Abstract
OBJECTIVES: This study aims to assess the limitations of the height loss ratio (HLR) method and introduce a new approach that integrates a deep learning (DL) model to enhance vertebral compression fracture (VCF) detection performance. METHODS: We conducted a retrospective study on 589 patients with chronic VCFs. We compared four different methods: HLR-only, DL-only, a combination of HLR and DL for positive VCF, and a combination of HLR and DL for negative VCF. The models were evaluated using dice similarity coefficient, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). RESULTS: The combined method (HLR + DL, positive) demonstrated the best performance with an AUROC of 0.968, sensitivity (94.95%), and specificity (90.59%). The HLR-only and the HLR + DL (negative) also showed strong discriminatory power, with AUROCs of 0.948 and 0.947, respectively. The DL-only model achieved the highest specificity (95.92%) but exhibited lower sensitivity (82.83%). CONCLUSIONS: Our study highlights the limitations of the HLR method in detecting chronic VCFs and demonstrates the improved performance of combining HLR with DL models.