For the nervous system, there is evidence of relative shortening of the spinal cord, reflected by both reduced cord length to vertebral column ratio and a change in cross-sectional morphology of the cord. The cerebellar tonsils are low-lying in AIS subjects while significant regional volume differences in the brain are also evident between AIS subjects and controls. / From the results of this series of study, AIS girls are found to have morphological difference in multiple aspects when compared with age- and sex-matched normal controls. / Idiopathic scoliosis is a common worldwide problem and has been treated for many decades; however, there still remain uncertain areas about this disorder. Its involvement and impact on different parts of the human body remain underestimated due to lack of technology in imaging for objective assessment in the past. / In the skeletal system, AIS girls have generalized osteopenia and abnormal growth of the appendiceal skeleton. For the axial skeleton, abnormal ossification patterns have been found affecting both the longitudinal growth and axial growth pattern of the vertebral column. There is overgrowth of the anterior vertebral column, reversed asymmetry of the neural arch and smaller pedicle at the concavity of the scoliotic curve in AIS, suggestive of asynchronous growth between membraneous and endochondral ossifications. In the skull, both calvarium and basicranium are found have regional difference (including foramen magnum) between AIS subjects and controls, which is again probably reflecting a systemic process of asynchronous growth between membraneous and endochondral ossification. / It was concluded that the hypothesis "In adolescent idiopathic scoliosis, advanced magnetic resonance imaging techniques can be used to identify systemic features which are suggestive of asynchronous neuro-osseous growth of the disorder" was confirmed. (Abstract shortened by UMI.) / Taking together, the abnormalities in the skeletal system and nervous system are likely to be inter-related and reflecting a systemic process of asynchronous neuro-osseous growth. The above findings help to explain a number of well documented neurological abnormalities in AIS: Anatomically, there is increased incidence of Chiari malformation and syringomyelia in AIS subjects, while functionally, abnormal somatosensory evoked potential (SSEP) results, impaired postural balance, poor performance on combined visual and proprioceptive testing and spatial orientation testing as well as reports of abnormal nystagmus response to caloric testing are known to be associated with AIS. / The advances in imaging technique and image analysis technology have provided a novel approach for the understanding of the phenotypic presentation of neuro-osseous changes in AIS subjects as compared with normal controls. Dynamic imaging also assists in functional assessment of pulmonary function and respiratory mechanism in AIS subjects. / The hypothesis to be tested in this series of studies is: "In adolescent idiopathic scoliosis, advanced magnetic resonance imaging techniques can be used to identify systemic features which are suggestive of asynchronous neuro-osseous growth of the disorder". This thesis was based on a series of eight studies which were aimed to explore the "unknown" anatomical features in the skeletal and neural systems in AIS by the application of new advanced technique of MR imaging and sophisticated image analysis programs. / We are the first group who has undertaken a comprehensive morphological assessment of the skeletal and nervous systems in AIS subjects based on imaging findings which have not been reported previously. For the first time in literature, the spinal cord and vertebral column, brain and skull were thoroughly analyzed in AIS subjects and compared with age- and sex-matched normal controls. Detailed correlations with clinical information, neurological tests have also been made. As an appendix, MR imaging findings of the pulmonary system in AIS, including the lung, chest wall and diaphragms are also presented at the end of the thesis. / Chu Chiu-wing, Winnie. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0976. / Thesis (M.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 248-267). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Low back pain is the most common cause of disability in the United Kingdom with health care costs of more than 1 billion pounds per year. One reason associated with low back pain is the degeneration of intervertebral discs due to loads on the spine. Daily postures such as standing and sitting produce different loads on the discs. Previously, many studies investigated the stress and pressure within the disc in these postures. The results do not agree with each other and the experiments have many limitations. The aim of this project was to assess the feasibility of incorporating magnetic resonance (MR) imaging and finite element (FE) analysis to predict the pressure and stresses developed by different daily postures in an individual. Transient and non-transient subject specific 2D models of nine individuals in standing and sitting were created based on previously acquired MR images. The geometry of these FE models was based on supine MR images. The sitting and standing boundary conditions were calculated by comparing their MR images with the supine posture. The results showed that for six subjects sitting created more intradiscal pressure compared to standing and in one subject standing more than sitting. For two of the subjects the pressure was nearly the same in sitting and standing. Because of the 2D model’s limitations, 3D models of an individual were developed. Both transient and non-transient models of the individual were created. The intradiscal pressure results were three times lower compared to the 2D models. This was due to consideration of out of plane deformation in the 3D models. These results were in the range of in-vivo and in-vitro measurements available in the literature. In conclusion, it was possible to create kinematic transient subject specific FE models based on the MR images in different postures. 2D models provide a method for comparing the postures but 3D models may be more realistic.

This thesis addresses the problem of analysing clinical MRI using modern computer vision methods for a variety of clinical and research-related tasks. We use automated machine learning algorithms to develop a spinal MRI analysis framework for a number of tasks such as vertebrae detection, labelling; disc and vertebrae segmentation, and radiological grading, and we validate the framework on a large, heterogeneous dataset of 300 symptomatic back pain patients from multiple clinical sites and scanners. Our framework has a number of back pain research and other spine-related clinical applications and could hopefully find application in a clinical workflow in the future. Our framework has five steps -- detection, labelling, segmentation, support regions and features, and machine learning for radiological measurements. The framework works in full 3D and has currently been implemented on sagittal T2 slices. We use Deformable Part Models along with a chain model to detect and label vertebrae, and a powerful graph cuts based method for vertebrae and disc segmentation. The labelled detections and segmentations are used to place support regions for feature extraction, which are mapped into a number of radiological measurements -- namely Pfirrmann grade, disc space narrowing, and herniation/bulge. The radiological ground truth was provided by a clinical radiologist with 25 years experience. We demonstrate a high performance in the measurement in each. The measurements are performed using support vector machines and support vector regressors learned on training data. We next investigate the problem of what is the best method of obtaining support regions. We first used pixel intensity features to predict the Pfirrmann grade, narrowing and bulge/herniation, with vertebrae segmentation to localise their support regions. Since segmentation of spine images, especially intervertebral discs is an unsolved problem and algorithms are prone to failure, we then ask the question, to segment or not to segment. To answer the question, we compare results on Pfirrmann grade prediction with three different points on the no segmentation to full disc segmentation involving no segmentation, vertebrae segmentation, or disc segmentation and find that vertebrae segmentation suffices. We finally show preliminary results in distinguishing between different radiological conditions related to the posterior side of the disc more finely than before in literature, taking information from both sagittal and axial slices to attempt to distinguish between herniated and bulged discs.