The skeletal muscle exists in the whole body and can be observed in many cross sections in various tomographic images. Skeletal muscle atrophy is due to aging and disease, and the abnormality is difficult to distinguish visually. In addition, although skeletal muscle analysis requires a technique for accurate site-specific measurement of skeletal muscle, it is only realized in a limited region. We realized automatic site-specific recognition of skeletal muscle from whole-body CT images using model-based methods. Three-dimensional texture analysis revealed imaging features with statistically significant differences between amyotrophic lateral sclerosis (ALS) and other muscular diseases accompanied by atrophy. In recent years, deep learning technique is also used in the field of computer-aided diagnosis. Therefore, in this initial study, we performed automatic classification of amyotrophic diseases using deep learning for the upper extremity and lower limb regions. The classification accuracy was highest in the right forearm, which was 0.960 at the maximum (0.903 on average). In the future, methods for differentiating more kinds of muscular atrophy and clinical application of ALS detection by analyzing muscular regions must be considered.
Amyotrophic lateral sclerosis (ALS) causes functional disorders such as difficulty in breathing and swallowing through the atrophy of voluntary muscles. ALS in its early stages is difficult to diagnose because of the difficulty in differentiating it from other muscular diseases. In addition, image inspection methods for aggressive diagnosis for ALS have not yet been established. The purpose of this study is to develop an automatic analysis system of the whole skeletal muscle to support the early differential diagnosis of ALS using whole-body CT images. In this study, the muscular atrophy parts including ALS patients are automatically identified by recognizing and segmenting whole skeletal muscle in the preliminary steps. First, the skeleton is identified by its gray value information. Second, the initial area of the body cavity is recognized by the deformation of the thoracic cavity based on the anatomical segmented skeleton. Third, the abdominal cavity boundary is recognized using ABM for precisely recognizing the body cavity. The body cavity is precisely recognized by non-rigid registration method based on the reference points of the abdominal cavity boundary. Fourth, the whole skeletal muscle is recognized by excluding the skeleton, the body cavity, and the subcutaneous fat. Additionally, the areas of muscular atrophy including ALS patients are automatically identified by comparison of the muscle mass. The experiments were carried out for ten cases with abnormality in the skeletal muscle. Global recognition and segmentation of the whole skeletal muscle were well realized in eight cases. Moreover, the areas of muscular atrophy including ALS patients were well identified in the lower limbs. As a result, this study indicated the basic technology to detect the muscle atrophy including ALS. In the future, it will be necessary to consider methods to differentiate other kinds of muscular atrophy as well as the clinical application of this detection method for early ALS detection and examine a large number of cases with stage and disease type.
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