HealthiVert-GAN: A Novel Framework of Pseudo-Healthy Vertebral Image Synthesis for Interpretable Compression Fracture Grading

Osteoporotic vertebral compression fractures (OVCFs) are prevalent in the elderly population, typically assessed on computed tomography (CT) scans by evaluating vertebral height loss. This assessment helps determine the fracture's impact on spinal stability and the need for surgical intervention. However, the absence of pre-fracture CT scans and standardized vertebral references leads to measurement errors and inter-observer variability, while irregular compression patterns further challenge the precise grading of fracture severity. While deep learning methods have shown promise in aiding OVCFs screening, they often lack interpretability and sufficient sensitivity, limiting their clinical applicability. To address these challenges, we introduce a novel vertebra synthesis-height loss quantification-OVCFs grading framework. Our proposed model, HealthiVert-GAN¹, utilizes a coarse-to-fine synthesis network designed to generate pseudo-healthy vertebral images that simulate the pre-fracture state of fractured vertebrae. This model integrates three auxiliary modules that leverage the morphology and height information of adjacent healthy vertebrae to ensure anatomical consistency. Additionally, we introduce the Relative Height Loss of Vertebrae (RHLV) as a quantification metric, which divides each vertebra into three sections to measure height loss between pre-fracture and post-fracture states, followed by fracture severity classification using a Support Vector Machine (SVM). Our approach achieves state-of-the-art classification performance on both the Verse2019 dataset and in-house dataset, and it provides cross-sectional distribution maps of vertebral height loss. This practical tool enhances diagnostic accuracy in clinical settings and assisting in surgical decision-making.