Automated volumetric and statistical shape assessment of cam-type morphology of the femoral head-neck region from 3D magnetic resonance images

TL;DR

This study introduces CamMorph, an automated 3D pipeline for assessing cam morphology in femoroacetabular impingement from MRI, providing detailed volumetric and shape data that surpasses traditional 2D methods.

Contribution

The paper presents a novel automated 3D segmentation and measurement pipeline, CamMorph, for detailed analysis of cam morphology in FAI from MRI images, improving accuracy and specificity.

Findings

High agreement between manual and automated segmentation (DSI=0.964)

Male patients show significantly larger cam volume, surface area, and height than females

Automated 3D analysis reveals detailed morphological differences in FAI patients

Abstract

Femoroacetabular impingement (FAI) cam morphology is routinely assessed using two-dimensional alpha angles which do not provide specific data on cam size characteristics. The purpose of this study is to implement a novel, automated three-dimensional (3D) pipeline, CamMorph, for segmentation and measurement of cam volume, surface area and height from magnetic resonance (MR) images in patients with FAI. The CamMorph pipeline involves two processes: i) proximal femur segmentation using an approach integrating 3D U-net with focused shape modelling (FSM); ii) use of patient-specific anatomical information from 3D FSM to simulate healthy femoral bone models and pathological region constraints to identify cam bone mass. Agreement between manual and automated segmentation of the proximal femur was evaluated with the Dice similarity index (DSI) and surface distance measures. Independent t-tests or Mann-Whitney U rank tests were used to compare the femoral head volume, cam volume, surface area and height data between female and male patients with FAI. There was a mean DSI value of 0.964 between manual and automated segmentation of proximal femur volume. Compared to female FAI patients, male patients had a significantly larger mean femoral head volume (66.12cm3 v 46.02cm3, p<0.001). Compared to female FAI patients, male patients had a significantly larger mean cam volume (1136.87mm3 v 337.86mm3, p<0.001), surface area (657.36mm2 v 306.93mm2 , p<0.001), maximum-height (3.89mm v 2.23mm, p<0.001) and average-height (1.94mm v 1.00mm, p<0.001). Automated analyses of 3D MR images from patients with FAI using the CamMorph pipeline showed that, in comparison with female patients, male patients had significantly greater cam volume, surface area and height.