• Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
• Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
• Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina.
• Department of Radiology, University of California Davis School of Medicine, Sacramento, California.
• Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
• Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. Electronic address: llenchik@wakehealth.edu.

RATIONALE AND OBJECTIVES: To develop and evaluate an automated machine learning (ML) algorithm for segmenting the paraspinous muscles on chest computed tomography (CT) scans to evaluate for presence of sarcopenia.

MATERIALS AND METHODS: A convolutional neural network based on the U-Net architecture was trained to perform muscle segmentation on a dataset of 1875 single slice CT images and was tested on 209 CT images of participants in the National Lung Screening Trial. Low-dose, noncontrast CT examinations were obtained at 33 clinical sites, using scanners from four manufacturers. The study participants had a mean age of 71.6 years (range, 70-74 years). Ground truth was obtained by manually segmenting the left paraspinous muscle at the level of the T12 vertebra. Muscle cross-sectional area (CSA) and muscle attenuation (MA) were recorded. Comparison between the ML algorithm and ground truth measures of muscle CSA and MA were obtained using Dice similarity coefficients and Pearson correlations.

RESULTS: Compared to ground truth segmentation, the ML algorithm achieved median (standard deviation) Dice scores of 0.94 (0.04) in the test set. Mean (SD) muscle CSA was 14.3 (3.6) cm² for ground truth and 13.7 (3.5) cm² for ML segmentation. Mean (SD) MA was 41.6 (7.6) Hounsfield units (HU) for ground truth and 43.5 (7.9) HU for ML segmentation. There was high correlation between ML algorithm and ground truth for muscle CSA (r² = 0.86; p < 0.0001) and MA (r² = 0.95; p < 0.0001).

CONCLUSION: The ML algorithm for measurement of paraspinous muscles compared favorably to manual ground truth measurements in the NLST. The algorithm generalized well to a heterogeneous set of low-dose CT images and may be capable of automated quantification of muscle metrics to screen for sarcopenia on routine chest CT examinations.