A Staged Approach using Machine Learning and Uncertainty Quantification to Predict the Risk of Hip Fracture

Despite advancements in medical care, hip fractures impose a significant burden on individuals and healthcare systems. This paper focuses on the prediction of hip fracture risk in older and middle-aged adults, where falls and compromised bone quality are predominant factors. We propose a novel staged model that combines advanced imaging and clinical data to improve predictive performance. By using CNNs to extract features from hip DXA images, along with clinical variables, shape measurements, and texture features, our method provides a comprehensive framework for assessing fracture risk. A staged machine learning-based model was developed using two ensemble models: Ensemble 1 (clinical variables only) and Ensemble 2 (clinical variables and DXA imaging features). This staged approach used uncertainty quantification from Ensemble 1 to decide if DXA features are necessary for further prediction. Ensemble 2 exhibited the highest performance, achieving an AUC of 0.9541, an accuracy of 0.9195, a sensitivity of 0.8078, and a specificity of 0.9427. The staged model also performed well, with an AUC of 0.8486, an accuracy of 0.8611, a sensitivity of 0.5578, and a specificity of 0.9249, outperforming Ensemble 1, which had an AUC of 0.5549, an accuracy of 0.7239, a sensitivity of 0.1956, and a specificity of 0.8343. Furthermore, the staged model suggested that 54.49% of patients did not require DXA scanning. It effectively balanced accuracy and specificity, offering a robust solution when DXA data acquisition is not always feasible. Statistical tests confirmed significant differences between the models, highlighting the advantages of the advanced modeling strategies. Our staged approach could identify individuals at risk with a high accuracy but reduce the unnecessary DXA scanning. It has great promise to guide interventions to prevent hip fractures with reduced cost and radiation.

A Demographic-Conditioned Variational Autoencoder for fMRI Distribution Sampling and Removal of Confounds

Objective: fMRI and derived measures such as functional connectivity (FC) have been used to predict brain age, general fluid intelligence, psychiatric disease status, and preclinical neurodegenerative disease. However, it is not always clear that all demographic confounds, such as age, sex, and race, have been removed from fMRI data. Additionally, many fMRI datasets are restricted to authorized researchers, making dissemination of these valuable data sources challenging. Methods: We create a variational autoencoder (VAE)-based model, DemoVAE, to decorrelate fMRI features from demographics and generate high-quality synthetic fMRI data based on user-supplied demographics. We train and validate our model using two large, widely used datasets, the Philadelphia Neurodevelopmental Cohort (PNC) and Bipolar and Schizophrenia Network for Intermediate Phenotypes (BSNIP). Results: We find that DemoVAE recapitulates group differences in fMRI data while capturing the full breadth of individual variations. Significantly, we also find that most clinical and computerized battery fields that are correlated with fMRI data are not correlated with DemoVAE latents. An exception are several fields related to schizophrenia medication and symptom severity. Conclusion: Our model generates fMRI data that captures the full distribution of FC better than traditional VAE or GAN models. We also find that most prediction using fMRI data is dependent on correlation with, and prediction of, demographics. Significance: Our DemoVAE model allows for generation of high quality synthetic data conditioned on subject demographics as well as the removal of the confounding effects of demographics. We identify that FC-based prediction tasks are highly influenced by demographic confounds.

Multi-View Variational Autoencoder for Missing Value Imputation in Untargeted Metabolomics

Background: Missing data is a common challenge in mass spectrometry-based metabolomics, which can lead to biased and incomplete analyses. The integration of whole-genome sequencing (WGS) data with metabolomics data has emerged as a promising approach to enhance the accuracy of data imputation in metabolomics studies. Method: In this study, we propose a novel method that leverages the information from WGS data and reference metabolites to impute unknown metabolites. Our approach utilizes a multi-view variational autoencoder to jointly model the burden score, polygenetic risk score (PGS), and linkage disequilibrium (LD) pruned single nucleotide polymorphisms (SNPs) for feature extraction and missing metabolomics data imputation. By learning the latent representations of both omics data, our method can effectively impute missing metabolomics values based on genomic information. Results: We evaluate the performance of our method on empirical metabolomics datasets with missing values and demonstrate its superiority compared to conventional imputation techniques. Using 35 template metabolites derived burden scores, PGS and LD-pruned SNPs, the proposed methods achieved r2-scores > 0.01 for 71.55% of metabolites. Conclusion: The integration of WGS data in metabolomics imputation not only improves data completeness but also enhances downstream analyses, paving the way for more comprehensive and accurate investigations of metabolic pathways and disease associations. Our findings offer valuable insights into the potential benefits of utilizing WGS data for metabolomics data imputation and underscore the importance of leveraging multi-modal data integration in precision medicine research.

CLCLSA: Cross-omics Linked embedding with Contrastive Learning and Self Attention for multi-omics integration with incomplete multi-omics data

Integration of heterogeneous and high-dimensional multi-omics data is becoming increasingly important in understanding genetic data. Each omics technique only provides a limited view of the underlying biological process and integrating heterogeneous omics layers simultaneously would lead to a more comprehensive and detailed understanding of diseases and phenotypes. However, one obstacle faced when performing multi-omics data integration is the existence of unpaired multi-omics data due to instrument sensitivity and cost. Studies may fail if certain aspects of the subjects are missing or incomplete. In this paper, we propose a deep learning method for multi-omics integration with incomplete data by Cross-omics Linked unified embedding with Contrastive Learning and Self Attention (CLCLSA). Utilizing complete multi-omics data as supervision, the model employs cross-omics autoencoders to learn the feature representation across different types of biological data. The multi-omics contrastive learning, which is used to maximize the mutual information between different types of omics, is employed before latent feature concatenation. In addition, the feature-level self-attention and omics-level self-attention are employed to dynamically identify the most informative features for multi-omics data integration. Extensive experiments were conducted on four public multi-omics datasets. The experimental results indicated that the proposed CLCLSA outperformed the state-of-the-art approaches for multi-omics data classification using incomplete multi-omics data.

ImageNomer: developing an fMRI and omics visualization tool to detect racial bias in functional connectivity

It can be difficult to identify trends and perform quality control in large, high-dimensional fMRI or omics datasets. To remedy this, we develop ImageNomer, a data visualization and analysis tool that allows inspection of both subject-level and cohort-level features. The tool allows visualization of phenotype correlation with functional connectivity (FC), partial connectivity (PC), dictionary components (PCA and our own method), and genomic data (single-nucleotide polymorphisms, SNPs). In addition, it allows visualization of weights from arbitrary ML models. ImageNomer is built with a Python backend and a Vue frontend. We validate ImageNomer using the Philadelphia Neurodevelopmental Cohort (PNC) dataset, which contains multitask fMRI and SNP data of healthy adolescents. Using correlation, greedy selection, or model weights, we find that a set of 10 FC features can explain 15% of variation in age, compared to 35% for the full 34,716 feature model. The four most significant FCs are either between bilateral default mode network (DMN) regions or spatially proximal subcortical areas. Additionally, we show that whereas both FC (fMRI) and SNPs (genomic) features can account for 10-15% of intelligence variation, this predictive ability disappears when controlling for race. We find that FC features can be used to predict race with 85% accuracy, compared to 78% accuracy for sex prediction. Using ImageNomer, this work casts doubt on the possibility of finding unbiased intelligence-related features in fMRI and SNPs of healthy adolescents.

Multi-view information fusion using multi-view variational autoencoders to predict proximal femoral strength

Background and aim: Hip fracture can be devastating. The proximal femoral strength can be computed by subject-specific finite element (FE) analysis (FEA) using quantitative CT images. The aim of this paper is to design a deep learning-based model for hip fracture prediction with multi-view information fusion. Method: We developed a multi-view variational autoencoder (MMVAE) for feature representation learning and designed the product of expert model (PoE) for multi-view information fusion.We performed genome-wide association studies (GWAS) to select the most relevant genetic features with proximal femoral strengths and integrated genetic features with DXA-derived imaging features and clinical variables for proximal femoral strength prediction. Results: The designed model achieved the mean absolute percentage error of 0.2050,0.0739 and 0.0852 for linear fall, nonlinear fall and nonlinear stance fracture load prediction, respectively. For linear fall and nonlinear stance fracture load prediction, integrating genetic and DXA-derived imaging features were beneficial; while for nonlinear fall fracture load prediction, integrating genetic features, DXA-derived imaging features as well as clinical variables, the model achieved the best performance. Conclusion: The proposed model is capable of predicting proximal femoral strengths using genetic features, DXA-derived imaging features as well as clinical variables. Compared to performing FEA using QCT images to calculate proximal femoral strengths, the presented method is time-efficient and cost effective, and radiation dosage is limited. From the technique perspective, the final models can be applied to other multi-view information integration tasks.

Hip Fracture Prediction using the First Principal Component Derived from FEA-Computed Fracture Loads

Hip fracture risk assessment is an important but challenging task. Quantitative CT-based patient specific finite element analysis (FEA) computes the force (fracture load) to break the proximal femur in a particular loading condition. It provides different structural information about the proximal femur that can influence a subject overall fracture risk. To obtain a more robust measure of fracture risk, we used principal component analysis (PCA) to develop a global FEA computed fracture risk index that incorporates the FEA-computed yield and ultimate failure loads and energies to failure in four loading conditions (single-limb stance and impact from a fall onto the posterior, posterolateral, and lateral aspects of the greater trochanter) of 110 hip fracture subjects and 235 age and sex matched control subjects from the AGES-Reykjavik study. We found that the first PC (PC1) of the FE parameters was the only significant predictor of hip fracture. Using a logistic regression model, we determined if prediction performance for hip fracture using PC1 differed from that using FE parameters combined by stratified random resampling with respect to hip fracture status. The results showed that the average of the area under the receive operating characteristic curve (AUC) using PC1 was always higher than that using all FE parameters combined in the male subjects. The AUC of PC1 and AUC of the FE parameters combined were not significantly different than that in the female subjects or in all subjects

A robust kernel machine regression towards biomarker selection in multi-omics datasets of osteoporosis for drug discovery

Many statistical machine approaches could ultimately highlight novel features of the etiology of complex diseases by analyzing multi-omics data. However, they are sensitive to some deviations in distribution when the observed samples are potentially contaminated with adversarial corrupted outliers (e.g., a fictional data distribution). Likewise, statistical advances lag in supporting comprehensive data-driven analyses of complex multi-omics data integration. We propose a novel non-linear M-estimator-based approach, "robust kernel machine regression (RobKMR)," to improve the robustness of statistical machine regression and the diversity of fictional data to examine the higher-order composite effect of multi-omics datasets. We address a robust kernel-centered Gram matrix to estimate the model parameters accurately. We also propose a robust score test to assess the marginal and joint Hadamard product of features from multi-omics data. We apply our proposed approach to a multi-omics dataset of osteoporosis (OP) from Caucasian females. Experiments demonstrate that the proposed approach effectively identifies the inter-related risk factors of OP. With solid evidence (p-value = 0.00001), biological validations, network-based analysis, causal inference, and drug repurposing, the selected three triplets ((DKK1, SMTN, DRGX), (MTND5, FASTKD2, CSMD3), (MTND5, COG3, CSMD3)) are significant biomarkers and directly relate to BMD. Overall, the top three selected genes (DKK1, MTND5, FASTKD2) and one gene (SIDT1 at p-value= 0.001) significantly bond with four drugs- Tacrolimus, Ibandronate, Alendronate, and Bazedoxifene out of 30 candidates for drug repurposing in OP. Further, the proposed approach can be applied to any disease model where multi-omics datasets are available.

A Deep Learning-Based Approach to Extracting Periosteal and Endosteal Contours of Proximal Femur in Quantitative CT Images

Automatic CT segmentation of proximal femur is crucial for the diagnosis and risk stratification of orthopedic diseases; however, current methods for the femur CT segmentation mainly rely on manual interactive segmentation, which is time-consuming and has limitations in both accuracy and reproducibility. In this study, we proposed an approach based on deep learning for the automatic extraction of the periosteal and endosteal contours of proximal femur in order to differentiate cortical and trabecular bone compartments. A three-dimensional (3D) end-to-end fully convolutional neural network, which can better combine the information between neighbor slices and get more accurate segmentation results, was developed for our segmentation task. 100 subjects aged from 50 to 87 years with 24,399 slices of proximal femur CT images were enrolled in this study. The separation of cortical and trabecular bone derived from the QCT software MIAF-Femur was used as the segmentation reference. We randomly divided the whole dataset into a training set with 85 subjects for 10-fold cross-validation and a test set with 15 subjects for evaluating the performance of models. Two models with the same network structures were trained and they achieved a dice similarity coefficient (DSC) of 97.87% and 96.49% for the periosteal and endosteal contours, respectively. To verify the excellent performance of our model for femoral segmentation, we measured the volume of different parts of the femur and compared it with the ground truth and the relative errors between predicted result and ground truth are all less than 5%. It demonstrated a strong potential for clinical use, including the hip fracture risk prediction and finite element analysis.

A new approach to extracting coronary arteries and detecting stenosis in invasive coronary angiograms

In stable coronary artery disease (CAD), reduction in mortality and/or myocardial infarction with revascularization over medical therapy has not been reliably achieved. Coronary arteries are usually extracted to perform stenosis detection. We aim to develop an automatic algorithm by deep learning to extract coronary arteries from ICAs.In this study, a multi-input and multi-scale (MIMS) U-Net with a two-stage recurrent training strategy was proposed for the automatic vessel segmentation. Incorporating features such as the Inception residual module with depth-wise separable convolutional layers, the proposed model generated a refined prediction map with the following two training stages: (i) Stage I coarsely segmented the major coronary arteries from pre-processed single-channel ICAs and generated the probability map of vessels; (ii) during the Stage II, a three-channel image consisting of the original preprocessed image, a generated probability map, and an edge-enhanced image generated from the preprocessed image was fed to the proposed MIMS U-Net to produce the final segmentation probability map. During the training stage, the probability maps were iteratively and recurrently updated by feeding into the neural network. After segmentation, an arterial stenosis detection algorithm was developed to extract vascular centerlines and calculate arterial diameters to evaluate stenotic level. Experimental results demonstrated that the proposed method achieved an average Dice score of 0.8329, an average sensitivity of 0.8281, and an average specificity of 0.9979 in our dataset with 294 ICAs obtained from 73 patient. Moreover, our stenosis detection algorithm achieved a true positive rate of 0.6668 and a positive predictive value of 0.7043.