Relationship between machine-learning image classification of T2-weighted intramedullary hypointensity on 3T MRI and clinical outcome in dogs with severe spinal cord injury.

Early prognostic information in cases of severe spinal cord injury can aid treatment planning and stratification for clinical trials. Analysis of intraparenchymal signal change on MRI has been suggested to inform outcome prediction in traumatic spinal cord injury. We hypothesized that intraparenchymal T2-weighted hypointensity would be associated with a lower potential for functional recovery and a higher risk of progressive neurological deterioration in dogs with acute, severe, naturally occurring spinal cord injury. Our objectives were: 1) to demonstrate capacity for machine-learning criteria to identify clinically relevant regions of hypointensity; and, 2) to compare clinical outcomes for cases with and without such regions. A total of 95 dogs with complete spinal cord injury was evaluated. An image classification system based on Speeded-Up Robust Features (SURF) was trained to recognize individual axial T2-weighted slices that contained hypointensity. The presence of such slices in a given transverse series was correlated with a lower chance of functional recovery (OR 0.08 (CI 0.02-0.38); p < 10-3) and with a higher risk of neurological deterioration (OR 0.14 (CI 0.05-0.42); p < 10-3). Identification of intraparenchymal T2W hypointensity in severe, naturally -occurring spinal cord injury may be assisted by an image classification tool and is correlated with functional recovery.