The classic metaphyseal lesion (CML) is a distinct injury that is highly specific for infant abuse. It commonly occurs in the distal tibia. To aid radiologists detect these subtle fractures, we need to develop a model that can flag abnormal distal tibial radiographs (i.e. those with CMLs). Unfortunately, the development of such a model requires a large and diverse training database, which is often not available. To address this limitation, we propose a novel generative model for data augmentation. Unlike previous models that fail to generate data that span the diverse radiographic appearance of the distal tibial CML, our proposed masked conditional diffusion model (MaC-DM) not only generates realistic-appearing and wide-ranging synthetic images of the distal tibial radiographs with and without CMLs, it also generates their associated segmentation labels. To achieve these tasks, MaC-DM combines the weighted segmentation masks of the tibias and the CML fracture sites as additional conditions for classifier guidance. The augmented images from our model improved the performances of ResNet-34 in classifying normal radiographs and those with CMLs. Further, the augmented images and their associated segmentation masks enhanced the performance of the U-Net in labeling areas of the CMLs on distal tibial radiographs.
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