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Main Authors: Subah, Mohseu Rashid, Zilani, Mohammed Abdul Gani, Nickolas, Thomas L., Allen, Matthew R., Warden, Stuart J., Surowiec, Rachel K.
Format: Preprint
Published: 2026
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Online Access:https://arxiv.org/abs/2603.09137
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author Subah, Mohseu Rashid
Zilani, Mohammed Abdul Gani
Nickolas, Thomas L.
Allen, Matthew R.
Warden, Stuart J.
Surowiec, Rachel K.
author_facet Subah, Mohseu Rashid
Zilani, Mohammed Abdul Gani
Nickolas, Thomas L.
Allen, Matthew R.
Warden, Stuart J.
Surowiec, Rachel K.
contents Osteoporosis is a skeletal disease typically diagnosed using dual-energy X-ray absorptiometry (DXA), which quantifies areal bone mineral density but overlooks bone microarchitecture and surrounding soft tissues. High-resolution peripheral quantitative computed tomography (HR-pQCT) enables three-dimensional microstructural imaging with minimal radiation. However, current analysis pipelines largely focus on mineralized bone compartments, leaving much of the acquired image data underutilized. We introduce a fully automated framework for binary osteoporosis classification using radiomics features extracted from anatomically segmented HR-pQCT images. To our knowledge, this work is the first to leverage a transformer-based segmentation architecture, i.e., the SegFormer, for fully automated multi-region HR-pQCT analysis. The SegFormer model simultaneously delineated the cortical and trabecular bone of the tibia and fibula along with surrounding soft tissues and achieved a mean F1 score of 95.36%. Soft tissues were further subdivided into skin, myotendinous, and adipose regions through post-processing. From each region, 939 radiomic features were extracted and dimensionally reduced to train six machine learning classifiers on an independent dataset comprising 20,496 images from 122 HR-pQCT scans. The best image level performance was achieved using myotendinous tissue features, yielding an accuracy of 80.08% and an area under the receiver operating characteristic curve (AUROC) of 0.85, outperforming bone-based models. At the patient level, replacing standard biological, DXA, and HR-pQCT parameters with soft tissue radiomics improved AUROC from 0.792 to 0.875. These findings demonstrate that automated, multi-region HR-pQCT segmentation enables the extraction of clinically informative signals beyond bone alone, highlighting the importance of integrated tissue assessment for osteoporosis detection.
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spellingShingle Transformer-Based Multi-Region Segmentation and Radiomic Analysis of HR-pQCT Imaging for Osteoporosis Classification
Subah, Mohseu Rashid
Zilani, Mohammed Abdul Gani
Nickolas, Thomas L.
Allen, Matthew R.
Warden, Stuart J.
Surowiec, Rachel K.
Computer Vision and Pattern Recognition
Osteoporosis is a skeletal disease typically diagnosed using dual-energy X-ray absorptiometry (DXA), which quantifies areal bone mineral density but overlooks bone microarchitecture and surrounding soft tissues. High-resolution peripheral quantitative computed tomography (HR-pQCT) enables three-dimensional microstructural imaging with minimal radiation. However, current analysis pipelines largely focus on mineralized bone compartments, leaving much of the acquired image data underutilized. We introduce a fully automated framework for binary osteoporosis classification using radiomics features extracted from anatomically segmented HR-pQCT images. To our knowledge, this work is the first to leverage a transformer-based segmentation architecture, i.e., the SegFormer, for fully automated multi-region HR-pQCT analysis. The SegFormer model simultaneously delineated the cortical and trabecular bone of the tibia and fibula along with surrounding soft tissues and achieved a mean F1 score of 95.36%. Soft tissues were further subdivided into skin, myotendinous, and adipose regions through post-processing. From each region, 939 radiomic features were extracted and dimensionally reduced to train six machine learning classifiers on an independent dataset comprising 20,496 images from 122 HR-pQCT scans. The best image level performance was achieved using myotendinous tissue features, yielding an accuracy of 80.08% and an area under the receiver operating characteristic curve (AUROC) of 0.85, outperforming bone-based models. At the patient level, replacing standard biological, DXA, and HR-pQCT parameters with soft tissue radiomics improved AUROC from 0.792 to 0.875. These findings demonstrate that automated, multi-region HR-pQCT segmentation enables the extraction of clinically informative signals beyond bone alone, highlighting the importance of integrated tissue assessment for osteoporosis detection.
title Transformer-Based Multi-Region Segmentation and Radiomic Analysis of HR-pQCT Imaging for Osteoporosis Classification
topic Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2603.09137