We propose a methodology to aid clinicians in performing lumbar spinal stenosis detection through semantic segmentation and delineation of magnetic resonance imaging (MRI) scans of the lumbar spine using deep learning. Our dataset contains MRI studies of 515 patients with symptomatic back pains. Each study is annotated by expert radiologists with notes regarding the observed characteristics and condition of the lumbar spine. We have developed a ground truth dataset, containing image labels of four important regions in the lumbar spine, to be used as the training and test images to develop classification models for segmentation. We developed two novel metrics, namely confidence, and consistency, to assess the quality of the ground truth dataset through a derivation of the Jaccard Index. We experimented with semantic segmentation of our dataset using SegNet. Our evaluation of the segmentation and the delineation results show that our proposed methodology produces a very good performance as measured by several contourbased and region-based metrics. In addition, using the Cohen's kappa and frequency-weighted confidence metrics, we can show that 1) the model's performance is within the range of the worst and the best manual labeling results and 2) the ground-truth dataset has an excellent inter-rater agreement score. We also presented two representative delineation results of the worst and best segmentation based on their BF-score to show visually how accurate and suitable the results are for computer-aided-diagnosis purposes.
Lumbar Spinal Stenosis causes low back pain through pressures exerted on the spinal nerves. This can be verified by measuring the anteroposterior diameter and foraminal widths of the patient’s lumbar spine. Our goal is to develop a novel strategy for assessing the extent of Lumbar Spinal Stenosis by automatically calculating these distances from the patient’s lumbar spine MRI. Our method starts with a semantic segmentation of T1- and T2-weighted composite axial MRI images using SegNet that partitions the image into six regions of interest. They consist of three main regions-of-interest, namely the Intervertebral Disc, Posterior Element, and Thecal Sac, and three auxiliary regions-of-interest that includes the Area between Anterior and Posterior elements. A novel contour evolution algorithm is then applied to improve the accuracy of the segmentation results along important region boundaries. Nine anatomical landmarks on the image are located by delineating the region boundaries found in the segmented image before the anteroposterior diameter and foraminal widths can be measured. The performance of the proposed algorithm was evaluated through a set of experiments on the Lumbar Spine MRI dataset containing MRI studies of 515 patients. These experiments compare the performance of our contour evolution algorithm with the Geodesic Active Contour and Chan-Vese methods over 22 different setups. We found that our method works best when our contour evolution algorithm is applied to improve the accuracy of both the label images used to train the SegNet model and the automatically segmented image. The average error of the calculated right and left foraminal distances relative to their expert-measured distances are 0.28 mm ( p = 0.92) and 0.29 mm ( p = 0.97), respectively. The average error of the calculated anteroposterior diameter relative to their expert-measured diameter is 0.90 mm ( p = 0.92). The method also achieves 96.7% agreement with an expert opinion on determining the severity of the Intervertebral Disc herniations.
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Artificial Intelligence through supervised machine learning remains an attractive and popular research area in medical image processing. The objective of such research is often tied to the development of an intelligent computer aided diagnostic system whose aim is to assist physicians in their task of diagnosing diseases. The quality of the resulting
This paper addresses the central problem of automatic segmentation of lumbar spine Magnetic Resonance Imaging (MRI) images to delineate boundaries between the anterior arch and posterior arch of the lumbar spine. This is necessary to efficiently detect the occurrence of lumbar spinal stenosis as a leading cause of Chronic Lower Back Pain. A patchbased classification neural network consisting of convolutional and fully connected layers is used to classify and label pixels in MRI images. The classifier is trained using overlapping patches of size 25x25 pixels taken from a set of cropped axial-view T2weighted MRI images of the bottom three intervertebral discs. A set of experiment is conducted to measure the performance of the classification network in segmenting the images when either all or each of the discs separately is used. Using pixel accuracy, mean accuracy, mean Intersection over Union (IoU), and frequency weighted IoU as the performance metrics we have shown that our approach produces better segmentation results than eleven other pixel classifiers. Furthermore, our experiment result also indicates that our approach produces more accurate delineation of all important boundaries and making it best suited for the subsequent stage of lumbar spinal stenosis detection.
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