Can AI Assist in Predicting Spinal Fractures in Patients With Cancer?

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A new study published by Ahmadian et al in the International Journal for Numerical Methods in Biomedical Engineering suggests how scientists may use artificial intelligence (AI) to predict how cancer may affect the probability of fractures along the spinal column. The report described how the researchers trained an AI-assisted framework called ReconGAN to create a digital twin—a virtual reconstruction of a patient’s vertebra. 

In the United States, more than 1.6 million cases of cancer are diagnosed every year, and about 10% of those patients eventually experience spinal metastasis. One of the biggest clinical concerns patients face is the risk of spinal fractures due to these tumors, which can lead to severe pain and spinal instability.

“Spinal fracture increases the risk of patient death by about 15%,” said Soheil Soghrati, PhD, coauthor of the study and Associate Professor of Mechanical and Aerospace Engineering at The Ohio State University. “By predicting the outcome of these fractures, our research offers medical experts the opportunity to design better treatment strategies and help patients make better-informed decisions.” 

Benefit of Using AI

While many of the changes the body undergoes when exposed to cancerous lesions are still a mystery, with the power of computational modeling, scientists can get a better idea of what’s happening to the spine, said Dr. Soghrati. 

Unlike 3D printing, where a virtual model is turned into a physical object, the concept of a digital twin involves building a computer simulation of its real-life counterpart without creating it physically. Such a simulation can be used to predict an object or system’s future performance—in this case, how much stress the vertebra can take before cracking under pressure.

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By training ReconGAN on magnetic resonance imaging (MRI) and micro–computed tomography (CT) images obtained by taking slice-by-slice pictures of vertebrae acquired from a cadaver, researchers were able to generate realistic microstructural models of the spine. Using their simulation, Dr. Soghrati’s team was also able to virtually enlarge the model—a capability the study authors explained is imperative to understanding and incorporating changes into the entirety of a vertebra’s geometric shape. 

“What really makes [it] work in a distinct way is how detailed we were able to model the geometry of the vertebra,” said Dr. Soghrati. “We can virtually evolve the same bone from one stage to another.”

In this case, the researchers used CT/MRI scans from a 51-year-old female patient with metastatic lung cancer to simulate what might happen if cancer weakened some of the vertebrae, and how that would affect how much stress the bones could take before fracturing.

The model predicted how much strength parts of the vertebra would lose as a result of the tumors, as well as other changes that could be expected as the cancer progressed. Some of their predictions were confirmed by clinical observations in patients.

For a field like orthopedics, using a noninvasive tool like the digital twin can help surgeons understand new therapies, simulate different surgical scenarios, and envision how the bone will change over time, either due to bone weakness or to the effects of radiation. The digital twin can also be modified to patient-specific needs, Dr. Soghrati said. 

“The ultimate goal is to develop a digital twin of everything a surgeon may operate on,” he said. “Right now, they’re only used for very, very challenging surgeries, but we want to help run those simulations and tune those parameters even more.” 

But this was just a feasibility study and much more work is needed, Dr. Soghrati said. ReconGAN was trained on data from only one cadaveric sample, and more data is needed for AI to be perfected. 

The study authors concluded, “The AI-enhanced computational framework… is a promising first step toward establishing such patient-specific models for the assessment of the risk of vertebral fracture and designing potential preventive therapeutic interventions accordingly.”

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The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.