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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Abnormalities and defects that can cause lumbar spinal stenosis often occur in the Intervertebral Disc (IVD) of the patient’s lumbar spine. Their automatic detection and classification require an application of an image analysis algorithm on suitable images, such as mid-sagittal images or traverse mid-height intervertebral disc slices, as inputs. Hence the process of selecting and separating these images from other medical images in the patient’s set of scans is necessary. However, the technological progress in making this process automated is still lagging behind other areas in medical image classification research. In this paper, we report the result of our investigation on the suitability and performance of different approaches of machine learning to automatically select the best traverse plane that cuts closest to the half-height of an IVD from a database of lumbar spine MRI images. This study considers images features extracted using eleven different pre-trained Deep Convolution Neural Network (DCNN) models. We investigate the effectiveness of three dimensionality-reduction techniques and three feature-selection techniques on the classification performance. We also investigate the performance of five different Machine Learning (ML) algorithms and three Fully Connected (FC) neural network learning optimizers which are used to train an image classifier with hyperparameter optimization using a wide range of hyperparameter options and values. The different combinations of methods are tested on a publicly available lumbar spine MRI dataset consisting of MRI studies of 515 patients with symptomatic back pain. Our experiment shows that applying the Support Vector Machine algorithm with a short Gaussian kernel on full-length image features extracted using a pre-trained DenseNet201 model is the best approach to use. This approach gives the minimum per-class classification performance of around 0.88 when measured using the precision and recall metrics. The median performance measured using the precision metric ranges from 0.95 to 0.99 whereas that using the recall metric ranges from 0.93 to 1.0. When only considering the L3/L4, L4/L5, and L5/S1 classes, the minimum F1-Scores range between 0.93 to 0.95, whereas the median F1-Scores range between 0.97 to 0.99.

Image segmentation is an important precursor to boundary delineation of medical images. One of the major challenges in applying automatic image segmentation in medical images is the imperfection in the imaging process which can result in inconsistent contrast and brightness levels, and low image sharpness and vanishing boundaries. Although recent advances in deep learning produce vast improvements in the quality of image segmentation, the accuracy of segmentation around object boundaries still requires improvement. We developed a new approach to contour evolution that is more intuitive but shares some common principles with the active contour model method. The method uses two concepts, namely the boundary grid and sparse boundary representation, as an implicit and explicit representation of the boundary points. We tested our method using lumbar spine MRI images of 515 patients. The experiment results show that our method performs up to 10.2 times faster and more flexible than the geodesic active contours method. Using BF-score contour-based metric, we show that our method improves the boundary accuracy from 74% to 84% as opposed to 63% by the latter method.