Toward a clinical lumbar CAD: herniation diagnosis

Purpose A CAD system for lumbar disc degeneration and herniation based on clinical MR images can aid diagnostic decision-making provided the method is robust, efficient, and accurate. Material and methods A Bayesian-based classifier with a Gibbs distribution was designed and implemented for diagnosing lumbar disc herniation. Each disc is segmented with a gradient vector flow active contour model (GVF-snake) to extract shape features that feed a classifier. The GVF-snake is automatically initialized with an inner boundary of the disc initiated by a point inside the disc. This point is automatically generated by our previous work on lumbar disc labeling. The classifier operates on clinical T2-SPIR weighted sagittal MRI of the lumbar area. The classifier is applied slice-by-slice to tag herniated discs if they are classified as herniated in any of the 2D slices. This technique detects all visible herniated discs regardless of their location (lateral or central). The gold standard for the ground truth was obtained from collaborating radiologists by analyzing the clinical diagnosis report for each case. Results An average 92.5% herniation diagnosis accuracy was observed in a cross-validation experiment with 65 clinical cases. The random leave-out experiment runs ten rounds; in each round, 35 cases were used for testing and the remaining 30 cases were used for training. Conclusion An automatic robust disk herniation diagnostic method for clinical lumbar MRI was developed and tested. The method is intended for clinical practice to support reliable decision-making.