Enamundram Naga Karthik

Purpose: To develop a deep learning tool for the automatic segmentation of the spinal cord and intramedullary lesions in spinal cord injury (SCI) on T2-weighted MRI scans. Materials and Methods: This retrospective study included MRI data acquired between July 2002 and February 2023. The data consisted of T2-weighted MRI scans acquired using different scanner manufacturers with various image resolutions (isotropic and anisotropic) and orientations (axial and sagittal). Patients had different lesion etiologies (traumatic, ischemic, and hemorrhagic) and lesion locations across the cervical, thoracic, and lumbar spine. A deep learning model, SCIseg (which is open source and accessible through the Spinal Cord Toolbox, version 6.2 and above), was trained in a three-phase process involving active learning for the automatic segmentation of intramedullary SCI lesions and the spinal cord. The segmentations from the proposed model were visually and quantitatively compared with those from three other open-source methods (PropSeg, DeepSeg, and contrast-agnostic, all part of the Spinal Cord Toolbox). The Wilcoxon signed rank test was used to compare quantitative MRI biomarkers of SCI (lesion volume, lesion length, and maximal axial damage ratio) derived from the manual reference standard lesion masks and biomarkers obtained automatically with SCIseg segmentations. Results: The study included 191 patients with SCI (mean age, 48.1 years ± 17.9 [SD]; 142 [74%] male patients). SCIseg achieved a mean Dice score of 0.92 ± 0.07 and 0.61 ± 0.27 for spinal cord and SCI lesion segmentation, respectively. There was no evidence of a difference between lesion length (P = .42) and maximal axial damage ratio (P = .16) computed from manually annotated lesions and the lesion segmentations obtained using SCIseg. Conclusion: SCIseg accurately segmented intramedullary lesions on a diverse dataset of T2-weighted MRI scans and automatically extracted clinically relevant lesion characteristics. Keywords: Spinal Cord, Trauma, Segmentation, MR Imaging, Supervised Learning, Convolutional Neural Network (CNN) Published under a CC BY 4.0 license.

The cross-sectional area (CSA) of the spinal cord (SC) computed from its segmentation is a relevant clinical biomarker for the diagnosis and monitoring of cord compression and atrophy. One key limitation of existing automatic methods is that their SC segmentations depend on the MRI contrast, resulting in different CSA across contrasts. Furthermore, these methods rely on CNNs, leaving a gap in the literature for exploring the performance of modern deep learning (DL) architectures. In this study, we extend our recent work \citeBdard2023TowardsCS by evaluating the contrast-agnostic SC segmentation capabilities of different classes of DL architectures, namely, ConvNeXt, vision transformers (ViTs), and hierarchical ViTs. We compared 7 different DL models using the open-source \textitSpine Generic Database of healthy participants () consisting of 6 MRI contrasts per participant. Given a fixed dataset size, our results show that CNNs produce robust SC segmentations across contrasts, followed by ConvNeXt, and hierarchical ViTs. This suggests that: (i) inductive biases such as learning hierarchical feature reprensentations via pooling (common in CNNs) are crucial for good performance on SC segmentation, and (ii) hierarchical ViTs that incorporate several CNN-based priors can perform similarly to pure CNN-based models.