Assessing radial shock wave therapy in knee osteoarthritis using a morphology-based graph-cut algorithm on CT images

This study aimed to investigate the application effect of a morphology-based automatic graph-cut algorithm for computed tomography (CT) images in assessing the efficacy of radial shockwave therapy (RSWT) in knee osteoarthritis (KOA). The study designed an automatic graph-cut algorithm based on morphological markers and compared its performance with traditional graph-cut and threshold-based graph-cut algorithms. Subsequently, 86 patients with KOA were randomly assigned to two groups: experimental group (N = 43) receiving RSWT, and control group (N = 43) receiving oral non-steroidal anti-inflammatory drugs (celecoxib capsules) as a positive control. The proposed algorithm was utilized to process knee CT images of patients before and after treatment, quantitatively analyze changes in femoral cartilage thickness, and compare Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Activity of Daily Living (AD) scores between the two groups. The proposed morphological automatic graph-cut algorithm demonstrated a processing time of (0.087 ± 0.011) s and achieved a Dice similarity coefficient of (0.945 ± 0.021), with its performance being significantly superior to the comparative algorithms ( P < 0.05). Clinical results indicated that cartilage thickness in all femoral regions increased in both groups after treatment compared to pre-treatment levels ( P < 0.05), with the experimental group exhibiting a significantly greater increase (femoral trochlea: 1.79 ± 0.22 mm vs. 2.31 ± 0.25 mm) than the control group ( P < 0.05). The experimental group showed significantly greater improvements than the control group in VAS scores (3.21 ± 0.21 vs. 4.03 ± 0.78), total WOMAC scores (39.66 ± 5.18 vs. 46.78 ± 3.95), and AD scores (25.55 ± 1.54 vs. 29.23 ± 3.22) ( P < 0.05). The automatic graph-cut algorithm based on morphological markers can efficiently and accurately segment CT images of patients with KOA, providing a reliable tool for the quantitative analysis of joint structures. Preliminary clinical results suggest that radial shockwave therapy (RSWT) may be superior to non-steroidal anti-inflammatory drug treatment in alleviating KOA pain, improving joint function, and promoting functional rehabilitation.