{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:11:21Z","timestamp":1792782681821,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["RS-2022-KH129266"],"award-info":[{"award-number":["RS-2022-KH129266"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Research Foundation of Korea","award":["RS-2023-00262309"],"award-info":[{"award-number":["RS-2023-00262309"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Research Foundation of Korea","award":["RS-2025-16652968"],"award-info":[{"award-number":["RS-2025-16652968"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Skeletal Radiol"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and validate a hierarchical deep learning model for differentiating acute and chronic lumbar osteoporotic vertebral compression fractures (OVCFs) using X-ray images.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed approximately 2600 lateral lumbar radiographs obtained from patients clinically suspected of having OVCFs between 2007 and 2022. After excluding poor-quality images and surgically instrumented vertebrae, 1299 radiographs (6495 vertebral patches, L1\u2013L5) were included. Labeling was performed by neurosurgeons and radiologists using X-ray images, with CT and\/or MRI findings serving as the reference standard. A two-step hierarchical classification was implemented: first classifying vertebrae into Normal-Chronic, Acute, and Indeterminate (cement-augmented vertebrae without instrumentation) groups, followed by subdivision of the Normal-Chronic group into Normal and Chronic categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1299 radiographs were evaluated. The hierarchical model achieved an accuracy of 91% in the initial three-class step. For the detection of acute fractures in the final classification step, the model demonstrated a sensitivity of 91.0% (95% CI 84.8\u201395.0%), a specificity of 82.1% (95% CI 79.8\u201384.5%), and a high negative predictive value (NPV) of 98.8% (95% CI 97.9\u201399.3%). The Normal-aligned hierarchical approach outperformed the Acute-aligned and end-to-end models, particularly for acute and chronic cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The proposed hierarchical approach enhances the diagnostic utility of standard X-ray images by enabling more accurate classification of lumbar fracture types. This study is limited by its single-institution retrospective design. This model may reduce reliance on advanced imaging and support faster and more informed clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00256-026-05328-7","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:26:00Z","timestamp":1786469160000},"page":"3181-3193","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hierarchical classification of acute and chronic osteoporotic vertebral compression fractures of the lumbar spine using X-ray images"],"prefix":"10.1007","volume":"55","author":[{"given":"Joohyun","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keewon","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungjae","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subum","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo-Keun","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Younggyu","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu-Chong","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungjin","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-Sik","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junseok W.","family":"Hur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"issue":"3","key":"5328_CR1","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.spinee.2004.09.013","volume":"5","author":"ME Majd","year":"2005","unstructured":"Majd ME, Farley S, Holt RT. 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