Cascade learning in multi-task encoder-decoder networks for concurrent bone segmentation and glenohumeral joint assessment in shoulder CT scans

Osteoarthritis is a degenerative condition affecting bones and cartilage, often leading to osteophyte formation, bone density loss, and joint space narrowing. Treatment options to restore normal joint function vary depending on the severity of the condition. This work introduces an innovative deep-learning framework processing shoulder CT scans. It features the semantic segmentation of the proximal humerus and scapula, the 3D reconstruction of bone surfaces, the identification of the glenohumeral (GH) joint region, and the staging of three common osteoarthritic-related pathologies: osteophyte formation (OS), GH space reduction (JS), and humeroscapular alignment (HSA). The pipeline comprises two cascaded CNN architectures: 3D CEL-UNet for segmentation and 3D Arthro-Net for threefold classification. A retrospective dataset of 571 CT scans featuring patients with various degrees of GH osteoarthritic-related pathologies was used to train, validate, and test the pipeline. Root mean squared error and Hausdorff distance median values for 3D reconstruction were 0.22mm and 1.48mm for the humerus and 0.24mm and 1.48mm for the scapula, outperforming state-of-the-art architectures and making it potentially suitable for a PSI-based shoulder arthroplasty preoperative plan context. The classification accuracy for OS, JS, and HSA consistently reached around 90% across all three categories. The computational time for the inference pipeline was less than 15s, showcasing the framework's efficiency and compatibility with orthopedic radiology practice. The outcomes represent a promising advancement toward the medical translation of artificial intelligence tools. This progress aims to streamline the preoperative planning pipeline delivering high-quality bone surfaces and supporting surgeons in selecting the most suitable surgical approach according to the unique patient joint conditions.