# Automatic Grading of Individual Knee Osteoarthritis Features in Plain Radiographs using Deep Convolutional Neural Networks

## TL;DR

This paper presents a deep learning-based automated system for grading knee osteoarthritis features in radiographs, improving reliability and accuracy over traditional methods by leveraging ensemble residual networks and transfer learning.

## Contribution

The study introduces a multi-task deep learning approach that simultaneously predicts KL and OARSI grades, achieving high agreement and outperforming existing methods on large datasets.

## Key findings

- Cohen's kappa of 0.82 for KL-grade
- Area under ROC curve of 0.98 for OA detection
- Outperforms current state-of-the-art methods

## Abstract

Knee osteoarthritis (OA) is the most common musculoskeletal disease in the world. In primary healthcare, knee OA is diagnosed using clinical examination and radiographic assessment. Osteoarthritis Research Society International (OARSI) atlas of OA radiographic features allows to perform independent assessment of knee osteophytes, joint space narrowing and other knee features. This provides a fine-grained OA severity assessment of the knee, compared to the gold standard and most commonly used Kellgren-Lawrence (KL) composite score. However, both OARSI and KL grading systems suffer from moderate inter-rater agreement, and therefore, the use of computer-aided methods could help to improve the reliability of the process. In this study, we developed a robust, automatic method to simultaneously predict KL and OARSI grades in knee radiographs. Our method is based on Deep Learning and leverages an ensemble of deep residual networks with 50 layers, squeeze-excitation and ResNeXt blocks. Here, we used transfer learning from ImageNet with a fine-tuning on the whole Osteoarthritis Initiative (OAI) dataset. An independent testing of our model was performed on the whole Multicenter Osteoarthritis Study (MOST) dataset. Our multi-task method yielded Cohen's kappa coefficients of 0.82 for KL-grade and 0.79, 0.84, 0.94, 0.83, 0.84, 0.90 for femoral osteophytes, tibial osteophytes and joint space narrowing for lateral and medial compartments respectively. Furthermore, our method yielded area under the ROC curve of 0.98 and average precision of 0.98 for detecting the presence of radiographic OA (KL $\geq 2$), which is better than the current state-of-the-art.