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Fan G, Li Y, Wang D, Zhang J, Du X, Liu H, Liao X. Automatic segmentation of dura for quantitative analysis of lumbar stenosis: A deep learning study with 518 CT myelograms. J Appl Clin Med Phys 2024; 25:e14378. [PMID: 38729652 PMCID: PMC11244674 DOI: 10.1002/acm2.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/01/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The diagnosis of lumbar spinal stenosis (LSS) can be challenging because radicular pain is not often present in the culprit-level localization. Accurate segmentation and quantitative analysis of the lumbar dura on radiographic images are key to the accurate differential diagnosis of LSS. The aim of this study is to develop an automatic dura-contouring tool for radiographic quantification on computed tomography myelogram (CTM) for patients with LSS. METHODS A total of 518 CTM cases with or without lumbar stenosis were included in this study. A deep learning (DL) segmentation algorithm 3-dimensional (3D) U-Net was deployed. A total of 210 labeled cases were used to develop the dura-contouring tool, with the ratio of the training, independent testing, and external validation datasets being 150:30:30. The Dice score (DCS) was the primary measure to evaluate the segmentation performance of the 3D U-Net, which was subsequently developed as the dura-contouring tool to segment another unlabeled 308 CTM cases with LSS. Automatic masks of 446 slices on the stenotic levels were then meticulously reviewed and revised by human experts, and the cross-sectional area (CSA) of the dura was compared. RESULTS The mean DCS of the 3D U-Net were 0.905 ± 0.080, 0.933 ± 0.018, and 0.928 ± 0.034 in the five-fold cross-validation, the independent testing, and the external validation datasets, respectively. The segmentation performance of the dura-contouring tool was also comparable to that of the second observer (the human expert). With the dura-contouring tool, only 59.0% (263/446) of the automatic masks of the stenotic slices needed to be revised. In the revised cases, there were no significant differences in the dura CSA between automatic masks and corresponding revised masks (p = 0.652). Additionally, a strong correlation of dura CSA was found between the automatic masks and corresponding revised masks (r = 0.805). CONCLUSIONS A dura-contouring tool was developed that could automatically segment the dural sac on CTM, and it demonstrated high accuracy and generalization ability. Additionally, the dura-contouring tool has the potential to be applied in patients with LSS because it facilitates the quantification of the dural CSA on stenotic slices.
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Affiliation(s)
- Guoxin Fan
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yufeng Li
- Department of Sports Medicine, Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Dongdong Wang
- Department of Orthopaedics, Putuo People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jianjin Zhang
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Xiaokang Du
- Department of Orthopedics, The People's Hospital of Wenshang County, Wenshang, Shandong, China
| | - Huaqing Liu
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua PearlRiverDelta, Guangzhou, China
| | - Xiang Liao
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Zhao J, Sun L, Sun Z, Zhou X, Si H, Zhang D. MSEF-Net: Multi-scale edge fusion network for lumbosacral plexus segmentation with MR image. Artif Intell Med 2024; 148:102771. [PMID: 38325928 DOI: 10.1016/j.artmed.2024.102771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 12/08/2023] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
Nerve damage of spine areas is a common cause of disability and paralysis. The lumbosacral plexus segmentation from magnetic resonance imaging (MRI) scans plays an important role in many computer-aided diagnoses and surgery of spinal nerve lesions. Due to the complex structure and low contrast of the lumbosacral plexus, it is difficult to delineate the regions of edges accurately. To address this issue, we propose a Multi-Scale Edge Fusion Network (MSEF-Net) to fully enhance the edge feature in the encoder and adaptively fuse multi-scale features in the decoder. Specifically, to highlight the edge structure feature, we propose an edge feature fusion module (EFFM) by combining the Sobel operator edge detection and the edge-guided attention module (EAM), respectively. To adaptively fuse the multi-scale feature map in the decoder, we introduce an adaptive multi-scale fusion module (AMSF). Our proposed MSEF-Net method was evaluated on the collected spinal MRI dataset with 89 patients (a total of 2848 MR images). Experimental results demonstrate that our MSEF-Net is effective for lumbosacral plexus segmentation with MR images, when compared with several state-of-the-art segmentation methods.
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Affiliation(s)
- Junyong Zhao
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, the Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing 211106, China
| | - Liang Sun
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, the Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing 211106, China; Nanjing University of Aeronautics and Astronautics Shenzhen Research Institute, Shenzhen 518063, China.
| | - Zhi Sun
- Department of Medical Imaging, Shandong Provincial Hospital, Jinan 250021, China
| | - Xin Zhou
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Haipeng Si
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.
| | - Daoqiang Zhang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, the Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing 211106, China; Nanjing University of Aeronautics and Astronautics Shenzhen Research Institute, Shenzhen 518063, China.
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Tabarestani TQ, Salven DS, Sykes DAW, Bardeesi AM, Bartlett AM, Wang TY, Paturu MR, Dibble CF, Shaffrey CI, Ray WZ, Chi JH, Wiggins WF, Abd-El-Barr MM. Using Novel Segmentation Technology to Define Safe Corridors for Minimally Invasive Posterior Lumbar Interbody Fusion. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-01010. [PMID: 38149852 DOI: 10.1227/ons.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There has been a rise in minimally invasive methods to access the intervertebral disk space posteriorly given their decreased tissue destruction, lower blood loss, and earlier return to work. Two such options include the percutaneous lumbar interbody fusion through the Kambin triangle and the endoscopic transfacet approach. However, without accurate preoperative visualization, these approaches carry risks of damaging surrounding structures, especially the nerve roots. Using novel segmentation technology, our goal was to analyze the anatomic borders and relative sizes of the safe triangle, trans-Kambin, and the transfacet corridors to assist surgeons in planning a safe approach and determining cannula diameters. METHODS The areas of the safe triangle, Kambin, and transfacet corridors were measured using commercially available software (BrainLab, Munich, Germany). For each approach, the exiting nerve root, traversing nerve roots, theca, disk, and vertebrae were manually segmented on 3-dimensional T2-SPACE magnetic resonance imaging using a region-growing algorithm. The triangles' borders were delineated ensuring no overlap between the area and the nerves. RESULTS A total of 11 patients (65.4 ± 12.5 years, 33.3% female) were retrospectively reviewed. The Kambin, safe, and transfacet corridors were measured bilaterally at the operative level. The mean area (124.1 ± 19.7 mm2 vs 83.0 ± 11.7 mm2 vs 49.5 ± 11.4 mm2) and maximum permissible cannula diameter (9.9 ± 0.7 mm vs 6.8 ± 0.5 mm vs 6.05 ± 0.7 mm) for the transfacet triangles were significantly larger than Kambin and the traditional safe triangles, respectively (P < .001). CONCLUSION We identified, in 3-dimensional, the borders for the transfacet corridor: the traversing nerve root extending inferiorly until the caudal pedicle, the theca medially, and the exiting nerve root superiorly. These results illustrate the utility of preoperatively segmenting anatomic landmarks, specifically the nerve roots, to help guide decision-making when selecting the optimal operative approach.
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Affiliation(s)
- Troy Q Tabarestani
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - David S Salven
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - David A W Sykes
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anas M Bardeesi
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Alyssa M Bartlett
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Mounica R Paturu
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Christopher F Dibble
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | | | - Wilson Z Ray
- Department of Neurosurgery, Washington University, St. Louis, Missouri, USA
| | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Walter F Wiggins
- Department of Radiology, Duke University Hospital, Durham, North Carolina, USA
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Schnider E, Wolleb J, Huck A, Toranelli M, Rauter G, Müller-Gerbl M, Cattin PC. Improved distinct bone segmentation in upper-body CT through multi-resolution networks. Int J Comput Assist Radiol Surg 2023; 18:2091-2099. [PMID: 37338664 PMCID: PMC10589171 DOI: 10.1007/s11548-023-02957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Automated distinct bone segmentation from CT scans is widely used in planning and navigation workflows. U-Net variants are known to provide excellent results in supervised semantic segmentation. However, in distinct bone segmentation from upper-body CTs a large field of view and a computationally taxing 3D architecture are required. This leads to low-resolution results lacking detail or localisation errors due to missing spatial context when using high-resolution inputs. METHODS We propose to solve this problem by using end-to-end trainable segmentation networks that combine several 3D U-Nets working at different resolutions. Our approach, which extends and generalizes HookNet and MRN, captures spatial information at a lower resolution and skips the encoded information to the target network, which operates on smaller high-resolution inputs. We evaluated our proposed architecture against single-resolution networks and performed an ablation study on information concatenation and the number of context networks. RESULTS Our proposed best network achieves a median DSC of 0.86 taken over all 125 segmented bone classes and reduces the confusion among similar-looking bones in different locations. These results outperform our previously published 3D U-Net baseline results on the task and distinct bone segmentation results reported by other groups. CONCLUSION The presented multi-resolution 3D U-Nets address current shortcomings in bone segmentation from upper-body CT scans by allowing for capturing a larger field of view while avoiding the cubic growth of the input pixels and intermediate computations that quickly outgrow the computational capacities in 3D. The approach thus improves the accuracy and efficiency of distinct bone segmentation from upper-body CT.
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Affiliation(s)
- Eva Schnider
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B, 4123, Allschwil, Switzerland.
| | - Julia Wolleb
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B, 4123, Allschwil, Switzerland
| | - Antal Huck
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B, 4123, Allschwil, Switzerland
| | - Mireille Toranelli
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Basel, Switzerland
| | - Georg Rauter
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B, 4123, Allschwil, Switzerland
| | - Magdalena Müller-Gerbl
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Basel, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B, 4123, Allschwil, Switzerland
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Wang M, Su Z, Liu Z, Chen T, Cui Z, Li S, Pang S, Lu H. Deep Learning-Based Automated Magnetic Resonance Image Segmentation of the Lumbar Structure and Its Adjacent Structures at the L4/5 Level. Bioengineering (Basel) 2023; 10:963. [PMID: 37627848 PMCID: PMC10451852 DOI: 10.3390/bioengineering10080963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: This study aims to develop a deep learning model based on a 3D Deeplab V3+ network to automatically segment multiple structures from magnetic resonance (MR) images at the L4/5 level. (2) Methods: After data preprocessing, the modified 3D Deeplab V3+ network of the deep learning model was used for the automatic segmentation of multiple structures from MR images at the L4/5 level. We performed five-fold cross-validation to evaluate the performance of the deep learning model. Subsequently, the Dice Similarity Coefficient (DSC), precision, and recall were also used to assess the deep learning model's performance. Pearson's correlation coefficient analysis and the Wilcoxon signed-rank test were employed to compare the morphometric measurements of 3D reconstruction models generated by manual and automatic segmentation. (3) Results: The deep learning model obtained an overall average DSC of 0.886, an average precision of 0.899, and an average recall of 0.881 on the test sets. Furthermore, all morphometry-related measurements of 3D reconstruction models revealed no significant difference between ground truth and automatic segmentation. Strong linear relationships and correlations were also obtained in the morphometry-related measurements of 3D reconstruction models between ground truth and automated segmentation. (4) Conclusions: We found it feasible to perform automated segmentation of multiple structures from MR images, which would facilitate lumbar surgical evaluation by establishing 3D reconstruction models at the L4/5 level.
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Affiliation(s)
- Min Wang
- Department of Spinal Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua Dong Lu, Xiangzhou District, Zhuhai 519000, China; (M.W.); (Z.S.); (Z.L.); (T.C.); (Z.C.)
| | - Zhihai Su
- Department of Spinal Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua Dong Lu, Xiangzhou District, Zhuhai 519000, China; (M.W.); (Z.S.); (Z.L.); (T.C.); (Z.C.)
| | - Zheng Liu
- Department of Spinal Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua Dong Lu, Xiangzhou District, Zhuhai 519000, China; (M.W.); (Z.S.); (Z.L.); (T.C.); (Z.C.)
| | - Tao Chen
- Department of Spinal Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua Dong Lu, Xiangzhou District, Zhuhai 519000, China; (M.W.); (Z.S.); (Z.L.); (T.C.); (Z.C.)
| | - Zhifei Cui
- Department of Spinal Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua Dong Lu, Xiangzhou District, Zhuhai 519000, China; (M.W.); (Z.S.); (Z.L.); (T.C.); (Z.C.)
| | - Shaolin Li
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua Dong Lu, Xiangzhou District, Zhuhai 519000, China;
| | - Shumao Pang
- School of Biomedical Engineering, Guangzhou Medical University, No. 1, Xinzao Road, Xinzao Town, Panyu, Guangzhou 511436, China
| | - Hai Lu
- Department of Spinal Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua Dong Lu, Xiangzhou District, Zhuhai 519000, China; (M.W.); (Z.S.); (Z.L.); (T.C.); (Z.C.)
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Pang C, Su Z, Lin L, Lin G, He J, Lu H, Feng Q, Pang S. Automated measurement of spine indices on axial MR images for lumbar spinal stenosis diagnosis using segmentation-guided regression network. Med Phys 2023; 50:104-116. [PMID: 36029008 DOI: 10.1002/mp.15961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/03/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Automated measurement of spine indices on axial magnetic resonance (MR) images plays a significant role in lumbar spinal stenosis diagnosis. Existing direct spine indices measurement approaches fail to explicitly focus on the task-specific region or feature channel with the additional information for guiding. We aim to achieve accurate spine indices measurement by introducing the guidance of the segmentation task. METHODS In this paper, we propose a segmentation-guided regression network (SGRNet) to achieve automated spine indices measurement. SGRNet consists of a segmentation path for generating the spine segmentation prediction and a regression path for producing spine indices estimation. The segmentation path is a U-Net-like network which includes a segmentation encoder and a decoder which generates multilevel segmentation features and segmentation prediction. The proposed segmentation-guided attention module (SGAM) in the regression encoder extracts the attention-aware regression feature under the guidance of the segmentation feature. Based on the attention-aware regression feature, a fully connected layer is utilized to output the accurate spine indices estimation. RESULTS Experiments on the open-access Lumbar Spine MRI data set show that SGRNet achieves state-of-the-art performance with a mean absolute error of 0.49 mm and mean Pearson correlation coefficient of 0.956 for four indices estimation. CONCLUSIONS The proposed SGAM in SGRNet is capable of improving the performance of spine indices measurement by focusing on the task-specific region and feature channel under the guidance of the segmentation task.
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Affiliation(s)
- Chunlan Pang
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhihai Su
- Department of Spinal Surgery, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Liyan Lin
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Guoye Lin
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Ji He
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
| | - Hai Lu
- Department of Spinal Surgery, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Qianjin Feng
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Shumao Pang
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
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Waguia R, Gupta N, Gamel KL, Ukachukwu A. Current and Future Applications of the Kambin’s Triangle in Lumbar Spine Surgery. Cureus 2022; 14:e25686. [PMID: 35812644 PMCID: PMC9259071 DOI: 10.7759/cureus.25686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Kambin’s triangle has become the anatomical location of choice when accessing the lumbar spine to treat degenerative spinal disorders. Currently, lumbar interbody fusion is the most common procedure utilizing this space; however, with the advent of the Kambin’s prism definition, advanced imaging modalities, and robotic-assisted techniques, lumbar spine surgery has become increasingly precise and less invasive. These technological and procedural advances have drastically reduced the rate of complications, improved patient outcomes, and expanded the use of the Kambin’s triangle to treat different pathologies utilizing cutting-edge techniques. In this review, the authors present the current uses of the Kambin’s triangle and the future application of this anatomical corridor in lumbar spine surgery.
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