{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:21:59Z","timestamp":1791393719087,"version":"4.3.3"},"reference-count":31,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2023YFC2507700"],"award-info":[{"award-number":["2023YFC2507700"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004608","name":"Natural Science Foundation of Jiangsu Province","doi-asserted-by":"crossref","award":["BK20230147"],"award-info":[{"award-number":["BK20230147"]}],"id":[{"id":"10.13039\/501100004608","id-type":"DOI","asserted-by":"crossref"}]},{"name":"AO Spine Asia Pacific National Research","award":["AOSRG2024023"],"award-info":[{"award-number":["AOSRG2024023"]}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"crossref","award":["2022M711581"],"award-info":[{"award-number":["2022M711581"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Nanjing Medical Science and Technology Development Foundation","award":["YKK22098"],"award-info":[{"award-number":["YKK22098"]}]},{"DOI":"10.13039\/501100013058","name":"Jiangsu Provincial Key Research and Development Program","doi-asserted-by":"crossref","award":["BE2023658"],"award-info":[{"award-number":["BE2023658"]}],"id":[{"id":"10.13039\/501100013058","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective diagnostic study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop a fine-grained classification model based on deep learning using X-ray images, to screen for scoliosis, and further to screen for atypical scoliosis patterns associated with Chiari Malformation type I (CMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 508 pairs of coronal and sagittal X-ray images from patients with CMS, adolescent idiopathic scoliosis (AIS), and normal controls (NC) were processed through construction of the ResNet-50 model, including the development of ResNet-50 Coronal, ResNet-50 Sagittal, ResNet-50 Dual, ResNet-50 Concat, and ResNet-50 Bilinear models. Evaluation metrics calculated included accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both the scoliosis diagnosis system and the CMS diagnosis system, along with the generation of receiver operating characteristic (ROC) curves and heatmaps for CMS diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The classification results for the scoliosis diagnosis system showed that the ResNet-50 Coronal model had the best overall performance. For the CMS diagnosis system, the ResNet-50 Coronal and ResNet-50 Dual models demonstrated optimal performance. Specifically, the ResNet-50 Dual model reached the diagnostic level of senior spine surgeons, and the ResNet-50 Coronal model even surpassed senior surgeons in specificity and PPV. The CMS heatmaps revealed that major classification weights were concentrated on features such as atypical curve types, significant lateral shift of scoliotic segments, longer affected segments, and severe trunk tilt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The fine-grained classification model based on the ResNet-50 network can accurately screen for atypical scoliosis patterns associated with CMS, highlighting the importance of radiographic features such as atypical curve types in model classification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251349999","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T01:17:41Z","timestamp":1749691061000},"page":"501-512","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Identification of Atypical Scoliosis Patterns Using X-ray Images Based on Fine-Grained Techniques in Deep Learning"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2013-2686","authenticated-orcid":false,"given":"Yi","family":"Chen","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Medical School, Nanjing University, Nanjing Drum Tower Hospital"},{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9008-904X","authenticated-orcid":false,"given":"Zhong","family":"He","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Medical School, Nanjing University, Nanjing Drum Tower Hospital"},{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth Guangpu","family":"Yang","sequence":"additional","affiliation":[{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"},{"name":"The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Qin","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Medical School, Nanjing University, Nanjing Drum Tower Hospital"},{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam Yiu-Chung","family":"Lau","sequence":"additional","affiliation":[{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"},{"name":"The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2027-8088","authenticated-orcid":false,"given":"Zhen","family":"Liu","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Medical School, Nanjing University, Nanjing Drum Tower Hospital"},{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neng","family":"Lu","sequence":"additional","affiliation":[{"name":"Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack Chun-Yiu","family":"Cheng","sequence":"additional","affiliation":[{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"},{"name":"The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne Yuk-Wai","family":"Lee","sequence":"additional","affiliation":[{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"},{"name":"The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvis Chun-Sing","family":"Chui","sequence":"additional","affiliation":[{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"},{"name":"The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Qiu","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Medical School, Nanjing University, Nanjing Drum Tower Hospital"},{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Liu","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xipu","family":"Chen","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Medical School, Nanjing University, Nanjing Drum Tower Hospital"},{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8569-3595","authenticated-orcid":false,"given":"Zezhang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Medical School, Nanjing University, Nanjing Drum Tower Hospital"},{"name":"Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-007-0535-y"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2021.04.015"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23051"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2000.92.6.0920"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/2010.12.PEDS10379"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-198811000-00008"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181ba6623"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.26211"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/app12189039"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2015.06.005"},{"key":"e_1_3_5_12_2","doi-asserted-by":"crossref","unstructured":"Szegedy C Wei L Yangqing J Pierre S Scott R Dragomir A Dumitru E Vincent V and Andrew R. \u201cGoing deeper with convolutions.\u201d In Proceedings of the IEEE conference on computer vision and pattern recognition pp. 1-9. 2015.","DOI":"10.1109\/CVPR.2015.7298594"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR.2017.243"},{"key":"e_1_3_5_14_2","unstructured":"Tan M Le Q. Efficientnet: rethinking model scaling for convolutional neural networks. In Proceedings of the 36th International Conference on Machine Learning ICML 2019 Long Beach 9-15 June 2019:6105-6114."},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/mp.14719"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1109\/ICCV.2017.324"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR.2016.319"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.3171\/2017.3.JNS162479"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1109\/JBHI.2020.3016886"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2022.110287"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001406"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-007-0472-1"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000333302.72307.3b"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000781"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-84164-2"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-015-4108-6"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-014-3265-3"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318281dba6"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2018.02.013"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.04.048"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.14245\/ns.1836154.077"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR.2015.7298685"}],"container-title":["Global Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682251349999","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21925682251349999","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682251349999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:16:13Z","timestamp":1777446973000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21925682251349999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,11]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/21925682251349999"],"URL":"https:\/\/doi.org\/10.1177\/21925682251349999","relation":{},"ISSN":["2192-5682","2192-5690"],"issn-type":[{"value":"2192-5682","type":"print"},{"value":"2192-5690","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,11]]}}}