Fully automated evaluation of paraspinal muscle morphology and composition in patients with low back pain

Abstract

Chronic Low Back Pain (LBP) is one of the most prevalent musculoskeletal conditions and is the leading cause of disability worldwide. The morphology and composition of lumbar paraspinal muscles, in terms of infiltrated adipose tissue, constitute important guidelines for diagnosis and treatment choice but still require manual procedures to be assessed. We developed a fully automated artificial intelligence based algorithm both to segment paraspinal muscles from MRI scans through a U-Net architecture and to estimate the amount of fatty infiltrations by a home-made intensity- and region-based processing; we further validated our results by statistical assessment of the accuracy and agreement between our automated measures and the clinically reported values, achieving dice scores greater than 95 % on the preliminary segmentation task, as well as an excellent degree of agreement on the following area estimates (ICC_2,1 = 0.89). Furthermore, we employed an external public dataset to validate our model generalization abilities, reaching dice scores greater than 94 % with an average processing time of 21.92s(±3.38s) per subject. Hence, a deterministic and reliable measuring tool is proposed, without any manual confounding effect, to efficiently support daily clinical practice in LBP management.