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Ayobi A, Chang PD, Chow DS, Weinberg BD, Tassy M, Franciosini A, Scudeler M, Quenet S, Avare C, Chaibi Y. Performance and clinical utility of an artificial intelligence-enabled tool for pulmonary embolism detection. Clin Imaging 2024; 113:110245. [PMID: 39094243 DOI: 10.1016/j.clinimag.2024.110245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/25/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Diagnosing pulmonary embolism (PE) is still challenging due to other conditions that can mimic its appearance, leading to incomplete or delayed management and several inter-observer variabilities. This study evaluated the performance and clinical utility of an artificial intelligence (AI)-based application designed to assist clinicians in the detection of PE on CT pulmonary angiography (CTPA). PATIENTS AND METHODS CTPAs from 230 US cities acquired on 57 scanner models from 6 different vendors were retrospectively collected. Three US board certified expert radiologists defined the ground truth by majority agreement. The same cases were analyzed by CINA-PE, an AI-driven algorithm capable of detecting and highlighting suspected PE locations. The algorithm's performance at a per-case and per-finding level was evaluated. Furthermore, cases with PE not mentioned in the clinical report but correctly detected by the algorithm were analyzed. RESULTS A total of 1204 CTPAs (mean age 62.1 years ± 16.6[SD], 44.4 % female, 14.9 % positive) were included in the study. Per-case sensitivity and specificity were 93.9 % (95%CI: 89.3 %-96.9 %) and 94.8 % (95%CI: 93.3 %-96.1 %), respectively. Per-finding positive predictive value was 89.5 % (95%CI: 86.7 %-91.9 %). Among the 196 positive cases, 29 (15.6 %) were not mentioned in the clinical report. The algorithm detected 22/29 (76 %) of these cases, leading to a reduction in the miss rate from 15.6 % to 3.8 % (7/186). CONCLUSIONS The AI-based application may improve diagnostic accuracy in detecting PE and enhance patient outcomes through timely intervention. Integrating AI tools in clinical workflows can reduce missed or delayed diagnoses, and positively impact healthcare delivery and patient care.
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Affiliation(s)
- Angela Ayobi
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
| | - Peter D Chang
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA; Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Daniel S Chow
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA; Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Maxime Tassy
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
| | | | | | - Sarah Quenet
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
| | | | - Yasmina Chaibi
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
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2
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Belkouchi Y, Lederlin M, Ben Afia A, Fabre C, Ferretti G, De Margerie C, Berge P, Liberge R, Elbaz N, Blain M, Brillet PY, Chassagnon G, Cadour F, Caramella C, Hajjam ME, Boussouar S, Hadchiti J, Fablet X, Khalil A, Luciani A, Cotten A, Meder JF, Talbot H, Lassau N. Detection and quantification of pulmonary embolism with artificial intelligence: The SFR 2022 artificial intelligence data challenge. Diagn Interv Imaging 2023; 104:485-489. [PMID: 37321875 DOI: 10.1016/j.diii.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE In 2022, the French Society of Radiology together with the French Society of Thoracic Imaging and CentraleSupelec organized their 13th data challenge. The aim was to aid in the diagnosis of pulmonary embolism, by identifying the presence of pulmonary embolism and by estimating the ratio between right and left ventricular (RV/LV) diameters, and an arterial obstruction index (Qanadli's score) using artificial intelligence. MATERIALS AND METHODS The data challenge was composed of three tasks: the detection of pulmonary embolism, the RV/LV diameter ratio, and Qanadli's score. Sixteen centers all over France participated in the inclusion of the cases. A health data hosting certified web platform was established to facilitate the inclusion process of the anonymized CT examinations in compliance with general data protection regulation. CT pulmonary angiography images were collected. Each center provided the CT examinations with their annotations. A randomization process was established to pool the scans from different centers. Each team was required to have at least a radiologist, a data scientist, and an engineer. Data were provided in three batches to the teams, two for training and one for evaluation. The evaluation of the results was determined to rank the participants on the three tasks. RESULTS A total of 1268 CT examinations were collected from the 16 centers following the inclusion criteria. The dataset was split into three batches of 310, 580 and 378 C T examinations provided to the participants respectively on September 5, 2022, October 7, 2022 and October 9, 2022. Seventy percent of the data from each center were used for training, and 30% for the evaluation. Seven teams with a total of 48 participants including data scientists, researchers, radiologists and engineering students were registered for participation. The metrics chosen for evaluation included areas under receiver operating characteristic curves, specificity and sensitivity for the classification task, and the coefficient of determination r2 for the regression tasks. The winning team achieved an overall score of 0.784. CONCLUSION This multicenter study suggests that the use of artificial intelligence for the diagnosis of pulmonary embolism is possible on real data. Moreover, providing quantitative measures is mandatory for the interpretability of the results, and is of great aid to the radiologists especially in emergency settings.
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Affiliation(s)
- Younes Belkouchi
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France; Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France.
| | | | - Amira Ben Afia
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Clement Fabre
- Department of Radiology, Centre Hospitalier de Laval, 53000 Laval, France
| | - Gilbert Ferretti
- Universite Grenobles Alpes, Service de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Constance De Margerie
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 75010 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Pierre Berge
- Department of Radiology, CHU Angers, 49000 Angers, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, 44000 Nantes, France
| | - Nicolas Elbaz
- Department of Radiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Maxime Blain
- Department of Radiology, Hopital Henri Mondor, AP-HP, 94000 Créteil, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, 93000 Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Farah Cadour
- APHM, Hôpital Universitaire Timone, CEMEREM, 13005 Marseille, France
| | - Caroline Caramella
- Department of Radiology, Groupe hospitalier Paris Saint-Joseph, Île-de-France, 75015 Paris, France
| | - Mostafa El Hajjam
- Department of Radiology, Ambroise Paré Hospital GH AP-HP Paris Saclay, UMR 1179 INSERM/UVSQ, Team 3, 92100 Boulogne-Billancourt, France
| | - Samia Boussouar
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), 75013 Paris, France
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Xavier Fablet
- Department of Radiology, CHU Rennes, 35000 Rennes, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000 Lille, France
| | - Jean-Francois Meder
- Department of Neuroimaging, Sainte-Anne Hospital, 75013 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Hugues Talbot
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
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Hamelink II, de Heide EEJ, Pelgrim GJGJ, Kwee TCT, van Ooijen PMAP, de Bock GHT, Vliegenthart RR. Validation of an AI-based algorithm for measurement of the thoracic aortic diameter in low-dose chest CT. Eur J Radiol 2023; 167:111067. [PMID: 37659209 DOI: 10.1016/j.ejrad.2023.111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES To evaluate the performance of artificial intelligence (AI) software for automatic thoracic aortic diameter assessment in a heterogeneous cohort with low-dose, non-contrast chest computed tomography (CT). MATERIALS AND METHODS Participants of the Imaging in Lifelines (ImaLife) study who underwent low-dose, non-contrast chest CT (August 2017-May 2022) were included using random samples of 80 participants <50y, ≥80y, and with thoracic aortic diameter ≥40 mm. AI-based aortic diameters at eight guideline compliant positions were compared with manual measurements. In 90 examinations (30 per group) diameters were reassessed for intra- and inter-reader variability, which was compared to discrepancy of the AI system using Bland-Altman analysis, paired samples t-testing and linear mixed models. RESULTS We analyzed 240 participants (63 ± 16 years; 50 % men). AI evaluation failed in 11 cases due to incorrect segmentation (4.6 %), leaving 229 cases for analysis. No difference was found in aortic diameter between manual and automatic measurements (32.7 ± 6.4 mm vs 32.7 ± 6.0 mm, p = 0.70). Bland-Altman analysis yielded no systematic bias and a repeatability coefficient of 4.0 mm for AI. Mean discrepancy of AI (1.3 ± 1.6 mm) was comparable to inter-reader variability (1.4 ± 1.4 mm); only at the proximal aortic arch showed AI higher discrepancy (2.0 ± 1.8 mm vs 0.9 ± 0.9 mm, p < 0.001). No difference between AI discrepancy and inter-reader variability was found for any subgroup (all: p > 0.05). CONCLUSION The AI software can accurately measure thoracic aortic diameters, with discrepancy to a human reader similar to inter-reader variability in a range from normal to dilated aortas.
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Affiliation(s)
- I Iris Hamelink
- Department of Radiology, University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands.
| | - E Erik Jan de Heide
- Department of Radiology, University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands.
| | - G J Gert Jan Pelgrim
- Department of Radiology, University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands.
| | - T C Thomas Kwee
- Department of Radiology, University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands.
| | - P M A Peter van Ooijen
- Department of Radiation Oncology, University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands.
| | - G H Truuske de Bock
- Department of Epidemiology, University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands.
| | - R Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center of Groningen, 9713GZ Groningen, The Netherlands.
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Fanni SC, Greco G, Rossi S, Aghakhanyan G, Masala S, Scaglione M, Tonerini M, Neri E. Role of artificial intelligence in oncologic emergencies: a narrative review. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:344-354. [PMID: 37205309 PMCID: PMC10185441 DOI: 10.37349/etat.2023.00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 05/21/2023] Open
Abstract
Oncologic emergencies are a wide spectrum of oncologic conditions caused directly by malignancies or their treatment. Oncologic emergencies may be classified according to the underlying physiopathology in metabolic, hematologic, and structural conditions. In the latter, radiologists have a pivotal role, through an accurate diagnosis useful to provide optimal patient care. Structural conditions may involve the central nervous system, thorax, or abdomen, and emergency radiologists have to know the characteristics imaging findings of each one of them. The number of oncologic emergencies is growing due to the increased incidence of malignancies in the general population and also to the improved survival of these patients thanks to the advances in cancer treatment. Artificial intelligence (AI) could be a solution to assist emergency radiologists with this rapidly increasing workload. To our knowledge, AI applications in the setting of the oncologic emergency are mostly underexplored, probably due to the relatively low number of oncologic emergencies and the difficulty in training algorithms. However, cancer emergencies are defined by the cause and not by a specific pattern of radiological symptoms and signs. Therefore, it can be expected that AI algorithms developed for the detection of these emergencies in the non-oncological field can be transferred to the clinical setting of oncologic emergency. In this review, a craniocaudal approach was followed and central nervous system, thoracic, and abdominal oncologic emergencies have been addressed regarding the AI applications reported in literature. Among the central nervous system emergencies, AI applications have been reported for brain herniation and spinal cord compression. In the thoracic district the addressed emergencies were pulmonary embolism, cardiac tamponade and pneumothorax. Pneumothorax was the most frequently described application for AI, to improve sensibility and to reduce the time-to-diagnosis. Finally, regarding abdominal emergencies, AI applications for abdominal hemorrhage, intestinal obstruction, intestinal perforation, and intestinal intussusception have been described.
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Affiliation(s)
- Salvatore Claudio Fanni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Giuseppe Greco
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Sara Rossi
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Gayane Aghakhanyan
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Michele Tonerini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, 56126 Pisa, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
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Angriman F, Franchin L, Piroli F, Imazio M. Machine learning to identifying patients with pulmonary hypertension: Hope or hype? Int J Cardiol 2023; 376:172-173. [PMID: 36746200 DOI: 10.1016/j.ijcard.2023.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Federico Angriman
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Franchin
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Francesco Piroli
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Imazio
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Baratella E, Fiorese I, Minelli P, Veiluva A, Marrocchio C, Ruaro B, Cova MA. Aging-Related Findings of the Respiratory System in Chest Imaging: Pearls and Pitfalls. CURRENT RADIOLOGY REPORTS 2023; 11:1-11. [PMID: 36471674 PMCID: PMC9713755 DOI: 10.1007/s40134-022-00405-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review The purpose of this review is to describe the main features of the aging chest, studied through different imaging modalities. Recent Findings Aging-related changes of the respiratory system are inevitable. Therefore, it is mandatory to be familiar with the para-physiological changes that occurs, in order to avoid inappropriate interpretation of radiological findings that put patients at risk of over or undertreatment. Summary The role of the radiologist is fundamental in evaluating aging-related processes affecting the respiratory system and in distinguishing them from frank diseases.
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Affiliation(s)
- Elisa Baratella
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Ilaria Fiorese
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Pierluca Minelli
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Alberto Veiluva
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Cristina Marrocchio
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Barbara Ruaro
- grid.5133.40000 0001 1941 4308Department of Pulmonology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Maria Assunta Cova
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
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Zhi Z, Elbadawi M, Daneshmend A, Orlu M, Basit A, Demosthenous A, Rodrigues M. Multimodal Diagnosis for Pulmonary Embolism from EHR Data and CT Images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2053-2057. [PMID: 36086373 DOI: 10.1109/embc48229.2022.9871041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pulmonary Embolism (PE) is a severe medical condition that can pose a significant risk to life. Traditional deep learning methods for PE diagnosis are based on Computed Tomography (CT) images and do not consider the patient's clinical context. To make full use of patient's clinical information, this article presents a multimodal fusion model ingesting Electronic Health Record (EHR) data and CT images for PE diagnosis. The proposed model is based on multilayer perception and convolutional neural networks. To remove the invalid information in the EHR data, the multidimensional scaling algorithm is performed for feature dimension reduction. The EHR data and CT images of 600 patients are used for experiments. The experiment results show that the proposed models outperform existing methods and the multimodal fusion model shows better performance than the single-input model.
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Cho B, Geng E, Arvind V, Valliani AA, Tang JE, Schwartz J, Dominy C, Cho SK, Kim JS. Understanding Artificial Intelligence and Predictive Analytics: A Clinically Focused Review of Machine Learning Techniques. JBJS Rev 2022; 10:01874474-202203000-00013. [PMID: 35302963 DOI: 10.2106/jbjs.rvw.21.00142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
» Machine learning and artificial intelligence have seen tremendous growth in recent years and have been applied in numerous studies in the field of orthopaedics. » Machine learning will soon become critical in the day-to-day operations of orthopaedic practice; therefore, it is imperative that providers become accustomed to and familiar with not only the terminology but also the fundamental techniques behind the technology. » A foundation of knowledge regarding machine learning is critical for physicians so they can begin to understand the details in the algorithms that are being developed, which provide improved accuracy compared with clinicians, decreased time required, and a heightened ability to triage patients.
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Affiliation(s)
- Brian Cho
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY
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9
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Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism. Eur Radiol 2021; 32:2178-2187. [PMID: 34854928 PMCID: PMC8921171 DOI: 10.1007/s00330-021-08364-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/05/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022]
Abstract
Objectives Closer reading of computed tomography pulmonary angiography (CTPA) scans of patients presenting with acute pulmonary embolism (PE) may identify those at high risk of developing chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to validate the predictive value of six radiological predictors that were previously proposed. Methods Three hundred forty-one patients with acute PE were prospectively followed for development of CTEPH in six European hospitals. Index CTPAs were analysed post hoc by expert chest radiologists blinded to the final diagnosis. The accuracy of the predictors using a predefined threshold for ‘high risk’ (≥ 3 predictors) and the expert overall judgment on the presence of CTEPH were assessed. Results CTEPH was confirmed in nine patients (2.6%) during 2-year follow-up. Any sign of chronic thrombi was already present in 74/341 patients (22%) on the index CTPA, which was associated with CTEPH (OR 7.8, 95%CI 1.9–32); 37 patients (11%) had ≥ 3 of 6 radiological predictors, of whom 4 (11%) were diagnosed with CTEPH (sensitivity 44%, 95%CI 14–79; specificity 90%, 95%CI 86–93). Expert judgment raised suspicion of CTEPH in 27 patients, which was confirmed in 8 (30%; sensitivity 89%, 95%CI 52–100; specificity 94%, 95%CI 91–97). Conclusions The presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future CTEPH diagnosis, comparable to overall expert judgment, while the latter was associated with higher sensitivity. Dedicated CTPA reading for signs of CTEPH may therefore help in early detection of CTEPH after PE, although in our cohort this strategy would not have detected all cases. Key Points • Three expert chest radiologists re-assessed CTPA scans performed at the moment of acute pulmonary embolism diagnosis and observed a high prevalence of chronic thrombi and signs of pulmonary hypertension. • On these index scans, the presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), comparable to overall expert judgment. • Dedicated CTPA reading for signs of CTEPH may help in early detection of CTEPH after acute pulmonary embolism. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08364-0.
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Somani SS, Honarvar H, Narula S, Landi I, Lee S, Khachatoorian Y, Rehmani A, Kim A, De Freitas JK, Teng S, Jaladanki S, Kumar A, Russak A, Zhao SP, Freeman R, Levin MA, Nadkarni GN, Kagen AC, Argulian E, Glicksberg BS. Development of a machine learning model using electrocardiogram signals to improve acute pulmonary embolism screening. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 3:56-66. [PMID: 35355847 PMCID: PMC8946569 DOI: 10.1093/ehjdh/ztab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 01/30/2023]
Abstract
Aims Clinical scoring systems for pulmonary embolism (PE) screening have low specificity and contribute to computed tomography pulmonary angiogram (CTPA) overuse. We assessed whether deep learning models using an existing and routinely collected data modality, electrocardiogram (ECG) waveforms, can increase specificity for PE detection. Methods and results We create a retrospective cohort of 21 183 patients at moderate- to high suspicion of PE and associate 23 793 CTPAs (10.0% PE-positive) with 320 746 ECGs and encounter-level clinical data (demographics, comorbidities, vital signs, and labs). We develop three machine learning models to predict PE likelihood: an ECG model using only ECG waveform data, an EHR model using tabular clinical data, and a Fusion model integrating clinical data and an embedded representation of the ECG waveform. We find that a Fusion model [area under the receiver-operating characteristic curve (AUROC) 0.81 ± 0.01] outperforms both the ECG model (AUROC 0.59 ± 0.01) and EHR model (AUROC 0.65 ± 0.01). On a sample of 100 patients from the test set, the Fusion model also achieves greater specificity (0.18) and performance (AUROC 0.84 ± 0.01) than four commonly evaluated clinical scores: Wells' Criteria, Revised Geneva Score, Pulmonary Embolism Rule-Out Criteria, and 4-Level Pulmonary Embolism Clinical Probability Score (AUROC 0.50-0.58, specificity 0.00-0.05). The model is superior to these scores on feature sensitivity analyses (AUROC 0.66-0.84) and achieves comparable performance across sex (AUROC 0.81) and racial/ethnic (AUROC 0.77-0.84) subgroups. Conclusion Synergistic deep learning of ECG waveforms with traditional clinical variables can increase the specificity of PE detection in patients at least at moderate suspicion for PE.
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Affiliation(s)
- Sulaiman S Somani
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA
| | - Hossein Honarvar
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Sukrit Narula
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 20 Copeland Ave, Hamilton, ON L8L 2X2, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Isotta Landi
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Shawn Lee
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Yeraz Khachatoorian
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Arsalan Rehmani
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Andrew Kim
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Jessica K De Freitas
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Shelly Teng
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA
| | - Suraj Jaladanki
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA
| | - Arvind Kumar
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA
| | - Adam Russak
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Shan P Zhao
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA,Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Robert Freeman
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA,Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Matthew A Levin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Girish N Nadkarni
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 15th Fl, New York, NY, 10065, USA,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Alexander C Kagen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
| | - Edgar Argulian
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA,Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, USA
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11
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Lung Segmentation and Characterization in COVID-19 Patients for Assessing Pulmonary Thromboembolism: An Approach Based on Deep Learning and Radiomics. ELECTRONICS 2021. [DOI: 10.3390/electronics10202475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic is inevitably changing the world in a dramatic way, and the role of computed tomography (CT) scans can be pivotal for the prognosis of COVID-19 patients. Since the start of the pandemic, great care has been given to the relationship between interstitial pneumonia caused by the infection and the onset of thromboembolic phenomena. In this preliminary study, we collected n = 20 CT scans from the Polyclinic of Bari, all from patients positive with COVID-19, nine of which developed pulmonary thromboembolism (PTE). For eight CT scans, we obtained masks of the lesions caused by the infection, annotated by expert radiologists; whereas for the other four CT scans, we obtained masks of the lungs (including both healthy parenchyma and lesions). We developed a deep learning-based segmentation model that utilizes convolutional neural networks (CNNs) in order to accurately segment the lung and lesions. By considering the images from publicly available datasets, we also realized a training set composed of 32 CT scans and a validation set of 10 CT scans. The results obtained from the segmentation task are promising, allowing to reach a Dice coefficient higher than 97%, posing the basis for analysis concerning the assessment of PTE onset. We characterized the segmented region in order to individuate radiomic features that can be useful for the prognosis of PTE. Out of 919 extracted radiomic features, we found that 109 present different distributions according to the Mann–Whitney U test with corrected p-values less than 0.01. Lastly, nine uncorrelated features were retained that can be exploited to realize a prognostic signature.
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12
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Hong YJ, Shim J, Lee SM, Im DJ, Hur J. Dual-Energy CT for Pulmonary Embolism: Current and Evolving Clinical Applications. Korean J Radiol 2021; 22:1555-1568. [PMID: 34448383 PMCID: PMC8390816 DOI: 10.3348/kjr.2020.1512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022] Open
Abstract
Pulmonary embolism (PE) is a potentially fatal disease if the diagnosis or treatment is delayed. Currently, multidetector computed tomography (MDCT) is considered the standard imaging method for diagnosing PE. Dual-energy CT (DECT) has the advantages of MDCT and can provide functional information for patients with PE. The aim of this review is to present the potential clinical applications of DECT in PE, focusing on the diagnosis and risk stratification of PE.
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Affiliation(s)
- Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jina Shim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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13
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Colak E, Kitamura FC, Hobbs SB, Wu CC, Lungren MP, Prevedello LM, Kalpathy-Cramer J, Ball RL, Shih G, Stein A, Halabi SS, Altinmakas E, Law M, Kumar P, Manzalawi KA, Nelson Rubio DC, Sechrist JW, Germaine P, Lopez EC, Amerio T, Gupta P, Jain M, Kay FU, Lin CT, Sen S, Revels JW, Brussaard CC, Mongan J. The RSNA Pulmonary Embolism CT Dataset. Radiol Artif Intell 2021; 3:e200254. [PMID: 33937862 PMCID: PMC8043364 DOI: 10.1148/ryai.2021200254] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 01/11/2023]
Abstract
Supplemental material is available for this article.
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14
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Radiologists: Protagonists of the Health Care Artificial Intelligence Revolution. J Thorac Imaging 2020; 35 Suppl 1:S1-S2. [PMID: 32317573 DOI: 10.1097/rti.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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