Such an approach is more likely to result in inaccurate estimations, even for anatomically experienced evaluators. The quantification of certain tissues in small specific regions is often challenged by the limited resolution of clinical CT and MRI datasets 16, 17, 18 and has to be performed manually with all consequences of potential subjectivity. Available software such as OSIRIX (Pixmeo Sarl 2016, Geneva, Switzerland), Horos (The Horos Project, MD, USA ), SliceOMatic (TomoVision, Montreal, QC, Canada), Amira (Zuse Institute Berlin, Germany) or ImageJ (National Institutes of Health, Bethesda, MA, USA) are well established tools for both the qualitative and quantitative assessment of images based on the manual segmentation of regions of interest (ROI) 1, 2, 3, 4, 5, 6, 9, 10, 11, 12, 13, 14, 15. Commonly, data sets derived from magnetic resonance imaging (MRI) 2, 9, 10, 11, 12, 13, 14, 15 or computed tomography (CT) are used for this purpose. Quantification of tissue volumes and sub volumes using medical imaging is not a new technique 1, 2, 3, 4, 5, 6, 7, 8. VolSEQ is a viable and user-friendly method for sub-volume quantification of tissues in CT. PSIJ volume is sex-dependent after 65 years. Fat volume within the PSIJ remains unchanged throughout life. A significant difference in total PSIJ volume between sexes ( p < 0.01) but not in fat volume ( p = 0.3) was found only in the ≥ 65 years cohort. Total PSIJ volume ( p = 0.3) and fat volume ( p = 0.7) between sexes were non-different. PSIJ volumes in both software (VolSeq vs. Volume comparisons were made between sexes, sides and ages (≤ 30, 31–64 and > 65 years). Within VolSEQ, ‘fat’ Hounsfield units (− 150 to − 50 HU) are selected and the DICOM file of the patient scan and associated region of interest file from OSIRIX were imported and the pixel sub volumes were then automatically computed. In 37 CT scans of heathy individuals, the PSIJ were first manually segmented as a region of interest in OSIRIX. Differences within the cohort and the viability of the program for the quantification of fat in routine computed tomography (CT) scans were assessed. Using a novel Python-based software (VolSEQ), total PSIJ volume and fat volume were computed semi-automatically. This composite of fat and ligaments is hypothesized to serve a shock-absorbing, stabilizing function for the sacroiliac joint and the lumbopelvic transition region. Fat is physiologically embedded within the interosseous ligaments in the posterior part of the sacroiliac joint (PSIJ).
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