Academic Journal
Beyond SINS: A Critical Review of Biomechanical, Microstructural, and Radiomic Biomarkers for Predicting Fracture Risk in Spinal Metastases.
| Title: | Beyond SINS: A Critical Review of Biomechanical, Microstructural, and Radiomic Biomarkers for Predicting Fracture Risk in Spinal Metastases. |
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| Authors: | Tan, An Sen, Tjio, Calvin Kai En, Tan, Jonathan Jiong Hao, Kumar, Naresh, Ong, Wilson, Ge, Shuliang, Tan, Yi Liang, Fang, Eric, Vellayappan, Balamurugan A., Hallinan, James Thomas Patrick Decourcy |
| Source: | Diagnostics (2075-4418); Jun2026, Vol. 16 Issue 12, p1835, 28p |
| Subject Terms: | Finite element method, Radiomics, Bone metastasis, Risk factors of fractures, Biomarkers, Computer-assisted image analysis (Medicine) |
| Abstract: | Background/Objectives: Although the Spinal Instability Neoplastic Score (SINS) is widely used to estimate spinal metastases fracture risk and guide decisions on stabilisation procedures, prior studies have demonstrated mixed results. Patients with the same score exhibit clinically heterogeneous outcomes, with some SINS criteria correlating less well with the estimated fracture risk than others. There are also barriers to implementation such as the time burden required for manual calculation and interobserver variability associated with qualitative morphological criteria. SINS also lacks sensitivity for detecting latent structural compromise in treatment-naive patients and those susceptible to the iatrogenic effects of stereotactic body radiation therapy. This review aims to evaluate emerging imaging, biomechanical, and microstructural markers with the potential to improve fracture risk stratification and prognostication for spinal oncology patients. Methods: We synthesise evidence across three innovative frontiers: (1) biomechanical modelling, including CT-derived finite element analysis and failure-load pattern models; (2) radiomics, utilizing radiomics features from radiological imaging to develop a predictive model; and (3) microstructural MRI biomarkers, exploring the translatability of the Vertebral Bone Quality score, fat fraction, and paraspinal muscle atrophy from osteoporosis to the metastatic spine. Results: Emerging biomechanical, radiomic and microstructural imaging markers show potential in addressing some limitations of traditional SINS criteria for fracture risk stratification across the spinal oncology treatment continuum, from initial diagnosis to post-radiation surveillance, thereby facilitating more precise risk assessment. However, current evidence remains largely retrospective and heterogeneous, and further validation is required before clinical adoption. Conclusions: We propose a framework that shifts the paradigm from conventional morphological scoring toward a multiparametric assessment of spinal stability. [ABSTRACT FROM AUTHOR] |
| Copyright of Diagnostics (2075-4418) is the property of MDPI and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Biomedical Index |
| FullText | Text: Availability: 0 CustomLinks: – Url: https://resolver.ebsco.com/c/fiv2js/result?sid=EBSCO:edm&genre=article&issn=20754418&ISBN=&volume=16&issue=12&date=20260615&spage=1835&pages=1835-1862&title=Diagnostics (2075-4418)&atitle=Beyond%20SINS%3A%20A%20Critical%20Review%20of%20Biomechanical%2C%20Microstructural%2C%20and%20Radiomic%20Biomarkers%20for%20Predicting%20Fracture%20Risk%20in%20Spinal%20Metastases.&aulast=Tan%2C%20An%20Sen&id=DOI:10.3390/diagnostics16121835 Name: Full Text Finder (for New FTF UI) (ns324271) Category: fullText Text: Full Text Finder MouseOverText: Full Text Finder |
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| Items | – Name: Title Label: Title Group: Ti Data: Beyond SINS: A Critical Review of Biomechanical, Microstructural, and Radiomic Biomarkers for Predicting Fracture Risk in Spinal Metastases. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Tan%2C+An+Sen%22">Tan, An Sen</searchLink><br /><searchLink fieldCode="AR" term="%22Tjio%2C+Calvin+Kai+En%22">Tjio, Calvin Kai En</searchLink><br /><searchLink fieldCode="AR" term="%22Tan%2C+Jonathan+Jiong+Hao%22">Tan, Jonathan Jiong Hao</searchLink><br /><searchLink fieldCode="AR" term="%22Kumar%2C+Naresh%22">Kumar, Naresh</searchLink><br /><searchLink fieldCode="AR" term="%22Ong%2C+Wilson%22">Ong, Wilson</searchLink><br /><searchLink fieldCode="AR" term="%22Ge%2C+Shuliang%22">Ge, Shuliang</searchLink><br /><searchLink fieldCode="AR" term="%22Tan%2C+Yi+Liang%22">Tan, Yi Liang</searchLink><br /><searchLink fieldCode="AR" term="%22Fang%2C+Eric%22">Fang, Eric</searchLink><br /><searchLink fieldCode="AR" term="%22Vellayappan%2C+Balamurugan+A%2E%22">Vellayappan, Balamurugan A.</searchLink><br /><searchLink fieldCode="AR" term="%22Hallinan%2C+James+Thomas+Patrick+Decourcy%22">Hallinan, James Thomas Patrick Decourcy</searchLink> – Name: TitleSource Label: Source Group: Src Data: Diagnostics (2075-4418); Jun2026, Vol. 16 Issue 12, p1835, 28p – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Finite+element+method%22">Finite element method</searchLink><br /><searchLink fieldCode="DE" term="%22Radiomics%22">Radiomics</searchLink><br /><searchLink fieldCode="DE" term="%22Bone+metastasis%22">Bone metastasis</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+factors+of+fractures%22">Risk factors of fractures</searchLink><br /><searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22Computer-assisted+image+analysis+%28Medicine%29%22">Computer-assisted image analysis (Medicine)</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background/Objectives: Although the Spinal Instability Neoplastic Score (SINS) is widely used to estimate spinal metastases fracture risk and guide decisions on stabilisation procedures, prior studies have demonstrated mixed results. Patients with the same score exhibit clinically heterogeneous outcomes, with some SINS criteria correlating less well with the estimated fracture risk than others. There are also barriers to implementation such as the time burden required for manual calculation and interobserver variability associated with qualitative morphological criteria. SINS also lacks sensitivity for detecting latent structural compromise in treatment-naive patients and those susceptible to the iatrogenic effects of stereotactic body radiation therapy. This review aims to evaluate emerging imaging, biomechanical, and microstructural markers with the potential to improve fracture risk stratification and prognostication for spinal oncology patients. Methods: We synthesise evidence across three innovative frontiers: (1) biomechanical modelling, including CT-derived finite element analysis and failure-load pattern models; (2) radiomics, utilizing radiomics features from radiological imaging to develop a predictive model; and (3) microstructural MRI biomarkers, exploring the translatability of the Vertebral Bone Quality score, fat fraction, and paraspinal muscle atrophy from osteoporosis to the metastatic spine. Results: Emerging biomechanical, radiomic and microstructural imaging markers show potential in addressing some limitations of traditional SINS criteria for fracture risk stratification across the spinal oncology treatment continuum, from initial diagnosis to post-radiation surveillance, thereby facilitating more precise risk assessment. However, current evidence remains largely retrospective and heterogeneous, and further validation is required before clinical adoption. Conclusions: We propose a framework that shifts the paradigm from conventional morphological scoring toward a multiparametric assessment of spinal stability. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of Diagnostics (2075-4418) is the property of MDPI and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.3390/diagnostics16121835 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 28 StartPage: 1835 Subjects: – SubjectFull: Finite element method Type: general – SubjectFull: Radiomics Type: general – SubjectFull: Bone metastasis Type: general – SubjectFull: Risk factors of fractures Type: general – SubjectFull: Biomarkers Type: general – SubjectFull: Computer-assisted image analysis (Medicine) Type: general Titles: – TitleFull: Beyond SINS: A Critical Review of Biomechanical, Microstructural, and Radiomic Biomarkers for Predicting Fracture Risk in Spinal Metastases. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Tan, An Sen – PersonEntity: Name: NameFull: Tjio, Calvin Kai En – PersonEntity: Name: NameFull: Tan, Jonathan Jiong Hao – PersonEntity: Name: NameFull: Kumar, Naresh – PersonEntity: Name: NameFull: Ong, Wilson – PersonEntity: Name: NameFull: Ge, Shuliang – PersonEntity: Name: NameFull: Tan, Yi Liang – PersonEntity: Name: NameFull: Fang, Eric – PersonEntity: Name: NameFull: Vellayappan, Balamurugan A. – PersonEntity: Name: NameFull: Hallinan, James Thomas Patrick Decourcy IsPartOfRelationships: – BibEntity: Dates: – D: 15 M: 06 Text: Jun2026 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 20754418 Numbering: – Type: volume Value: 16 – Type: issue Value: 12 Titles: – TitleFull: Diagnostics (2075-4418) Type: main |
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