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Radiomics and Deep Learning for Disease Detection in Musculoskeletal Radiology: An Overview of Novel MRI- and CT-Based Approaches

Fritz, Benjamin; Yi, Paul H; Kijowski, Richard; Fritz, Jan
ABSTRACT/UNASSIGNED:Radiomics and machine learning-based methods offer exciting opportunities for improving diagnostic performance and efficiency in musculoskeletal radiology for various tasks, including acute injuries, chronic conditions, spinal abnormalities, and neoplasms. While early radiomics-based methods were often limited to a smaller number of higher-order image feature extractions, applying machine learning-based analytic models, multifactorial correlations, and classifiers now permits big data processing and testing thousands of features to identify relevant markers. A growing number of novel deep learning-based methods describe magnetic resonance imaging- and computed tomography-based algorithms for diagnosing anterior cruciate ligament tears, meniscus tears, articular cartilage defects, rotator cuff tears, fractures, metastatic skeletal disease, and soft tissue tumors. Initial radiomics and deep learning techniques have focused on binary detection tasks, such as determining the presence or absence of a single abnormality and differentiation of benign versus malignant. Newer-generation algorithms aim to include practically relevant multiclass characterization of detected abnormalities, such as typing and malignancy grading of neoplasms. So-called delta-radiomics assess tumor features before and after treatment, with temporal changes of radiomics features serving as surrogate markers for tumor responses to treatment. New approaches also predict treatment success rates, surgical resection completeness, and recurrence risk. Practice-relevant goals for the next generation of algorithms include diagnostic whole-organ and advanced classification capabilities. Important research objectives to fill current knowledge gaps include well-designed research studies to understand how diagnostic performances and suggested efficiency gains of isolated research settings translate into routine daily clinical practice. This article summarizes current radiomics- and machine learning-based magnetic resonance imaging and computed tomography approaches for musculoskeletal disease detection and offers a perspective on future goals and objectives.
PMID: 36070548
ISSN: 1536-0210
CID: 5337042

The KNee OsteoArthritis Prediction (KNOAP2020) challenge: An image analysis challenge to predict incident symptomatic radiographic knee osteoarthritis from MRI and X-ray images

Hirvasniemi, J; Runhaar, J; van der Heijden, R A; Zokaeinikoo, M; Yang, M; Li, X; Tan, J; Rajamohan, H R; Zhou, Y; Deniz, C M; Caliva, F; Iriondo, C; Lee, J J; Liu, F; Martinez, A M; Namiri, N; Pedoia, V; Panfilov, E; Bayramoglu, N; Nguyen, H H; Nieminen, M T; Saarakkala, S; Tiulpin, A; Lin, E; Li, A; Li, V; Dam, E B; Chaudhari, A S; Kijowski, R; Bierma-Zeinstra, S; Oei, E H G; Klein, S
OBJECTIVES/OBJECTIVE:The KNee OsteoArthritis Prediction (KNOAP2020) challenge was organized to objectively compare methods for the prediction of incident symptomatic radiographic knee osteoarthritis within 78 months on a test set with blinded ground truth. DESIGN/METHODS:The challenge participants were free to use any available data sources to train their models. A test set of 423 knees from the Prevention of Knee Osteoarthritis in Overweight Females (PROOF) study consisting of magnetic resonance imaging (MRI) and X-ray image data along with clinical risk factors at baseline was made available to all challenge participants. The ground truth outcomes, i.e., which knees developed incident symptomatic radiographic knee osteoarthritis (according to the combined ACR criteria) within 78 months, were not provided to the participants. To assess the performance of the submitted models, we used the area under the receiver operating characteristic curve (ROCAUC) and balanced accuracy (BACC). RESULTS:Seven teams submitted 23 entries in total. A majority of the algorithms were trained on data from the Osteoarthritis Initiative. The model with the highest ROCAUC (0.64 (95% confidence interval (CI): 0.57-0.70)) used deep learning to extract information from X-ray images combined with clinical variables. The model with the highest BACC (0.59 (95% CI: 0.52-0.65)) ensembled three different models that used automatically extracted X-ray and MRI features along with clinical variables. CONCLUSION/CONCLUSIONS:The KNOAP2020 challenge established a benchmark for predicting incident symptomatic radiographic knee osteoarthritis. Accurate prediction of incident symptomatic radiographic knee osteoarthritis is a complex and still unsolved problem requiring additional investigation.
PMID: 36243308
ISSN: 1522-9653
CID: 5361322

Emerging Technology in Musculoskeletal MRI and CT

Kijowski, Richard; Fritz, Jan
This article provides a focused overview of emerging technology in musculoskeletal MRI and CT. These technological advances have primarily focused on decreasing examination times, obtaining higher quality images, providing more convenient and economical imaging alternatives, and improving patient safety through lower radiation doses. New MRI acceleration methods using deep learning and novel reconstruction algorithms can reduce scanning times while maintaining high image quality. New synthetic techniques are now available that provide multiple tissue contrasts from a limited amount of MRI and CT data. Modern low-field-strength MRI scanners can provide a more convenient and economical imaging alternative in clinical practice, while clinical 7.0-T scanners have the potential to maximize image quality. Three-dimensional MRI curved planar reformation and cinematic rendering can provide improved methods for image representation. Photon-counting detector CT can provide lower radiation doses, higher spatial resolution, greater tissue contrast, and reduced noise in comparison with currently used energy-integrating detector CT scanners. Technological advances have also been made in challenging areas of musculoskeletal imaging, including MR neurography, imaging around metal, and dual-energy CT. While the preliminary results of these emerging technologies have been encouraging, whether they result in higher diagnostic performance requires further investigation.
PMID: 36413131
ISSN: 1527-1315
CID: 5384152

Age-Dependent Changes in Knee Cartilage T1 , T2 , and T1p Simultaneously Measured Using MRI Fingerprinting

Kijowski, Richard; Sharafi, Azadeh; Zibetti, Marcelo V W; Chang, Gregory; Cloos, Martijn A; Regatte, Ravinder R
BACKGROUND:Magnetic resonance fingerprinting (MRF) techniques have been recently described for simultaneous multiparameter cartilage mapping of the knee although investigation of their ability to detect early cartilage degeneration remains limited. PURPOSE/OBJECTIVE:relaxation times measured using a three-dimensional (3D) MRF sequence in healthy volunteers. STUDY TYPE/METHODS:Prospective. SUBJECTS/METHODS:The study group consisted of 24 healthy asymptomatic human volunteers (15 males with mean age 34.9 ± 14.4 years and 9 females with mean age 44.5 ± 13.1 years). FIELD STRENGTH/SEQUENCE/UNASSIGNED:maps of knee cartilage. ASSESSMENT/RESULTS:relaxation times of the knee were measured. STATISTICAL TESTS/METHODS:relaxation times. The value of P < 0.05 was considered statistically significant. RESULTS: = 0.54-0.66). CONCLUSION/CONCLUSIONS:relaxation times simultaneously measured using a 3D-MRF sequence in healthy volunteers showed age-dependent changes in knee cartilage, primarily within the medial compartment.
PMID: 36190187
ISSN: 1522-2586
CID: 5361572

Imaging in Osteoarthritis

Roemer, F W; Guermazi, A; Demehri, S; Wirth, W; Kijowski, R
Osteoarthritis (OA) is the most frequent form of arthritis with major implications on both individual and public health care levels. The field of joint imaging, and particularly magnetic resonance imaging (MRI), has evolved rapidly due to the application of technical advances to the field of clinical research. This narrative review will provide an introduction to the different aspects of OA imaging aimed at an audience of scientists, clinicians, students, industry employees, and others who are interested in OA but who do not necessarily focus on OA. The current role of radiography and recent advances in measuring joint space width will be discussed. The status of cartilage morphology assessment and evaluation of cartilage biochemical composition will be presented. Advances in quantitative three-dimensional morphologic cartilage assessment and semi-quantitative whole-organ assessment of OA will be reviewed. Although MRI has evolved as the most important imaging method used in OA research, other modalities such as ultrasound, computed tomography, and metabolic imaging play a complementary role and will also be discussed.
PMID: 34560261
ISSN: 1522-9653
CID: 5026902

Deep learning approach to predict pain progression in knee osteoarthritis

Guan, Bochen; Liu, Fang; Mizaian, Arya Haj; Demehri, Shadpour; Samsonov, Alexey; Guermazi, Ali; Kijowski, Richard
OBJECTIVE:To develop and evaluate deep learning (DL) risk assessment models for predicting pain progression in subjects with or at risk of knee osteoarthritis (OA). MATERIALS AND METHODS/METHODS:The incidence and progression cohorts of the Osteoarthritis Initiative, a multi-center longitudinal study involving 9348 knees in 4674 subjects with or at risk of knee OA that began in 2004 and is ongoing, were used to conduct this retrospective analysis. A subset of knees without and with pain progression (defined as a 9-point or greater increase in pain score between baseline and two or more follow-up time points over the first 48 months) was randomly stratified into training (4200 knees with a mean age of 61.0 years and 60% female) and hold-out testing (500 knees with a mean age of 60.8 years and 60% female) datasets. A DL model was developed to predict pain progression using baseline knee radiographs. An artificial neural network was used to develop a traditional risk assessment model to predict pain progression using demographic, clinical, and radiographic risk factors. A combined model was developed to combine demographic, clinical, and radiographic risk factors with DL analysis of baseline knee radiographs. Area under the curve (AUC) analysis was performed using the hold-out testing dataset to evaluate model performance. RESULTS:The traditional model had an AUC of 0.692 (66.9% sensitivity and 64.1% specificity). The DL model had an AUC of 0.770 (76.7% sensitivity and 70.5% specificity), which was significantly higher (p < 0.001) than the traditional model. The combined model had an AUC of 0.807 (72.3% sensitivity and 80.9% specificity), which was significantly higher (p < 0.05) than the traditional and DL models. CONCLUSIONS:DL models using baseline knee radiographs had higher diagnostic performance for predicting pain progression than traditional models using demographic, clinical, and radiographic risk factors.
PMID: 33835240
ISSN: 1432-2161
CID: 4839652

Artificial intelligence in musculoskeletal imaging: a perspective on value propositions, clinical use, and obstacles

Fritz, Jan; Kijowski, Richard; Recht, Michael P
Artificial intelligence and deep learning (DL) offer musculoskeletal radiology exciting possibilities in multiple areas, including image reconstruction and transformation, tissue segmentation, workflow support, and disease detection. Novel DL-based image reconstruction algorithms correcting aliasing artifacts, signal loss, and noise amplification with previously unobtainable effectiveness are prime examples of how DL algorithms deliver promised value propositions in musculoskeletal radiology. The speed of DL-based tissue segmentation promises great efficiency gains that may permit the inclusion of tissue compositional-based information routinely into radiology reports. Similarly, DL algorithms give rise to a myriad of opportunities for workflow improvements, including intelligent and adaptive hanging protocols, speech recognition, report generation, scheduling, precertification, and billing. The value propositions of disease-detecting DL algorithms include reduced error rates and increased productivity. However, more studies using authentic clinical workflow settings are necessary to fully understand the value of DL algorithms for disease detection in clinical practice. Successful workflow integration and management of multiple algorithms are critical for translating the value propositions of DL algorithms into clinical practice but represent a major roadblock for which solutions are critically needed. While there is no consensus about the most sustainable business model, radiology departments will need to carefully weigh the benefits and disadvantages of each commercially available DL algorithm. Although more studies are needed to understand the value and impact of DL algorithms on clinical practice, DL technology will likely play an important role in the future of musculoskeletal imaging.
PMID: 33983500
ISSN: 1432-2161
CID: 4867662

Standardization of Compositional MRI of Knee Cartilage: Why and How [Comment]

Kijowski, Richard
PMID: 34491134
ISSN: 1527-1315
CID: 5048682

Magnetic resonance parameter mapping using model-guided self-supervised deep learning

Liu, Fang; Kijowski, Richard; El Fakhri, Georges; Feng, Li
PURPOSE/OBJECTIVE:To develop a model-guided self-supervised deep learning MRI reconstruction framework called reference-free latent map extraction (RELAX) for rapid quantitative MR parameter mapping. METHODS:mapping in both simulated and actually acquired MRI data sets and was compared with supervised learning and conventional constrained reconstruction for suppressing noise and/or undersampling-induced artifacts. RESULTS:mapping data sets, RELAX achieved superior reconstruction quality compared with conventional iterative reconstruction, and similar reconstruction performance to supervised deep learning reconstruction. CONCLUSION/CONCLUSIONS:This work has demonstrated the initial feasibility of rapid quantitative MR parameter mapping based on self-supervised deep learning. The RELAX framework may also be further extended to other quantitative MRI applications by incorporating corresponding quantitative imaging models.
PMID: 33464652
ISSN: 1522-2594
CID: 4760442

3D MRI of Articular Cartilage

Kijowski, Richard
Osteoarthritis, characterized by the breakdown of articular cartilage and other joint structures, is one of the most prevalent and disabling chronic diseases in the United States. Magnetic resonance imaging is a commonly used imaging modality to evaluate patients with joint pain. Both two-dimensional fast spin-echo sequences (2D-FSE) and three-dimensional (3D) sequences are used in clinical practice to evaluate articular cartilage. The 3D sequences have many advantages compared with 2D-FSE sequences, such as their high in-plane spatial resolution, thin continuous slices that reduce the effects of partial volume averaging, and ability to create multiplanar reformat images following a single acquisition. This article reviews the different 3D imaging techniques available for evaluating cartilage morphology, illustrates the strengths and weaknesses of 3D approaches compared with 2D-FSE approaches for cartilage imaging, and summarizes the diagnostic performance of 2D-FSE and 3D sequences for detecting cartilage lesions within the knee and hip joints.
PMID: 34547805
ISSN: 1098-898x
CID: 5061482