MR-Transformer: A Vision Transformer-based Deep Learning Model for Total Knee Replacement Prediction Using MRI

Purpose To develop a transformer-based deep learning model-MR-Transformer-that leverages ImageNet pretraining and three-dimensional spatial correlations to predict the progression of knee osteoarthritis to total knee replacement using MRI. Materials and Methods This retrospective study included 353 case-control matched pairs of coronal intermediate-weighted turbo spin-echo (COR-IW-TSE) and sagittal intermediate-weighted turbo spin-echo with fat suppression (SAG-IW-TSE-FS) knee MRI scans from the Osteoarthritis Initiative database, with a follow-up period up to 9 years, and 270 case-control matched pairs of coronal short-tau inversion recovery (COR-STIR) and sagittal proton-density fat-saturated (SAG-PD-FAT-SAT) knee MRI scans from the Multicenter Osteoarthritis Study database, with a follow-up period up to 7 years. Performance of the MR-Transformer to predict the progression of knee osteoarthritis was compared with that of existing state-of-the-art deep learning models (TSE-Net, 3DMeT, and MRNet) using sevenfold nested cross-validation across the four MRI tissue sequences. Results Among the 353 Osteoarthritis Initiative case-control pairs, 215 were women (mean age, 63 years ± 8 [SD]); among the 270 Multicenter Osteoarthritis Study case-control pairs, 203 were women (mean age, 65 years ± 7). The MR-Transformer achieved areas under the receiver operating characteristic curve (AUCs) of 0.88 (95% CI: 0.85, 0.91), 0.88 (95% CI: 0.85, 0.90), 0.86 (95% CI: 0.82, 0.89), and 0.84 (95% CI: 0.81, 0.87) for COR-IW-TSE, SAG-IW-TSE-FS, COR-STIR, and SAG-PD-FAT-SAT, respectively. The model achieved a higher AUC than that of 3DMeT for all MRI sequences (P < .001). The model showed the highest sensitivity of 83% (95% CI: 78, 87) and specificity of 83% (95% CI: 76, 88) for the COR-IW-TSE MRI sequence. Conclusion Compared with the existing deep learning models, the MR-Transformer exhibited state-of-the-art performance in predicting the progression of knee osteoarthritis to total knee replacement using MRI scans. Keywords: MRI, Knee, Prognosis, Supervised Learning Supplemental material is available for this article. © RSNA, 2025.