Multicenter Validation of Automated Segmentation and Composition Analysis of Lumbar Paraspinal Muscles Using Multisequence MRI

“Just Accepted” papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Chronic low back pain is a global health issue with considerable socioeconomic burdens and is associated with changes in lumbar paraspinal muscles (LPM). In this retrospective study, a deep learning method was trained and externally validated for automated LPM segmentation, muscle volume quantification, and fatty infiltration assessment across multisequence MRIs. A total of 1,302 MRIs from 641 participants across five centers were included. Data from two centers were used for model training and tuning, while data from the remaining three centers were used for external testing. Model segmentation performance was evaluated against manual segmentation using the Dice similarity coefficient (DSC), and measurement accuracy was assessed using two one-sided tests and Intraclass Correlation Coefficients (ICCs). The model achieved global DSC values of 0.98 on the internal test set and 0.93 to 0.97 on external test sets. Statistical equivalence between automated and manual measurements of muscle volume and fat ratio was confirmed in most regions ( P < .05). Agreement between automated and manual measurements was high (ICCs > 0.92). In conclusion, the proposed automated method accurately segmented LPM and demonstrated statistical equivalence to manual measurements of muscle volume and fatty infiltration ratio across multisequence, multicenter MRIs. ©RSNA, 2025