Correlation of texture analysis of paraspinal musculature on MRI with different clinical endpoints: Lumbar Stenosis Outcome Study (LSOS)
The aim of this study was to apply texture analysis (TA) on paraspinal musculature in T2-weighted (T2w) magnetic resonance images (MRI) of symptomatic lumbar spinal stenosis (LSS) patients and correlate the findings with clinical outcome measures.
Ninety patients were prospectively enrolled in the multi-centric Lumbar Stenosis Outcome Study (LSOS). All patients received a T2w MRI, from which we selected axial images perpendicular to the intervertebral disc at level L3/4 for TA. Regions-of-interest (ROI) were drawn of the paraspinal musculature and 304 TA features/ ROI were calculated. As clinical outcome measurements, we analysed three commonly applied measures: Spinal Stenosis Measure (SSM), Roland-Morris Disability Questionnaire (RMDQ), as well as the Numeric Rating Scale (NRS). We used two machine learning-based classifiers: Decision table, and k-nearest neighbours (k-NN).
We observed no meaningful correlation between TA in paraspinal musculature and the two clinical outcome measures SSM symptoms and SSM function, while a moderate correlation was observed regarding the outcome measures RMDQ (k-NN: r = 0.56) and NRS (Decision Table: r = 0.72).
In conclusion, MR TA is a viable tool to quantify medical images and illustrate correlations of microarchitectural changes invisible to a human reader with potential clinical impact.
• TA is feasible on paraspinal musculature using MRI.
• TA on paraspinal musculature correlates with SSM and RMDQ.
• TA may enable a statement regarding clinical impact of imaging findings.
KeywordsMagnetic resonance imaging Machine learning Spine Muscles
Area under the curve
Cross-sectional muscle area
Digital imaging and communications in medicine
Grey-level co-occurrence matrix
Lumbar back pain
Lumbar spinal stenosis
Magnetic resonance imaging
Numeric rating scale (pain)
Picture archiving and communication system
Region of interest
Spinal stenosis measure
Turbo spin echo
This study has received funding by Helmut Horten Foundation, Baugarten Foundation, Pfizer-Foundation for geriatrics & research in geriatrics, Symphasis Charitable Foundation and OPO Foundation funds.
Compliance with ethical standards
The scientific guarantor of this publication is Roman Guggenberger, MD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Ulrike Held and Jakob M. Burgstaller kindly provided statistical advice for this manuscript.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
• multicentre study
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