Amir Jamaludin, Meelis Lootus, Timor Kadir, Andrew Zisserman, Jill Urban, Michele C. Battié, Jeremy Fairbank, Iain McCall

April 2017, Volume 26, Issue 5, pp 1374 - 1383 Original Article Read Full Article 10.1007/s00586-017-4956-3

First Online: 06 February 2017

Study design

Investigation of the automation of radiological features from magnetic resonance images (MRIs) of the lumbar spine.


To automate the process of grading lumbar intervertebral discs and vertebral bodies from MRIs.

Summary of background data

MR imaging is the most common imaging technique used in investigating low back pain (LBP). Various features of degradation, based on MRIs, are commonly recorded and graded, e.g., Modic change and Pfirrmann grading of intervertebral discs. Consistent scoring and grading is important for developing robust clinical systems and research. Automation facilitates this consistency and reduces the time of radiological analysis considerably and hence the expense.


12,018 intervertebral discs, from 2009 patients, were graded by a radiologist and were then used to train: (1) a system to detect and label vertebrae and discs in a given scan, and (2) a convolutional neural network (CNN) model that predicts several radiological gradings. The performance of the model, in terms of class average accuracy, was compared with the intra-observer class average accuracy of the radiologist.


The detection system achieved 95.6% accuracy in terms of disc detection and labeling. The model is able to produce predictions of multiple pathological gradings that consistently matched those of the radiologist. The model identifies ‘Evidence Hotspots’ that are the voxels that most contribute to the degradation scores.


Automation of radiological grading is now on par with human performance. The system can be beneficial in aiding clinical diagnoses in terms of objectivity of gradings and the speed of analysis. It can also draw the attention of a radiologist to regions of degradation. This objectivity and speed is an important stepping stone in the investigation of the relationship between MRIs and clinical diagnoses of back pain in large cohorts.

Level of Evidence: Level 3.

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