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Palm V, Norajitra T, von Stackelberg O, Heussel CP, Skornitzke S, Weinheimer O, Kopytova T, Klein A, Almeida SD, Baumgartner M, Bounias D, Scherer J, Kades K, Gao H, Jäger P, Nolden M, Tong E, Eckl K, Nattenmüller J, Nonnenmacher T, Naas O, Reuter J, Bischoff A, Kroschke J, Rengier F, Schlamp K, Debic M, Kauczor HU, Maier-Hein K, Wielpütz MO. AI-Supported Comprehensive Detection and Quantification of Biomarkers of Subclinical Widespread Diseases at Chest CT for Preventive Medicine. Healthcare (Basel) 2022; 10:2166. [PMID: 36360507 PMCID: PMC9690402 DOI: 10.3390/healthcare10112166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 08/12/2023] Open
Abstract
Automated image analysis plays an increasing role in radiology in detecting and quantifying image features outside of the perception of human eyes. Common AI-based approaches address a single medical problem, although patients often present with multiple interacting, frequently subclinical medical conditions. A holistic imaging diagnostics tool based on artificial intelligence (AI) has the potential of providing an overview of multi-system comorbidities within a single workflow. An interdisciplinary, multicentric team of medical experts and computer scientists designed a pipeline, comprising AI-based tools for the automated detection, quantification and characterization of the most common pulmonary, metabolic, cardiovascular and musculoskeletal comorbidities in chest computed tomography (CT). To provide a comprehensive evaluation of each patient, a multidimensional workflow was established with algorithms operating synchronously on a decentralized Joined Imaging Platform (JIP). The results of each patient are transferred to a dedicated database and summarized as a structured report with reference to available reference values and annotated sample images of detected pathologies. Hence, this tool allows for the comprehensive, large-scale analysis of imaging-biomarkers of comorbidities in chest CT, first in science and then in clinical routine. Moreover, this tool accommodates the quantitative analysis and classification of each pathology, providing integral diagnostic and prognostic value, and subsequently leading to improved preventive patient care and further possibilities for future studies.
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Affiliation(s)
- Viktoria Palm
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Tobias Norajitra
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Claus P. Heussel
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Stephan Skornitzke
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Taisiya Kopytova
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Andre Klein
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Silvia D. Almeida
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Michael Baumgartner
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Dimitrios Bounias
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Jonas Scherer
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Klaus Kades
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Hanno Gao
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Paul Jäger
- Interactive Machine Learning Research Group, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Marco Nolden
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Elizabeth Tong
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Kira Eckl
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Tobias Nonnenmacher
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Omar Naas
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Julia Reuter
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Arved Bischoff
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Jonas Kroschke
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Fabian Rengier
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Kai Schlamp
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Manuel Debic
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Klaus Maier-Hein
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Division of Medical Imaging Computing, German Cancer Research Center Heidelberg, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
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Astuto B, Flament I, K. Namiri N, Shah R, Bharadwaj U, M. Link T, D. Bucknor M, Pedoia V, Majumdar S. Automatic Deep Learning-assisted Detection and Grading of Abnormalities in Knee MRI Studies. Radiol Artif Intell 2021; 3:e200165. [PMID: 34142088 PMCID: PMC8166108 DOI: 10.1148/ryai.2021200165] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/17/2020] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To test the hypothesis that artificial intelligence (AI) techniques can aid in identifying and assessing lesion severity in the cartilage, bone marrow, meniscus, and anterior cruciate ligament (ACL) in the knee, improving overall MRI interreader agreement. MATERIALS AND METHODS This retrospective study was conducted on 1435 knee MRI studies (n = 294 patients; mean age, 43 years ± 15 [standard deviation]; 153 women) collected within three previous studies (from 2011 to 2014). All MRI studies were acquired using high-spatial-resolution three-dimensional fast-spin-echo CUBE sequence. Three-dimensional convolutional neural networks were developed to detect the regions of interest within MRI studies and grade abnormalities of the cartilage, bone marrow, menisci, and ACL. Evaluation included sensitivity, specificity, and Cohen linear-weighted ĸ. The impact of AI-aided grading in intergrader agreement was assessed on an external dataset. RESULTS Binary lesion sensitivity reported for all tissues was between 70% and 88%. Specificity ranged from 85% to 89%. The area under the receiver operating characteristic curve for all tissues ranged from 0.83 to 0.93. Deep learning-assisted intergrader Cohen ĸ agreement significantly improved in 10 of 16 comparisons among two attending physicians and two trainees for all tissues. CONCLUSION The three-dimensional convolutional neural network had high sensitivity, specificity, and accuracy for knee-lesion-severity scoring and also increased intergrader agreement when used on an external dataset.Supplemental material is available for this article. Keywords: Bone Marrow, Cartilage, Computer Aided Diagnosis (CAD), Computer Applications-3D, Computer Applications-Detection/Diagnosis, Knee, Ligaments, MR-Imaging, Neural Networks, Observer Performance, Segmentation, Statistics © RSNA, 2021See also the commentary by Li and Chang in this issue.: An earlier incorrect version of this article appeared online. This article was corrected on April 16, 2021.
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Affiliation(s)
- Bruno Astuto
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Io Flament
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Nikan K. Namiri
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Rutwik Shah
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Upasana Bharadwaj
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Thomas M. Link
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Matthew D. Bucknor
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Valentina Pedoia
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
| | - Sharmila Majumdar
- From the Center for Intelligent Imaging and Musculoskeletal and
Quantitative Imaging Research Group, Department of Radiology and Biomedical
Imaging (B.A., I.F., N.K.N., R.S., U.B., T.M.L., M.D.B., V.P., S.M.), and Center
of Digital Health Innovation (V.P., S.M.), University of California–San
Francisco, 1700 Fourth St, Suite 201, QB3 Building, San Francisco, CA
94107
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