Enhanced Detection Performance of Acute Vertebral Compression Fractures Using a Hybrid Deep Learning and Traditional Quantitative Measurement Approach: Beyond the Limitations of Genant Classification

OBJECTIVE: This study evaluated the applicability of the classical method, height loss ratio (HLR), for identifying major acute compression fractures in clinical practice and compared its performance with deep learning (DL)-based VCF detection methods. Additionally, it examined whether combining the HLR with DL approaches could enhance performance, exploring the potential integration of classical and DL methodologies. METHODS: End-to-End VCF Detection (EEVD), Two-Stage VCF Detection with Segmentation and Detection (TSVD_SD), and Two-Stage VCF Detection with Detection and Classification (TSVD_DC). The models were evaluated on a dataset of 589 patients, focusing on sensitivity, specificity, accuracy, and precision. RESULTS: TSVD_SD outperformed all other methods, achieving the highest sensitivity (84.46%) and accuracy (95.05%), making it particularly effective for identifying true positives. The complementary use of DL methods with HLR further improved detection performance. For instance, combining HLR-negative cases with TSVD_SD increased sensitivity to 87.84%, reducing missed fractures, while combining HLR-positive cases with EEVD achieved the highest specificity (99.77%), minimizing false positives. CONCLUSION: These findings demonstrated that DL-based approaches, particularly TSVD_SD, provided robust alternatives or complements to traditional methods, significantly enhancing diagnostic accuracy for acute VCFs in clinical practice.