VerteNet -- A Multi-Context Hybrid CNN Transformer for Accurate Vertebral Landmark Localization in Lateral Spine DXA Images

Lateral Spine Image (LSI) analysis is important for medical diagnosis, treatment planning, and detailed spinal health assessments. Although modalities like Computed Tomography and Digital X-ray Imaging are commonly used, Dual Energy X-ray Absorptiometry (DXA) is often preferred due to lower radiation exposure, seamless capture, and cost-effectiveness. Accurate Vertebral Landmark Localization (VLL) on LSIs is important to detect spinal conditions like kyphosis and lordosis, as well as assessing Abdominal Aortic Calcification (AAC) using Inter-Vertebral Guides (IVGs). Nonetheless, few automated VLL methodologies have concentrated on DXA LSIs. We present VerteNet, a hybrid CNN-Transformer model featuring a novel dual-resolution attention mechanism in self and cross-attention domains, referred to as Dual Resolution Self-Attention (DRSA) and Dual Resolution Cross-Attention (DRCA). These mechanisms capture the diverse frequencies in DXA images by operating at two different feature map resolutions. Additionally, we design a Multi-Context Feature Fusion Block (MCFB) that efficiently integrates the features using DRSA and DRCA. We train VerteNet on 620 DXA LSIs from various machines and achieve superior results compared to existing methods. We also design an algorithm that utilizes VerteNet's predictions in estimating the Region of Interest (ROI) to detect potential abdominal aorta cropping, where inadequate soft tissue hinders calcification assessment. Additionally, we present a small proof-of-concept study to show that IVGs generated from VLL information can improve inter-reader correlation in AAC scoring, addressing two key areas of disagreement in expert AAC-24 scoring: IVG placement and quality control for full abdominal aorta assessment. The code for this work can be found at https://github.com/zaidilyas89/VerteNet.

SCOL: Supervised Contrastive Ordinal Loss for Abdominal Aortic Calcification Scoring on Vertebral Fracture Assessment Scans

Abdominal Aortic Calcification (AAC) is a known marker of asymptomatic Atherosclerotic Cardiovascular Diseases (ASCVDs). AAC can be observed on Vertebral Fracture Assessment (VFA) scans acquired using Dual-Energy X-ray Absorptiometry (DXA) machines. Thus, the automatic quantification of AAC on VFA DXA scans may be used to screen for CVD risks, allowing early interventions. In this research, we formulate the quantification of AAC as an ordinal regression problem. We propose a novel Supervised Contrastive Ordinal Loss (SCOL) by incorporating a label-dependent distance metric with existing supervised contrastive loss to leverage the ordinal information inherent in discrete AAC regression labels. We develop a Dual-encoder Contrastive Ordinal Learning (DCOL) framework that learns the contrastive ordinal representation at global and local levels to improve the feature separability and class diversity in latent space among the AAC-24 genera. We evaluate the performance of the proposed framework using two clinical VFA DXA scan datasets and compare our work with state-of-the-art methods. Furthermore, for predicted AAC scores, we provide a clinical analysis to predict the future risk of a Major Acute Cardiovascular Event (MACE). Our results demonstrate that this learning enhances inter-class separability and strengthens intra-class consistency, which results in predicting the high-risk AAC classes with high sensitivity and high accuracy.