Back ground To date, spine radiography is the only standardized method for the evaluation of Adolescent Idiopathic Scoliosis (AIS). However, due to the emission of ionizing radiation, it is considered an invasive method, unsuitable for frequent monitoring and large-scale screening. In an attempt to reduce radiation exposure during follow-up, for several years now, various non-ionizing investigation techniques have been appearing on the international scientific landscape that allow to select patients for whom an X-ray examination is actually necessary. A technique that is proving promising is photography, which, however, is not yet routinely used in clinical practice. Aims of the study The main aims of our study was the quantification, on 2D photographic images, of the asymmetries of waist triangles in a group of subjects with AIS. The secondary and tertiary aims were the search for a possible relationship between the measurements obtained and some radiographic parameters (site and Cobb angle of the main curve) or clinical (hump and clinically evident asymmetries). In addition, we wanted to evaluate whether in our study sample there was a correlation between Cobb angle and hump, already documented in the literature. Materials and methods The study was conducted on a sample of 40 AIS patients. The clinical parameters related to the hump were obtained measuring with the Ferraro's gibbometer, while those relating to the asymmetries of the waist triangles were the result of a subjective qualitative evaluation of an expert clinical eye describing their laterality and severity. The 2D photographic image of the patient's back was captured using a tripod-mounted camera. On the captured frame, the areas of the waist triangles were measured using Image J, an open source image analysis program. From these measurement the ratio of the areas of the triangles of the left size on the right (waist ratio) and the ratio of the areas of the triangles of the largest size to the smallest (waist MAX/min) were derived . The radiographic parameters, side and Cobb angle of the main curve, were taken from the last AP radiogram of the spine in orthostatism. For statistical analysis, the Kruskal-Wallis test and the Spearman correlation were used. Results A statistically significant relationship (p < 0.05) was found between waist ratio and laterality of triangle asymmetry of clinically detected size and between waist MAX/min and severity of clinically detected asymmetry. On the other hand, no significance emerged from the comparison between the photographic indices of the asymmetry of the size triangles and radiographic (side and Cobb angle of the main curve) and clinical parameters (hump measured with Ferraro's gibbometer). Finally, a statistically significant correlation (p < 0.05) between Cobb angle and hump was detected, reconfirming what has already been documented in the literature. Conclusion From the present study it emerged that in subjects affected by AIS the quantification of the asymmetries of the size triangles, obtained by measuring the photographic image with Image J, can represent a valid tool to determine the severity and laterality of the asymmetry, more precisely than what is clinically detected. Our work has also reconfirmed the correlation between Cobb's angle and hump, already documented in the literature. Since this is a pilot study, it is necessary to deepen these aspects, expanding the sample size of the study, increasing the number of clinical and radiographic photographic parameters examined, stratifying the sample on the basis of BMI (Body Mass Index) and evaluating the reliability and error of the materials and methods adopted. Nevertheless, out results are interesting as they could constitute a first step towards the realization of an application useful for screening, monitoring, evaluation and treatment of asymmetries of the trunk.
Presupposti:La radiografia del rachide rappresenta,ad oggi,l’unico metodo standardizzato per la valutazione della Scoliosi Idiopatica Adolescenziale (SIA).Tuttavia,a causa dell’emissione di radiazioni ionizzanti,è considerata una metodica invasiva,inadatta ad un monitoraggio frequente e ad uno screening su larga scala.Nel tentativo di ridurre l’esposizione alle radiazioni durante il follow-up,ormai da diversi anni,si stanno affacciando sul panorama scientifico internazionale varie tecniche di indagine non ionizzanti capaci di selezionare i pazienti per i quali è effettivamente necessario un radiogramma.Una tecnica che si sta dimostrando promettente è la fotografia,la quale però non è ancora utilizzata di routine nella pratica clinica. Scopo dello studio:L’ obiettivo principale del nostro studio è stato la quantificazione,su immagini fotografiche 2D,delle asimmetrie dei triangoli della taglia (tdt) in un gruppo di soggetti con SIA.Gli obiettivi secondario e terziario sono stati la ricerca di una relazione tra le misurazioni ottenute e alcuni parametri radiografici (sede e angolo di Cobb della curva principale) o clinici (gibbo e asimmetrie clinicamente evidenti).In aggiunta,si è andati a valutare se anche nel nostro campione di studio vi fosse una correlazione tra angolo di Cobb e gibbo,già documentata in letteratura. Materiali e metodi:Sono stati reclutati 40 pazienti affetti da SIA.I parametri clinici relativi al gibbo sono stati ottenuti mediante gibbometro di Ferraro,mentre quelli relativi alle asimmetrie dei tdt sono frutto di una valutazione qualitativa soggettiva di un occhio clinico esperto descrivente la loro lateralità e severità.L’immagine fotografica 2D del dorso del paziente è stata acquisita mediante una macchinetta fotografica montata su un treppiede.Sul fotogramma acquisito sono state misurate le aree dei tdt mediante Image J, un programma di analisi delle immagini open source.Da queste sono stati ricavati il rapporto delle aree dei tdt sinistro su destro (waist ratio) e il rapporto delle aree dei tdt maggiore su minore (waist MAX/min). I parametri radiografici, sede e angolo di Cobb della curva principale, sono stati prelevati dall’ultimo radiogramma AP del rachide in ortostatismo.Per l’analisi statistica sono stati usati il test di Kruskal-Wallis e la correlazione di Spearman. Risultati:È stata riscontrata una relazione statisticamente significativa (p < 0,05) tra waist ratio e lateralità dell’asimmetria dei tdt rilevata clinicamente e tra waist MAX/min e severità dell’asimmetria rilevata clinicamente.Non è invece emersa alcuna significatività dal confronto tra indici fotografici dell’asimmetria dei tdt e parametri radiografici (sede e angolo di Cobb della curva principale) e clinici (gibbo misurato con il gibbometro di Ferraro).È stata infine rilevata una correlazione statisticamente significativa (p < 0,05) tra angolo di Cobb e gibbo,riconfermando quanto già documentato in letteratura. Conclusione:Dal presente studio è emerso che, nei soggetti con SIA,la quantificazione delle asimmetrie dei tdt,ottenuta tramite misurazione dell'immagine fotografica con Image J,può rappresentare un valido strumento per determinare la severità e la lateralità dell'asimmetria, in maniera più precisa rispetto a quanto rilevato clinicamente.Il nostro lavoro ha, inoltre, riconfermato la correlazione tra angolo di Cobb e gibbo.Trattandosi di uno studio pilota, si reputa necessario approfondire questi aspetti, ampliando la numerosità campionaria.
Correlazione tra immagini cliniche e radiografiche nella scoliosi idiopatica adolescenziale
REFOSCO, MICHELA
2022/2023
Abstract
Back ground To date, spine radiography is the only standardized method for the evaluation of Adolescent Idiopathic Scoliosis (AIS). However, due to the emission of ionizing radiation, it is considered an invasive method, unsuitable for frequent monitoring and large-scale screening. In an attempt to reduce radiation exposure during follow-up, for several years now, various non-ionizing investigation techniques have been appearing on the international scientific landscape that allow to select patients for whom an X-ray examination is actually necessary. A technique that is proving promising is photography, which, however, is not yet routinely used in clinical practice. Aims of the study The main aims of our study was the quantification, on 2D photographic images, of the asymmetries of waist triangles in a group of subjects with AIS. The secondary and tertiary aims were the search for a possible relationship between the measurements obtained and some radiographic parameters (site and Cobb angle of the main curve) or clinical (hump and clinically evident asymmetries). In addition, we wanted to evaluate whether in our study sample there was a correlation between Cobb angle and hump, already documented in the literature. Materials and methods The study was conducted on a sample of 40 AIS patients. The clinical parameters related to the hump were obtained measuring with the Ferraro's gibbometer, while those relating to the asymmetries of the waist triangles were the result of a subjective qualitative evaluation of an expert clinical eye describing their laterality and severity. The 2D photographic image of the patient's back was captured using a tripod-mounted camera. On the captured frame, the areas of the waist triangles were measured using Image J, an open source image analysis program. From these measurement the ratio of the areas of the triangles of the left size on the right (waist ratio) and the ratio of the areas of the triangles of the largest size to the smallest (waist MAX/min) were derived . The radiographic parameters, side and Cobb angle of the main curve, were taken from the last AP radiogram of the spine in orthostatism. For statistical analysis, the Kruskal-Wallis test and the Spearman correlation were used. Results A statistically significant relationship (p < 0.05) was found between waist ratio and laterality of triangle asymmetry of clinically detected size and between waist MAX/min and severity of clinically detected asymmetry. On the other hand, no significance emerged from the comparison between the photographic indices of the asymmetry of the size triangles and radiographic (side and Cobb angle of the main curve) and clinical parameters (hump measured with Ferraro's gibbometer). Finally, a statistically significant correlation (p < 0.05) between Cobb angle and hump was detected, reconfirming what has already been documented in the literature. Conclusion From the present study it emerged that in subjects affected by AIS the quantification of the asymmetries of the size triangles, obtained by measuring the photographic image with Image J, can represent a valid tool to determine the severity and laterality of the asymmetry, more precisely than what is clinically detected. Our work has also reconfirmed the correlation between Cobb's angle and hump, already documented in the literature. Since this is a pilot study, it is necessary to deepen these aspects, expanding the sample size of the study, increasing the number of clinical and radiographic photographic parameters examined, stratifying the sample on the basis of BMI (Body Mass Index) and evaluating the reliability and error of the materials and methods adopted. Nevertheless, out results are interesting as they could constitute a first step towards the realization of an application useful for screening, monitoring, evaluation and treatment of asymmetries of the trunk.| File | Dimensione | Formato | |
|---|---|---|---|
|
Refosco_Michela.pdf
accesso riservato
Dimensione
2.92 MB
Formato
Adobe PDF
|
2.92 MB | Adobe PDF |
The text of this website © Università degli studi di Padova. Full Text are published under a non-exclusive license. Metadata are under a CC0 License
https://hdl.handle.net/20.500.12608/47839