1
|
Klontzas ME, Vassalou EE, Spanakis K, Meurer F, Woertler K, Zibis A, Marias K, Karantanas AH. Deep learning enables the differentiation between early and late stages of hip avascular necrosis. Eur Radiol 2024; 34:1179-1186. [PMID: 37581656 PMCID: PMC10853078 DOI: 10.1007/s00330-023-10104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To develop a deep learning methodology that distinguishes early from late stages of avascular necrosis of the hip (AVN) to determine treatment decisions. METHODS Three convolutional neural networks (CNNs) VGG-16, Inception ResnetV2, InceptionV3 were trained with transfer learning (ImageNet) and finetuned with a retrospectively collected cohort of (n = 104) MRI examinations of AVN patients, to differentiate between early (ARCO 1-2) and late (ARCO 3-4) stages. A consensus CNN ensemble decision was recorded as the agreement of at least two CNNs. CNN and ensemble performance was benchmarked on an independent cohort of 49 patients from another country and was compared to the performance of two MSK radiologists. CNN performance was expressed with areas under the curve (AUC), the respective 95% confidence intervals (CIs) and precision, and recall and f1-scores. AUCs were compared with DeLong's test. RESULTS On internal testing, Inception-ResnetV2 achieved the highest individual performance with an AUC of 99.7% (95%CI 99-100%), followed by InceptionV3 and VGG-16 with AUCs of 99.3% (95%CI 98.4-100%) and 97.3% (95%CI 95.5-99.2%) respectively. The CNN ensemble the same AUCs Inception ResnetV2. On external validation, model performance dropped with VGG-16 achieving the highest individual AUC of 78.9% (95%CI 51.6-79.6%) The best external performance was achieved by the model ensemble with an AUC of 85.5% (95%CI 72.2-93.9%). No significant difference was found between the CNN ensemble and expert MSK radiologists (p = 0.22 and 0.092 respectively). CONCLUSION An externally validated CNN ensemble accurately distinguishes between the early and late stages of AVN and has comparable performance to expert MSK radiologists. CLINICAL RELEVANCE STATEMENT This paper introduces the use of deep learning for the differentiation between early and late avascular necrosis of the hip, assisting in a complex clinical decision that can determine the choice between conservative and surgical treatment. KEY POINTS • A convolutional neural network ensemble achieved excellent performance in distinguishing between early and late avascular necrosis. • The performance of the deep learning method was similar to the performance of expert readers.
Collapse
Affiliation(s)
- Michail E Klontzas
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Crete, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Nikolaou Plastira 100, 70013, Heraklion, Crete, Greece
| | - Evangelia E Vassalou
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Konstantinos Spanakis
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Felix Meurer
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Aristeidis Zibis
- Department of Anatomy, Medical School, University of Thessaly, Neofytou 9 St., 41223, Larissa, Greece
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Department of Electrical & Computer Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Crete, Greece.
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece.
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Nikolaou Plastira 100, 70013, Heraklion, Crete, Greece.
| |
Collapse
|
2
|
Van Den Berghe T, Babin D, Chen M, Callens M, Brack D, Maes H, Lievens J, Lammens M, Van Sumere M, Morbée L, Hautekeete S, Schatteman S, Jacobs T, Thooft WJ, Herregods N, Huysse W, Jaremko JL, Lambert R, Maksymowych W, Laloo F, Baraliakos X, De Craemer AS, Carron P, Van den Bosch F, Elewaut D, Jans L. Neural network algorithm for detection of erosions and ankylosis on CT of the sacroiliac joints: multicentre development and validation of diagnostic accuracy. Eur Radiol 2023; 33:8310-8323. [PMID: 37219619 DOI: 10.1007/s00330-023-09704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the feasibility and diagnostic accuracy of a deep learning network for detection of structural lesions of sacroiliitis on multicentre pelvic CT scans. METHODS Pelvic CT scans of 145 patients (81 female, 121 Ghent University/24 Alberta University, 18-87 years old, mean 40 ± 13 years, 2005-2021) with a clinical suspicion of sacroiliitis were retrospectively included. After manual sacroiliac joint (SIJ) segmentation and structural lesion annotation, a U-Net for SIJ segmentation and two separate convolutional neural networks (CNN) for erosion and ankylosis detection were trained. In-training validation and tenfold validation testing (U-Net-n = 10 × 58; CNN-n = 10 × 29) on a test dataset were performed to assess performance on a slice-by-slice and patient level (dice coefficient/accuracy/sensitivity/specificity/positive and negative predictive value/ROC AUC). Patient-level optimisation was applied to increase the performance regarding predefined statistical metrics. Gradient-weighted class activation mapping (Grad-CAM++) heatmap explainability analysis highlighted image parts with statistically important regions for algorithmic decisions. RESULTS Regarding SIJ segmentation, a dice coefficient of 0.75 was obtained in the test dataset. For slice-by-slice structural lesion detection, a sensitivity/specificity/ROC AUC of 95%/89%/0.92 and 93%/91%/0.91 were obtained in the test dataset for erosion and ankylosis detection, respectively. For patient-level lesion detection after pipeline optimisation for predefined statistical metrics, a sensitivity/specificity of 95%/85% and 82%/97% were obtained for erosion and ankylosis detection, respectively. Grad-CAM++ explainability analysis highlighted cortical edges as focus for pipeline decisions. CONCLUSIONS An optimised deep learning pipeline, including an explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical performance on a slice-by-slice and patient level. CLINICAL RELEVANCE STATEMENT An optimised deep learning pipeline, including a robust explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical metrics on a slice-by-slice and patient level. KEY POINTS • Structural lesions of sacroiliitis can be detected automatically in pelvic CT scans. • Both automatic segmentation and disease detection yield excellent statistical outcome metrics. • The algorithm takes decisions based on cortical edges, rendering an explainable solution.
Collapse
Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Danilo Babin
- Department of Telecommunication and Information Processing - Image Processing and Interpretation (TELIN-IPI), Faculty of Engineering and Architecture, Ghent University - IMEC, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Martijn Callens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Denim Brack
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Helena Maes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jan Lievens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marie Lammens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maxime Van Sumere
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Simon Hautekeete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stijn Schatteman
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tom Jacobs
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Willem-Jan Thooft
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wouter Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Robert Lambert
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Walter Maksymowych
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstraße 45, 44649, Herne, Germany
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|