Development and Validation of Deep Learning-Based Algorithms for Predicting Lumbar Herniated Nucleus Pulposus Using Lumbar X-rays

Lumbar herniated nucleus pulposus (HNP) is difficult to diagnose using lumbar radiography. HNP is typically diagnosed using magnetic resonance imaging (MRI). This study developed and validated an artificial intelligence model that predicts lumbar HNP using lumbar radiography. A total of 180,271 lumbar radiographs were obtained from 34,661 patients in the form of lumbar X-ray and MRI images, which were matched together and labeled accordingly. The data were divided into a training set (31,149 patients and 162,257 images) and a test set (3512 patients and 18,014 images). Training data were used for learning using the EfficientNet-B5 model and four-fold cross-validation. The area under the curve (AUC) of the receiver operating characteristic (ROC) for the prediction of lumbar HNP was 0.73. The AUC of the ROC for predicting lumbar HNP in L (lumbar) 1-2, L2-3, L3-4, L4-5, and L5-S (sacrum)1 levels were 0.68, 0.68, 0.63, 0.67, and 0.72, respectively. Finally, an HNP prediction model was developed, although it requires further improvements.