Generative adversarial networks for spine imaging: A critical review of current applications

Purpose: In recent years, the field of medical imaging has witnessed remarkable advancements, with innovative technologies which revolutionized the visualization and analysis of the human spine. Among the groundbreaking developments in medical imaging, Generative Adversarial Networks (GANs) have emerged as a transformative tool, offering unprecedented possibilities in enhancing spinal imaging techniques and diagnostic outcomes. This review paper aims to provide a comprehensive overview of the use of GANs in spinal imaging, and to emphasize their potential to improve the diagnosis and treatment of spine-related disorders. A specific review focusing on Generative Adversarial Networks (GANs) in the context of medical spine imaging is needed to provide a comprehensive and specialized analysis of the unique challenges, applications, and advancements within this specific domain, which might not be fully addressed in broader reviews covering GANs in general medical imaging. Such a review can offer insights into the tailored solutions and innovations that GANs bring to the field of spinal medical imaging. Methods: An extensive literature search from 2017 until July 2023, was conducted using the most important search engines and identified studies that used GANs in spinal imaging. Results: The implementations include generating fat suppressed T2-weighted (fsT2W) images from T1 and T2weighted sequences, to reduce scan time. The generated images had a significantly better image quality than true fsT2W images and could improve diagnostic accuracy for certain pathologies. GANs were also utilized in generating virtual thin-slice images of intervertebral spaces, creating digital twins of human vertebrae, and predicting fracture response. Lastly, they could be applied to convert CT to MRI images, with the potential to generate near-MR images from CT without MRI. Conclusions: GANs have promising applications in personalized medicine, image augmentation, and improved diagnostic accuracy. However, limitations such as small databases and misalignment in CT-MRI pairs, must be considered.