• Terence P McSweeney, Aleksei Tiulpin, Simo Saarakkala, Jaakko Niinimäki, Rhydian Windsor, Amir Jamaludin, Timor Kadir, Jaro Karppinen, and Juhani Määttä.
• Research Unit of Health Sciences and Technology, University of Oulu.
• Spine. 2023 Apr 1; 48 (7): 484491484-491.

Study DesignThis is a retrospective observational study to externally validate a deep learning image classification model.ObjectiveDeep learning models such as SpineNet offer the possibility of automating the process of disk degeneration (DD) classification from magnetic resonance imaging (MRI). External validation is an essential step to their development. The aim of this study was to externally validate SpineNet predictions for DD using Pfirrmann classification and Modic changes (MCs) on data from the Northern Finland Birth Cohort 1966 (NFBC1966).Summary Of DataWe validated SpineNet using data from 1331 NFBC1966 participants for whom both lumbar spine MRI data and consensus DD gradings were available.Materials And MethodsSpineNet returned Pfirrmann grade and MC presence from T2-weighted sagittal lumbar MRI sequences from NFBC1966, a data set geographically and temporally separated from its training data set. A range of agreement and reliability metrics were used to compare predictions with expert radiologists. Subsets of data that match SpineNet training data more closely were also tested.ResultsBalanced accuracy for DD was 78% (77%-79%) and for MC 86% (85%-86%). Interrater reliability for Pfirrmann grading was Lin concordance correlation coefficient=0.86 (0.85-0.87) and Cohen κ=0.68 (0.67-0.69). In a low back pain subset, these reliability metrics remained largely unchanged. In total, 20.83% of disks were rated differently by SpineNet compared with the human raters, but only 0.85% of disks had a grade difference >1. Interrater reliability for MC detection was κ=0.74 (0.72-0.75). In the low back pain subset, this metric was almost unchanged at κ=0.76 (0.73-0.79).ConclusionsIn this study, SpineNet has been benchmarked against expert human raters in the research setting. It has matched human reliability and demonstrates robust performance despite the multiple challenges facing model generalizability.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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