Predicting knee osteoarthritis severity: comparative modeling based on patient's data and plain X-ray images

Knee osteoarthritis (KOA) is a disease that impairs knee function and causes pain. A radiologist reviews knee X-ray images and grades the severity level of the impairments according to the Kellgren and Lawrence grading scheme; a five-point ordinal scale (0--4). In this study, we used Elastic Net (EN) and Random Forests (RF) to build predictive models using patient assessment data (i.e. signs and symptoms of both knees and medication use) and a convolution neural network (CNN) trained using X-ray images only. Linear mixed effect models (LMM) were used to model the within subject correlation between the two knees. The root mean squared error for the CNN, EN, and RF models was 0.77, 0.97, and 0.94 respectively. The LMM shows similar overall prediction accuracy as the EN regression but correctly accounted for the hierarchical structure of the data resulting in more reliable inference. Useful explanatory variables were identified that could be used for patient monitoring before X-ray imaging. Our analyses suggest that the models trained for predicting the KOA severity levels achieve comparable results when modeling X-ray images and patient data. The subjectivity in the KL grade is still a primary concern.

Feature Learning to Automatically Assess Radiographic Knee Osteoarthritis Severity

This chapter presents the investigations and the results of feature learning using convolutional neural networks to automatically assess knee osteoarthritis (OA) severity and the associated clinical and diagnostic features of knee OA from X-ray images. Also, this chapter demonstrates that feature learning in a supervised manner is more effective than using conventional handcrafted features for automatic detection of knee joints and fine-grained knee OA image classification. In the general machine learning approach to automatically assess knee OA severity, the first step is to localize the region of interest that is to detect and extract the knee joint regions from the radiographs, and the next step is to classify the localized knee joints based on a radiographic classification scheme such as Kellgren and Lawrence grades. First, the existing approaches for detecting (or localizing) the knee joint regions based on handcrafted features are reviewed and outlined. Next, three new approaches are introduced: 1) to automatically detect the knee joint region using a fully convolutional network, 2) to automatically assess the radiographic knee OA using CNNs trained from scratch for classification and regression of knee joint images to predict KL grades in ordinal and continuous scales, and 3) to quantify the knee OA severity optimizing a weighted ratio of two loss functions: categorical cross entropy and mean-squared error using multi-objective convolutional learning and ordinal regression. Two public datasets: the OAI and the MOST are used to evaluate the approaches with promising results that outperform existing approaches. In summary, this work primarily contributes to the field of automated methods for localization (automatic detection) and quantification (image classification) of radiographic knee OA.

Automatic Detection of Knee Joints and Quantification of Knee Osteoarthritis Severity using Convolutional Neural Networks

This paper introduces a new approach to automatically quantify the severity of knee OA using X-ray images. Automatically quantifying knee OA severity involves two steps: first, automatically localizing the knee joints; next, classifying the localized knee joint images. We introduce a new approach to automatically detect the knee joints using a fully convolutional neural network (FCN). We train convolutional neural networks (CNN) from scratch to automatically quantify the knee OA severity optimizing a weighted ratio of two loss functions: categorical cross-entropy and mean-squared loss. This joint training further improves the overall quantification of knee OA severity, with the added benefit of naturally producing simultaneous multi-class classification and regression outputs. Two public datasets are used to evaluate our approach, the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST), with extremely promising results that outperform existing approaches.

An Interactive Segmentation Tool for Quantifying Fat in Lumbar Muscles using Axial Lumbar-Spine MRI

In this paper we present an interactive tool that can be used to quantify fat infiltration in lumbar muscles, which is useful in studying fat infiltration and lower back pain (LBP) in adults. Currently, a qualitative assessment by visual grading via a 5-point scale is used to study fat infiltration in lumbar muscles from an axial view of lumbar-spine MR Images. However, a quantitative approach (on a continuous scale of 0-100\%) may provide a greater insight. In this paper, we propose a method to precisely quantify the fat deposition / infiltration in a user-defined region of the lumbar muscles, which may aid better diagnosis and analysis. The key steps are interactively segmenting the region of interest (ROI) from the lumbar muscles using the well known livewire technique, identifying fatty regions in the segmented region based on variable-selection of threshold and softness levels, automatically detecting the center of the spinal column and fragmenting the lumbar muscles into smaller regions with reference to the center of the spinal column, computing key parameters [such as total and region-wise fat content percentage, total-cross sectional area (TCSA) and functional cross-sectional area (FCSA)] and exporting the computations and associated patient information from the MRI, into a database. A standalone application using MATLAB R2014a was developed to perform the required computations along with an intuitive graphical user interface (GUI).

Quantifying Radiographic Knee Osteoarthritis Severity using Deep Convolutional Neural Networks

This paper proposes a new approach to automatically quantify the severity of knee osteoarthritis (OA) from radiographs using deep convolutional neural networks (CNN). Clinically, knee OA severity is assessed using Kellgren \& Lawrence (KL) grades, a five point scale. Previous work on automatically predicting KL grades from radiograph images were based on training shallow classifiers using a variety of hand engineered features. We demonstrate that classification accuracy can be significantly improved using deep convolutional neural network models pre-trained on ImageNet and fine-tuned on knee OA images. Furthermore, we argue that it is more appropriate to assess the accuracy of automatic knee OA severity predictions using a continuous distance-based evaluation metric like mean squared error than it is to use classification accuracy. This leads to the formulation of the prediction of KL grades as a regression problem and further improves accuracy. Results on a dataset of X-ray images and KL grades from the Osteoarthritis Initiative (OAI) show a sizable improvement over the current state-of-the-art.