Bonnheim Noah B, Wang Linshanshan, Lazar Ann A, Chachad Ravi, Zhou Jiamin, Guo Xiaojie, O'Neill Conor, Castellanos Joel, Du Jiang, Jang Hyungseok, Krug Roland, Fields Aaron J
Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Quant Imaging Med Surg. 2023 May 1;13(5):2807-2821. doi: 10.21037/qims-22-729. Epub 2023 Mar 10.
BACKGROUND: T2* relaxation times in the spinal cartilage endplate (CEP) measured using ultra-short echo time magnetic resonance imaging (UTE MRI) reflect aspects of biochemical composition that influence the CEP's permeability to nutrients. Deficits in CEP composition measured using T2* biomarkers from UTE MRI are associated with more severe intervertebral disc degeneration in patients with chronic low back pain (cLBP). The goal of this study was to develop an objective, accurate, and efficient deep-learning-based method for calculating biomarkers of CEP health using UTE images. METHODS: Multi-echo UTE MRI of the lumbar spine was acquired from a prospectively enrolled cross-sectional and consecutive cohort of 83 subjects spanning a wide range of ages and cLBP-related conditions. CEPs from the L4-S1 levels were manually segmented on 6,972 UTE images and used to train neural networks utilizing the u-net architecture. CEP segmentations and mean CEP T2* values derived from manually- and model-generated segmentations were compared using Dice scores, sensitivity, specificity, Bland-Altman, and receiver-operator characteristic (ROC) analysis. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated and related to model performance. RESULTS: Compared with manual CEP segmentations, model-generated segmentations achieved sensitives of 0.80-0.91, specificities of 0.99, Dice scores of 0.77-0.85, area under the receiver-operating characteristic curve values of 0.99, and precision-recall (PR) AUC values of 0.56-0.77, depending on spinal level and sagittal image position. Mean CEP T2* values and principal CEP angles derived from the model-predicted segmentations had low bias in an unseen test dataset (T2* bias =0.33±2.37 ms, angle bias =0.36±2.65°). To simulate a hypothetical clinical scenario, the predicted segmentations were used to stratify CEPs into high, medium, and low T2* groups. Group predictions had diagnostic sensitivities of 0.77-0.86 and specificities of 0.86-0.95. Model performance was positively associated with image SNR and CNR. CONCLUSIONS: The trained deep learning models enable accurate, automated CEP segmentations and T2* biomarker computations that are statistically similar to those from manual segmentations. These models address limitations with inefficiency and subjectivity associated with manual methods. Such techniques could be used to elucidate the role of CEP composition in disc degeneration etiology and guide emerging therapies for cLBP.
背景:使用超短回波时间磁共振成像(UTE MRI)测量的脊柱软骨终板(CEP)的T2弛豫时间反映了影响CEP对营养物质通透性的生化组成方面。使用UTE MRI的T2生物标志物测量的CEP组成缺陷与慢性下腰痛(cLBP)患者更严重的椎间盘退变相关。本研究的目的是开发一种基于深度学习的客观、准确且高效的方法,用于使用UTE图像计算CEP健康的生物标志物。 方法:对83名年龄范围广泛且患有与cLBP相关疾病的前瞻性入组横断面连续队列进行腰椎多回波UTE MRI检查。在6972张UTE图像上手动分割L4 - S1水平的CEP,并用于训练采用u-net架构的神经网络。使用Dice分数、灵敏度、特异性、Bland - Altman分析和接受者操作特征(ROC)分析比较CEP分割以及手动生成和模型生成分割得出的平均CEP T2值。计算信噪比(SNR)和对比噪声比(CNR)并将其与模型性能相关联。 结果:与手动CEP分割相比,模型生成的分割在不同脊柱节段和矢状位图像位置的灵敏度为0.80 - 0.91,特异性为0.99,Dice分数为0.77 - 0.85,接受者操作特征曲线下面积值为0.99,精确召回率(PR)AUC值为0.56 - 0.77。在一个未见过的测试数据集中,模型预测分割得出的平均CEP T2值和主要CEP角度偏差较低(T2偏差 = 0.33±2.37 ms,角度偏差 = 0.36±2.65°)。为了模拟一个假设的临床场景,将预测分割用于将CEP分层为高、中、低T2组。组预测的诊断灵敏度为0.77 - 0.86,特异性为0.86 - 0.95。模型性能与图像SNR和CNR呈正相关。 结论:经过训练的深度学习模型能够实现准确、自动化的CEP分割和T2*生物标志物计算,在统计学上与手动分割相似。这些模型解决了与手动方法相关的效率低下和主观性的局限性。此类技术可用于阐明CEP组成在椎间盘退变病因中的作用,并指导cLBP的新兴治疗方法。
Quant Imaging Med Surg. 2023-5-1
J Med Imaging Radiat Oncol. 2013-8
Spine (Phila Pa 1976). 2018-5-15
Comput Methods Programs Biomed. 2017-5
J Med Internet Res. 2025-3-10
J Magn Reson Imaging. 2025-4