Semi-Supervised Bone Marrow Lesion Detection from Knee MRI Segmentation Using Mask Inpainting Models

Bone marrow lesions (BMLs) are critical indicators of knee osteoarthritis (OA). Since they often appear as small, irregular structures with indistinguishable edges in knee magnetic resonance images (MRIs), effective detection of BMLs in MRI is vital for OA diagnosis and treatment. This paper proposes a semi-supervised local anomaly detection method using mask inpainting models for identification of BMLs in high-resolution knee MRI, effectively integrating a 3D femur bone segmentation model, a large mask inpainting model, and a series of post-processing techniques. The method was evaluated using MRIs at various resolutions from a subset of the public Osteoarthritis Initiative database. Dice score, Intersection over Union (IoU), and pixel-level sensitivity, specificity, and accuracy showed an advantage over the multiresolution knowledge distillation method-a state-of-the-art global anomaly detection method. Especially, segmentation performance is enhanced on higher-resolution images, achieving an over two times performance increase on the Dice score and the IoU score at a 448x448 resolution level. We also demonstrate that with increasing size of the BML region, both the Dice and IoU scores improve as the proportion of distinguishable boundary decreases. The identified BML masks can serve as markers for downstream tasks such as segmentation and classification. The proposed method has shown a potential in improving BML detection, laying a foundation for further advances in imaging-based OA research.