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Akita K, Kusunose K, Haga A, Shimomura T, Kosaka Y, Ishiyama K, Hasegawa K, Fifer MA, Maurer MS, Shimada YJ. Deep learning of echocardiography distinguishes between presence and absence of late gadolinium enhancement on cardiac magnetic resonance in patients with hypertrophic cardiomyopathy. Echo Res Pract 2024; 11:23. [PMID: 39396969 PMCID: PMC11472433 DOI: 10.1186/s44156-024-00059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 08/06/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) can cause myocardial fibrosis, which can be a substrate for fatal ventricular arrhythmias and subsequent sudden cardiac death. Although late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) represents myocardial fibrosis and is associated with sudden cardiac death in patients with HCM, CMR is resource-intensive, can carry an economic burden, and is sometimes contraindicated. In this study for patients with HCM, we aimed to distinguish between patients with positive and negative LGE on CMR using deep learning of echocardiographic images. METHODS In the cross-sectional study of patients with HCM, we enrolled patients who underwent both echocardiography and CMR. The outcome was positive LGE on CMR. Among the 323 samples, we randomly selected 273 samples (training set) and employed deep convolutional neural network (DCNN) of echocardiographic 5-chamber view to discriminate positive LGE on CMR. We also developed a reference model using clinical parameters with significant differences between patients with positive and negative LGE. In the remaining 50 samples (test set), we compared the area under the receiver-operating-characteristic curve (AUC) between a combined model using the reference model plus the DCNN-derived probability and the reference model. RESULTS Among the 323 CMR studies, positive LGE was detected in 160 (50%). The reference model was constructed using the following 7 clinical parameters: family history of HCM, maximum left ventricular (LV) wall thickness, LV end-diastolic diameter, LV end-systolic volume, LV ejection fraction < 50%, left atrial diameter, and LV outflow tract pressure gradient at rest. The discriminant model combining the reference model with DCNN-derived probability significantly outperformed the reference model in the test set (AUC 0.86 [95% confidence interval 0.76-0.96] vs. 0.72 [0.57-0.86], P = 0.04). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined model were 0.84, 0.76, 0.78, and 0.83, respectively. CONCLUSION Compared to the reference model solely based on clinical parameters, our new model integrating the reference model and deep learning-based analysis of echocardiographic images demonstrated superiority in distinguishing LGE on CMR in patients with HCM. The novel deep learning-based method can be used as an assistive technology to facilitate the decision-making process of performing CMR with gadolinium enhancement.
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Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 3-342, New York, NY, 10032, USA
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Nephrology, and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Akihiro Haga
- Department of Medical Imaging Physics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Taisei Shimomura
- Department of Medical Imaging Physics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshitaka Kosaka
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Katsunori Ishiyama
- Department of Medical Imaging Physics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael A Fifer
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 3-342, New York, NY, 10032, USA
| | - Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 3-342, New York, NY, 10032, USA.
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Wu J, Li J, Huang B, Dong S, Wu L, Shen X, Zheng Z. Radiomics predicts the prognosis of patients with clear cell renal cell carcinoma by reflecting the tumor heterogeneity and microenvironment. Cancer Imaging 2024; 24:124. [PMID: 39285496 PMCID: PMC11403861 DOI: 10.1186/s40644-024-00768-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE We aimed to develop and externally validate a CT-based deep learning radiomics model for predicting overall survival (OS) in clear cell renal cell carcinoma (ccRCC) patients, and investigate the association of radiomics with tumor heterogeneity and microenvironment. METHODS The clinicopathological data and contrast-enhanced CT images of 512 ccRCC patients from three institutions were collected. A total of 3566 deep learning radiomics features were extracted from 3D regions of interest. We generated the deep learning radiomics score (DLRS), and validated this score using an external cohort from TCIA. Patients were divided into high and low-score groups by the DLRS. Sequencing data from the corresponding TCGA cohort were used to reveal the differences of tumor heterogeneity and microenvironment between different radiomics score groups. What's more, univariate and multivariate Cox regression were used to identify independent risk factors of poor OS after operation. A combined model was developed by incorporating the DLRS and clinicopathological features. The SHapley Additive exPlanation method was used for interpretation of predictive results. RESULTS At multivariate Cox regression analysis, the DLRS was identified as an independent risk factor of poor OS. The genomic landscape of different radiomics score groups was investigated. The heterogeneity of tumor cell and tumor microenvironment significantly varied between both groups. In the test cohort, the combined model had a great predictive performance, with AUCs (95%CI) for 1, 3 and 5-year OS of 0.879(0.868-0.931), 0.854(0.819-0.899) and 0.831(0.813-0.868), respectively. There was a significant difference in survival time between different groups stratified by the combined model. This model showed great discrimination and calibration, outperforming the existing prognostic models (all p values < 0.05). CONCLUSION The combined model allowed for the prognostic prediction of ccRCC patients by incorporating the DLRS and significant clinicopathologic features. The radiomics features could reflect the tumor heterogeneity and microenvironment.
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Affiliation(s)
- Ji Wu
- Department of General surgery, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
- Department of Radiology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Jian Li
- Department of Radiology, Changshu No People's HospitalThe Affiliated Changshu Hospital of Nantong University, Changshu, Jiangsu, China
| | - Bo Huang
- Department of Radiology, Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Sunbin Dong
- Department of Radiology, Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Luyang Wu
- Department of Radiology, Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Xiping Shen
- Department of General surgery, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China.
- Department of Radiology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China.
| | - Zhigang Zheng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Righetti F, Rubiu G, Penso M, Moccia S, Carerj ML, Pepi M, Pontone G, Caiani EG. Deep learning approaches for the detection of scar presence from cine cardiac magnetic resonance adding derived parametric images. Med Biol Eng Comput 2024:10.1007/s11517-024-03175-z. [PMID: 39105884 DOI: 10.1007/s11517-024-03175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
This work proposes a convolutional neural network (CNN) that utilizes different combinations of parametric images computed from cine cardiac magnetic resonance (CMR) images, to classify each slice for possible myocardial scar tissue presence. The CNN performance comparison in respect to expert interpretation of CMR with late gadolinium enhancement (LGE) images, used as ground truth (GT), was conducted on 206 patients (158 scar, 48 control) from Centro Cardiologico Monzino (Milan, Italy) at both slice- and patient-levels. Left ventricle dynamic features were extracted in non-enhanced cine images using parametric images based on both Fourier and monogenic signal analyses. The CNN, fed with cine images and Fourier-based parametric images, achieved an area under the ROC curve of 0.86 (accuracy 0.79, F1 0.81, sensitivity 0.9, specificity 0.65, and negative (NPV) and positive (PPV) predictive values 0.83 and 0.77, respectively), for individual slice classification. Remarkably, it exhibited 1.0 prediction accuracy (F1 0.98, sensitivity 1.0, specificity 0.9, NPV 1.0, and PPV 0.97) in patient classification as a control or pathologic. The proposed approach represents a first step towards scar detection in contrast-free CMR images. Patient-level results suggest its preliminary potential as a screening tool to guide decisions regarding LGE-CMR prescription, particularly in cases where indication is uncertain.
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Affiliation(s)
- Francesca Righetti
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy
| | - Giulia Rubiu
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy
| | - Marco Penso
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy
| | - Sara Moccia
- Department of Innovative Technologies in Medicine and Dentistry, Università degli Studi "G. d'Annunzio" Chieti, Pescara, Italy
| | - Maria L Carerj
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Enrico G Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy.
- Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy.
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Zhang Q, Fotaki A, Ghadimi S, Wang Y, Doneva M, Wetzl J, Delfino JG, O'Regan DP, Prieto C, Epstein FH. Improving the efficiency and accuracy of cardiovascular magnetic resonance with artificial intelligence-review of evidence and proposition of a roadmap to clinical translation. J Cardiovasc Magn Reson 2024; 26:101051. [PMID: 38909656 PMCID: PMC11331970 DOI: 10.1016/j.jocmr.2024.101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is an important imaging modality for the assessment of heart disease; however, limitations of CMR include long exam times and high complexity compared to other cardiac imaging modalities. Recently advancements in artificial intelligence (AI) technology have shown great potential to address many CMR limitations. While the developments are remarkable, translation of AI-based methods into real-world CMR clinical practice remains at a nascent stage and much work lies ahead to realize the full potential of AI for CMR. METHODS Herein we review recent cutting-edge and representative examples demonstrating how AI can advance CMR in areas such as exam planning, accelerated image reconstruction, post-processing, quality control, classification and diagnosis. RESULTS These advances can be applied to speed up and simplify essentially every application including cine, strain, late gadolinium enhancement, parametric mapping, 3D whole heart, flow, perfusion and others. AI is a unique technology based on training models using data. Beyond reviewing the literature, this paper discusses important AI-specific issues in the context of CMR, including (1) properties and characteristics of datasets for training and validation, (2) previously published guidelines for reporting CMR AI research, (3) considerations around clinical deployment, (4) responsibilities of clinicians and the need for multi-disciplinary teams in the development and deployment of AI in CMR, (5) industry considerations, and (6) regulatory perspectives. CONCLUSIONS Understanding and consideration of all these factors will contribute to the effective and ethical deployment of AI to improve clinical CMR.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.
| | - Anastasia Fotaki
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Sona Ghadimi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | - Yu Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | | | - Jens Wetzl
- Siemens Healthineers AG, Erlangen, Germany.
| | - Jana G Delfino
- US Food and Drug Administration, Center for Devices and Radiological Health (CDRH), Office of Science and Engineering Laboratories (OSEL), Silver Spring, MD, USA.
| | - Declan P O'Regan
- MRC Laboratory of Medical Sciences, Imperial College London, London, UK.
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
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Baeßler B, Engelhardt S, Hekalo A, Hennemuth A, Hüllebrand M, Laube A, Scherer C, Tölle M, Wech T. Perfect Match: Radiomics and Artificial Intelligence in Cardiac Imaging. Circ Cardiovasc Imaging 2024; 17:e015490. [PMID: 38889216 DOI: 10.1161/circimaging.123.015490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Cardiovascular diseases remain a significant health burden, with imaging modalities like echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging playing a crucial role in diagnosis and prognosis. However, the inherent heterogeneity of these diseases poses challenges, necessitating advanced analytical methods like radiomics and artificial intelligence. Radiomics extracts quantitative features from medical images, capturing intricate patterns and subtle variations that may elude visual inspection. Artificial intelligence techniques, including deep learning, can analyze these features to generate knowledge, define novel imaging biomarkers, and support diagnostic decision-making and outcome prediction. Radiomics and artificial intelligence thus hold promise for significantly enhancing diagnostic and prognostic capabilities in cardiac imaging, paving the way for more personalized and effective patient care. This review explores the synergies between radiomics and artificial intelligence in cardiac imaging, following the radiomics workflow and introducing concepts from both domains. Potential clinical applications, challenges, and limitations are discussed, along with solutions to overcome them.
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Affiliation(s)
- Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany (B.B., A. Hekalo, T.W.)
| | - Sandy Engelhardt
- Department of Internal Medicine III, Heidelberg University Hospital, Germany (S.E., M.T.)
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (S.E., M.T.)
| | - Amar Hekalo
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany (B.B., A. Hekalo, T.W.)
| | - Anja Hennemuth
- Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany (A. Hennemuth, M.H., A.L.)
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Germany (A. Hennemuth, M.H., A.L.)
- Fraunhofer Institute for Digital Medicine MEVIS, Berlin, Germany (A. Hennemuth, M.H.)
- DZHK (German Centre for Cardiovascular Research), partner site Berlin (A. Hennemuth, M.H., A.L.)
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany (A. Hennemuth)
| | - Markus Hüllebrand
- Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany (A. Hennemuth, M.H., A.L.)
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Germany (A. Hennemuth, M.H., A.L.)
- Fraunhofer Institute for Digital Medicine MEVIS, Berlin, Germany (A. Hennemuth, M.H.)
- DZHK (German Centre for Cardiovascular Research), partner site Berlin (A. Hennemuth, M.H., A.L.)
| | - Ann Laube
- Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany (A. Hennemuth, M.H., A.L.)
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Germany (A. Hennemuth, M.H., A.L.)
- DZHK (German Centre for Cardiovascular Research), partner site Berlin (A. Hennemuth, M.H., A.L.)
| | - Clemens Scherer
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany (C.S.)
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Germany (C.S.)
| | - Malte Tölle
- Department of Internal Medicine III, Heidelberg University Hospital, Germany (S.E., M.T.)
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (S.E., M.T.)
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany (B.B., A. Hekalo, T.W.)
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Germany (T.W.)
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6
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Ma ZP, Wang SW, Xue LY, Zhang XD, Zheng W, Zhao YX, Yuan SR, Li GY, Yu YN, Wang JN, Zhang TL. A study on the application of radiomics based on cardiac MR non-enhanced cine sequence in the early diagnosis of hypertensive heart disease. BMC Med Imaging 2024; 24:124. [PMID: 38802736 PMCID: PMC11129462 DOI: 10.1186/s12880-024-01301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The prevalence of hypertensive heart disease (HHD) is high and there is currently no easy way to detect early HHD. Explore the application of radiomics using cardiac magnetic resonance (CMR) non-enhanced cine sequences in diagnosing HHD and latent cardiac changes caused by hypertension. METHODS 132 patients who underwent CMR scanning were divided into groups: HHD (42), hypertension with normal cardiac structure and function (HWN) group (46), and normal control (NOR) group (44). Myocardial regions of the end-diastolic (ED) and end-systolic (ES) phases of the CMR short-axis cine sequence images were segmented into regions of interest (ROI). Three feature subsets (ED, ES, and ED combined with ES) were established after radiomic least absolute shrinkage and selection operator feature selection. Nine radiomic models were built using random forest (RF), support vector machine (SVM), and naive Bayes. Model performance was analyzed using receiver operating characteristic curves, and metrics like accuracy, area under the curve (AUC), precision, recall, and specificity. RESULTS The feature subsets included first-order, shape, and texture features. SVM of ED combined with ES achieved the highest accuracy (0.833), with a macro-average AUC of 0.941. AUCs for HHD, HWN, and NOR identification were 0.967, 0.876, and 0.963, respectively. Precisions were 0.972, 0.740, and 0.826; recalls were 0.833, 0.804, and 0.863, respectively; and specificities were 0.989, 0.863, and 0.909, respectively. CONCLUSIONS Radiomics technology using CMR non-enhanced cine sequences can detect early cardiac changes due to hypertension. It holds promise for future use in screening for latent cardiac damage in early HHD.
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Affiliation(s)
- Ze-Peng Ma
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
- Hebei Key Laboratory of Precise Imaging of Inflammation Related Tumors, Baoding, 071000, China
| | - Shi-Wei Wang
- College of Quality and Technical Supervision, Hebei University, Baoding, 071002, China
| | - Lin-Yan Xue
- College of Quality and Technical Supervision, Hebei University, Baoding, 071002, China
| | - Xiao-Dan Zhang
- Department of Ultrasound, Affiliated Hospital of Hebei University, 212 Yuhua East Road, Baoding, 071000, China.
| | - Wei Zheng
- College of Electronic and Information Engineering, Hebei University, Baoding, 071002, China
| | - Yong-Xia Zhao
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Shuang-Rui Yuan
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Gao-Yang Li
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Ya-Nan Yu
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Jia-Ning Wang
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Tian-Le Zhang
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
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Onnis C, van Assen M, Muscogiuri E, Muscogiuri G, Gershon G, Saba L, De Cecco CN. The Role of Artificial Intelligence in Cardiac Imaging. Radiol Clin North Am 2024; 62:473-488. [PMID: 38553181 DOI: 10.1016/j.rcl.2024.01.002] [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] [Indexed: 04/02/2024]
Abstract
Artificial intelligence (AI) is having a significant impact in medical imaging, advancing almost every aspect of the field, from image acquisition and postprocessing to automated image analysis with outreach toward supporting decision making. Noninvasive cardiac imaging is one of the main and most exciting fields for AI development. The aim of this review is to describe the main applications of AI in cardiac imaging, including CT and MR imaging, and provide an overview of recent advancements and available clinical applications that can improve clinical workflow, disease detection, and prognostication in cardiac disease.
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Affiliation(s)
- Carlotta Onnis
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, SS 554 km 4,500 Monserrato, Cagliari 09042, Italy. https://twitter.com/CarlottaOnnis
| | - Marly van Assen
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA. https://twitter.com/marly_van_assen
| | - Emanuele Muscogiuri
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Division of Thoracic Imaging, Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Giuseppe Muscogiuri
- Department of Diagnostic and Interventional Radiology, Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo BG 24127, Italy. https://twitter.com/GiuseppeMuscog
| | - Gabrielle Gershon
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA. https://twitter.com/gabbygershon
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, SS 554 km 4,500 Monserrato, Cagliari 09042, Italy. https://twitter.com/lucasabaITA
| | - Carlo N De Cecco
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University, Emory University Hospital, 1365 Clifton Road Northeast, Suite AT503, Atlanta, GA 30322, USA.
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8
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Crean AM. Scanning the Imaging Horizon for Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:899-906. [PMID: 38467329 DOI: 10.1016/j.cjca.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
In this article some of the recent advances in the use of noninvasive imaging applied to patients with hypertrophic cardiomyopathy (HCM) are discussed. Echocardiography and cardiac computed tomography are briefly discussed with respect to their power to detect apical aneurysmal disease. Echocardiographic phenotype-genotype correlations and the use of echocardiography to characterize myocardial work are reviewed. Positron emission tomography is reviewed in the context of ischemia imaging and also in the context of the use of a new tracer that might allow for recognition of early activation of the fibrosis pathway. Next, the technical capabilities of cardiovascular magnetic resonance to measure myocardial perfusion, oxygenation, and disarray are discussed as they apply to HCM. The application of radiomics to improve prediction of sudden cardiac death is touched upon. Finally, a deep learning approach to the recognition of HCM vs phenocopies is presented as a potential future diagnostic aid in the not-too-distant future.
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Affiliation(s)
- Andrew M Crean
- Manchester Heart Center, University of Manchester, Manchester, United Kingdom; Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Morales MA, Manning WJ, Nezafat R. Present and Future Innovations in AI and Cardiac MRI. Radiology 2024; 310:e231269. [PMID: 38193835 PMCID: PMC10831479 DOI: 10.1148/radiol.231269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 01/10/2024]
Abstract
Cardiac MRI is used to diagnose and treat patients with a multitude of cardiovascular diseases. Despite the growth of clinical cardiac MRI, complicated image prescriptions and long acquisition protocols limit the specialty and restrain its impact on the practice of medicine. Artificial intelligence (AI)-the ability to mimic human intelligence in learning and performing tasks-will impact nearly all aspects of MRI. Deep learning (DL) primarily uses an artificial neural network to learn a specific task from example data sets. Self-driving scanners are increasingly available, where AI automatically controls cardiac image prescriptions. These scanners offer faster image collection with higher spatial and temporal resolution, eliminating the need for cardiac triggering or breath holding. In the future, fully automated inline image analysis will most likely provide all contour drawings and initial measurements to the reader. Advanced analysis using radiomic or DL features may provide new insights and information not typically extracted in the current analysis workflow. AI may further help integrate these features with clinical, genetic, wearable-device, and "omics" data to improve patient outcomes. This article presents an overview of AI and its application in cardiac MRI, including in image acquisition, reconstruction, and processing, and opportunities for more personalized cardiovascular care through extraction of novel imaging markers.
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Affiliation(s)
- Manuel A. Morales
- From the Department of Medicine, Cardiovascular Division (M.A.M.,
W.J.M., R.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess
Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA
02215
| | - Warren J. Manning
- From the Department of Medicine, Cardiovascular Division (M.A.M.,
W.J.M., R.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess
Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA
02215
| | - Reza Nezafat
- From the Department of Medicine, Cardiovascular Division (M.A.M.,
W.J.M., R.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess
Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA
02215
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10
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Chen X, Yu Q, Peng J, He Z, Li Q, Ning Y, Gu J, Lv F, Jiang H, Xie K. A Combined Model Integrating Radiomics and Deep Learning Based on Contrast-Enhanced CT for Preoperative Staging of Laryngeal Carcinoma. Acad Radiol 2023; 30:3022-3031. [PMID: 37777428 DOI: 10.1016/j.acra.2023.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 10/02/2023]
Abstract
RATIONALE AND OBJECTIVES Accurate staging of laryngeal carcinoma can inform appropriate treatment decision-making. We developed a radiomics model, a deep learning (DL) model, and a combined model (incorporating radiomics features and DL features) based on the venous-phase CT images and explored the performance of these models in stratifying patients with laryngeal carcinoma into stage I-II and stage III-IV, and also compared these models with radiologists. MATERIALS AND METHODS Three hundreds and nineteen patients with pathologically confirmed laryngeal carcinoma were randomly divided into a training set (n = 223) and a test set (n = 96). In the training set, the radiomics features with inter- and intraclass correlation coefficients (ICCs)> 0.75 were screened by Spearman correlation analysis and recursive feature elimination (RFE); then support vector machine (SVM) classifier was applied to develop the radiomics model. The DL model was built using ResNet 18 by the cropped 2D regions of interest (ROIs) in the maximum tumor ROI slices and the last fully connected layer of this network served as the DL feature extractor. Finally, a combined model was developed by pooling the radiomics features and extracted DL features to predict the staging. RESULTS The area under the curves (AUCs) for radiomics model, DL model, and combined model in the test set were 0.704 (95% confidence interval [CI]: 0.588-0.820), 0.724 (95% CI: 0.613-0.835), and 0.849 (95% CI: 0.755-0.943), respectively. The combined model outperformed the radiomics model and the DL model in discriminating stage I-II from stage III-IV (p = 0.031 and p = 0.020, respectively). Only the combined model performed significantly better than radiologists (p < 0.050 for both). CONCLUSION The combined model can help tailor the therapeutic strategy for laryngeal carcinoma patients by enabling more accurate preoperative staging.
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Affiliation(s)
- Xinwei Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
| | - Qiang Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
| | - Juan Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.).
| | - Zhiyang He
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
| | - Quanjiang Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
| | - Youquan Ning
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
| | - Jinming Gu
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, China (J.G.)
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
| | - Huan Jiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
| | - Kai Xie
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.C., Q.Y., J.P., Z.H., Q.L., Y.N., F.L., H.J., K.X.)
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11
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Liu Q, Lu Q, Chai Y, Tao Z, Wu Q, Jiang M, Pu J. Papillary-Muscle-Derived Radiomic Features for Hypertrophic Cardiomyopathy versus Hypertensive Heart Disease Classification. Diagnostics (Basel) 2023; 13:diagnostics13091544. [PMID: 37174935 PMCID: PMC10177511 DOI: 10.3390/diagnostics13091544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose: This study aimed to assess the value of radiomic features derived from the myocardium (MYO) and papillary muscle (PM) for left ventricular hypertrophy (LVH) detection and hypertrophic cardiomyopathy (HCM) versus hypertensive heart disease (HHD) differentiation. Methods: There were 345 subjects who underwent cardiovascular magnetic resonance (CMR) examinations that were analyzed. After quality control and manual segmentation, the 3D radiomic features were extracted from the MYO and PM. The data were randomly split into training (70%) and testing (30%) datasets. Feature selection was performed on the training dataset. Five machine learning models were evaluated using the MYO, PM, and MYO+PM features in the detection and differentiation tasks. The optimal differentiation model was further evaluated using CMR parameters and combined features. Results: Six features were selected for the MYO, PM, and MYO+PM groups. The support vector machine models performed best in both the detection and differentiation tasks. For LVH detection, the highest area under the curve (AUC) was 0.966 in the MYO group. For HCM vs. HHD differentiation, the best AUC was 0.935 in the MYO+PM group. Comparing the radiomics models to the CMR parameter models for the differentiation tasks, the radiomics models achieved significantly improved the performance (p = 0.002). Conclusions: The radiomics model with the MYO+PM features showed similar performance to the models developed from the MYO features in the detection task, but outperformed the models developed from the MYO or PM features in the differentiation task. In addition, the radiomic models performed better than the CMR parameters' models.
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Affiliation(s)
- Qiming Liu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Qifan Lu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Yezi Chai
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Zhengyu Tao
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Qizhen Wu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Meng Jiang
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Jun Pu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
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12
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Wu H, Huang Z, Liu J, Dai J, Zhao Y, Luo W. The predictive value of deep learning-based cardiac ultrasound flow imaging for hypertrophic cardiomyopathy complicating arrhythmias. Eur J Med Res 2023; 28:36. [PMID: 36658623 PMCID: PMC9850559 DOI: 10.1186/s40001-022-00975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To investigate the predictive value of deep learning-based cardiac ultrasound flow imaging for hypertrophic cardiomyopathy (HCM) complicated by arrhythmias. METHODS The clinical data of 158 patients with hypertrophic cardiomyopathy were retrospectively collected from July 2019 to December 2021, and additionally divided into training group 106 cases, validation group 26 cases and test group 26 cases according to the ratio of 4:1:1, and divided into concurrent and non-concurrent groups according to whether they were complicated by arrhythmia or not, respectively. General data of patients (age, gender, BMI, systolic blood pressure, diastolic blood pressure, HR) were collected, a deep learning model for cardiac ultrasound flow imaging was established, and image data, LVEF, LAVI, E/e', vortex area change rate, circulation intensity change rate, mean blood flow velocity, and mean EL value were extracted. RESULTS The differences in general data (age, gender, BMI, systolic blood pressure, diastolic blood pressure, HR) between the three groups were not statistically significant, P > 0.05. The differences in age, gender, BMI, systolic blood pressure, diastolic blood pressure, HR between the patients in the concurrent and non-concurrent groups in the training group were not statistically significant, P > 0.05. CONCLUSIONS Deep learning-based cardiac ultrasound flow imaging can identify cardiac ultrasound images more accurately and has a high predictive value for arrhythmias complicating hypertrophic cardiomyopathy, and vortex area change rate, circulation intensity change rate, mean flow velocity, mean EL, LAVI, and E/e' are all risk factors for arrhythmias complicating hypertrophic cardiomyopathy.
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Affiliation(s)
- Haotang Wu
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, No. 3, Kangxin Road, West District, Zhongshan, 528400, China
| | - Zhiyong Huang
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, No. 3, Kangxin Road, West District, Zhongshan, 528400, China
| | - Juanjuan Liu
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, No. 3, Kangxin Road, West District, Zhongshan, 528400, China
| | - Jiancheng Dai
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, No. 3, Kangxin Road, West District, Zhongshan, 528400, China
| | - Yong Zhao
- Department of Internal Medicine-Cardiovascular, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528400, China
| | - Weiquan Luo
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, No. 3, Kangxin Road, West District, Zhongshan, 528400, China.
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13
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Navidi Z, Sun J, Chan RH, Hanneman K, Al-Arnawoot A, Munim A, Rakowski H, Maron MS, Woo A, Wang B, Tsang W. Interpretable machine learning for automated left ventricular scar quantification in hypertrophic cardiomyopathy patients. PLOS DIGITAL HEALTH 2023; 2:e0000159. [PMID: 36812626 PMCID: PMC9931226 DOI: 10.1371/journal.pdig.0000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/09/2022] [Indexed: 01/06/2023]
Abstract
Scar quantification on cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) images is important in risk stratifying patients with hypertrophic cardiomyopathy (HCM) due to the importance of scar burden in predicting clinical outcomes. We aimed to develop a machine learning (ML) model that contours left ventricular (LV) endo- and epicardial borders and quantifies CMR LGE images from HCM patients.We retrospectively studied 2557 unprocessed images from 307 HCM patients followed at the University Health Network (Canada) and Tufts Medical Center (USA). LGE images were manually segmented by two experts using two different software packages. Using 6SD LGE intensity cutoff as the gold standard, a 2-dimensional convolutional neural network (CNN) was trained on 80% and tested on the remaining 20% of the data. Model performance was evaluated using the Dice Similarity Coefficient (DSC), Bland-Altman, and Pearson's correlation. The 6SD model DSC scores were good to excellent at 0.91 ± 0.04, 0.83 ± 0.03, and 0.64 ± 0.09 for the LV endocardium, epicardium, and scar segmentation, respectively. The bias and limits of agreement for the percentage of LGE to LV mass were low (-0.53 ± 2.71%), and correlation high (r = 0.92). This fully automated interpretable ML algorithm allows rapid and accurate scar quantification from CMR LGE images. This program does not require manual image pre-processing, and was trained with multiple experts and software, increasing its generalizability.
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Affiliation(s)
- Zeinab Navidi
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
- Vector Institute, Toronto, Canada
| | - Jesse Sun
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Raymond H. Chan
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Kate Hanneman
- Department of Radiology, University Health Network, University of Toronto, Toronto, Canada
| | - Amna Al-Arnawoot
- Department of Radiology, University Health Network, University of Toronto, Toronto, Canada
| | | | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Martin S. Maron
- Division of Cardiology, Tufts Medical Center, Boston, United States of America
| | - Anna Woo
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Bo Wang
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
- Vector Institute, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Wendy Tsang
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
- * E-mail:
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