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Inter-software and inter-threshold reliability of quantitative paraspinal muscle segmentation.

Sihai Liu1, Hendrik Schmidt1, Katharina Ziegeler2

  • 1Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

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Summary

Image analysis software for low back pain research shows high agreement between programs. However, different segmentation methods yield varying results, so direct comparison is not advised.

Keywords:
Fatty infiltrationMagnetic resonance imagingParaspinal muscleSoftwareThreshold

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Area of Science:

  • Biomedical Imaging
  • Musculoskeletal Research
  • Quantitative Analysis

Background:

  • Low back pain is often associated with changes in lumbar multifidus (MF) and erector spinae (ES) muscle cross-sectional area (CSA) and functional cross-sectional area (FCSA).
  • Accurate assessment of muscle CSA and composition is crucial for understanding low back pain.
  • Current quantitative analysis methods for muscle segmentation lack a standardized gold standard for software and threshold techniques.

Purpose of the Study:

  • To analyze measurement errors between different image processing software (ImageJ, Amira) for lumbar muscle segmentation.
  • To evaluate the impact of different threshold methods (Circle, Overlap) on muscle CSA and FCSA measurements.
  • To determine the reliability and agreement of quantitative MRI analysis for MF and ES muscles.

Main Methods:

  • Magnetic resonance images (MRI) from 60 patients were analyzed for MF and ES muscles at L4/L5 and L5/S1 levels.
  • Muscle CSA, FCSA, and FCSA/CSA ratio were measured by two independent observers using two software programs and two threshold methods.
  • Inter-rater and inter-software reliability, as well as agreement between segmentation methods, were assessed.

Main Results:

  • Excellent inter-software agreement (0.75-0.99) was found for CSA, FCSA, and FCSA/CSA, irrespective of the threshold method.
  • High inter-rater reliability (0.75-0.99) was observed between observers for all measurements.
  • Poor inter-rater reliability was noted between different threshold methods, with significant differences in FCSA and FCSA/CSA measurements (P < 0.01).

Conclusions:

  • The two software programs evaluated demonstrate high reliability and agreement for lumbar muscle quantitative analysis.
  • Direct comparison of study results derived from different threshold segmentation methods is not recommended due to significant variability.
  • Standardization of threshold methods is needed for consistent and comparable quantitative MRI analysis of paraspinal muscles.