 0.875. These findings demonstrate that automated, multi-region HR-pQCT segmentation enables the extraction of clinically informative signals beyond bone alone, highlighting the importance of integrated tissue assessment for osteoporosis detection.

Farhan Sadik, Christopher L. Newman, Stuart J. Warden et al.

Rigid-motion artifacts, such as cortical bone streaking and trabecular smearing, hinder in vivo assessment of bone microstructures in high-resolution peripheral quantitative computed tomography (HR-pQCT). Despite various motion grading techniques, no motion correction methods exist due to the lack of standardized degradation models. We optimize a conventional sinogram-based method to simulate motion artifacts in HR-pQCT images, creating paired datasets of motion-corrupted images and their corresponding ground truth, which enables seamless integration into supervised learning frameworks for motion correction. As such, we propose an Edge-enhanced Self-attention Wasserstein Generative Adversarial Network with Gradient Penalty (ESWGAN-GP) to address motion artifacts in both simulated (source) and real-world (target) datasets. The model incorporates edge-enhancing skip connections to preserve trabecular edges and self-attention mechanisms to capture long-range dependencies, facilitating motion correction. A visual geometry group (VGG)-based perceptual loss is used to reconstruct fine micro-structural features. The ESWGAN-GP achieves a mean signal-to-noise ratio (SNR) of 26.78, structural similarity index measure (SSIM) of 0.81, and visual information fidelity (VIF) of 0.76 for the source dataset, while showing improved performance on the target dataset with an SNR of 29.31, SSIM of 0.87, and VIF of 0.81. The proposed methods address a simplified representation of real-world motion that may not fully capture the complexity of in vivo motion artifacts. Nevertheless, because motion artifacts present one of the foremost challenges to more widespread adoption of this modality, these methods represent an important initial step toward implementing deep learning-based motion correction in HR-pQCT.