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Zhang X, Zhang B, Zhang F. Stenosis Detection and Quantification of Coronary Artery Using Machine Learning and Deep Learning. Angiology 2024; 75:405-416. [PMID: 37399509 DOI: 10.1177/00033197231187063] [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: 07/05/2023]
Abstract
The aim of this review is to introduce some applications of artificial intelligence (AI) algorithms for the detection and quantification of coronary stenosis using computed tomography angiography (CTA). The realization of automatic/semi-automatic stenosis detection and quantification includes the following steps: vessel central axis extraction, vessel segmentation, stenosis detection, and quantification. Many new AI techniques, such as machine learning and deep learning, have been widely used in medical image segmentation and stenosis detection. This review also summarizes the recent progress regarding coronary stenosis detection and quantification, and discusses the development trends in this field. Through evaluation and comparison, researchers can better understand the research frontier in related fields, compare the advantages and disadvantages of various methods, and better optimize the new technologies. Machine learning and deep learning will promote the process of automatic detection and quantification of coronary artery stenosis. However, the machine learning and the deep learning methods need a large amount of data, so they also face some challenges because of the lack of professional image annotations (manually add labels by experts).
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Affiliation(s)
- Xinhong Zhang
- School of Software, Henan University, Kaifeng, China
| | - Boyan Zhang
- School of Software, Henan University, Kaifeng, China
| | - Fan Zhang
- Huaihe Hospital, Henan University, Kaifeng, China
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2
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Berman D, Hunter C, Hossain A, Yao J, Workman E, Guan S, Strickhart L, Beanlands R, Slater D, deKemp RA. Machine and deep learning models for accurate detection of ischemia and scar with myocardial blood flow positron emission tomography imaging. J Nucl Cardiol 2024; 32:101797. [PMID: 38185409 DOI: 10.1016/j.nuclcard.2024.101797] [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] [Indexed: 01/09/2024]
Abstract
BACKGROUND Quantification of myocardial blood flow (MBF) is used for the noninvasive diagnosis of patients with coronary artery disease (CAD). This study compared traditional statistics, machine learning, and deep learning techniques in their ability to diagnose disease using only the rest and stress MBF values. METHODS This study included 3245 rest and stress rubidium-82 positron emission tomography (PET) studies and matching diagnostic labels from perfusion reports. Standard logistic regression, lasso logistic regression, support vector machine, random forest, multilayer perceptron, and dense U-Net were compared for per-patient detection and per-vessel localization of scars and ischemia. RESULTS Receiver-operator characteristic area under the curve (AUC) of machine learning models was significantly higher than those of traditional statistics models for per-patient detection of disease (0.92-0.95 vs. 0.87) but not for per-vessel localization of ischemia or scar. Random forest showed the highest AUC = 0.95 among the different models compared. On the final hold-out set for generalizability, random forest showed an AUC of 0.92 for detection and 0.89 for localization of perfusion abnormalities. CONCLUSIONS For per-vessel localization, simple models trained on segmental data performed similarly to a convolutional neural network trained on polar-map data, highlighting the need to justify the use of complex predictive algorithms through comparison with simpler methods.
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Affiliation(s)
- Daniel Berman
- The MITRE Corporation, 7515 Colshire Drive, McLean, VA 22102, USA
| | - Chad Hunter
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7, Canada
| | - Alomgir Hossain
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7, Canada; The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Jason Yao
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7, Canada
| | - Emily Workman
- The MITRE Corporation, 7515 Colshire Drive, McLean, VA 22102, USA
| | - Steven Guan
- The MITRE Corporation, 7515 Colshire Drive, McLean, VA 22102, USA
| | - Laura Strickhart
- The MITRE Corporation, 7515 Colshire Drive, McLean, VA 22102, USA
| | - Rob Beanlands
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7, Canada
| | - David Slater
- The MITRE Corporation, 7515 Colshire Drive, McLean, VA 22102, USA
| | - Robert A deKemp
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7, Canada.
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Sandeep B, Liu X, Huang X, Wang X, Mao L, Xiao Z. Feasibility of artificial intelligence its current status, clinical applications, and future direction in cardiovascular disease. Curr Probl Cardiol 2024; 49:102349. [PMID: 38103818 DOI: 10.1016/j.cpcardiol.2023.102349] [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: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
In routine clinical practice, the diagnosis and treatment of cardiovascular disease (CVD) rely on data in a variety of formats. These formats comprise invasive angiography, laboratory data, non-invasive imaging diagnostics, and patient history. Artificial intelligence (AI) is a field of computer science that aims to mimic human thought processes, learning capacity, and knowledge storage. In cardiovascular medicine, artificial intelligence (AI) algorithms have been used to discover novel genotypes and phenotypes in established diseases enhance patient care, enable cost effectiveness, and lower readmission and mortality rates. AI will lead to a paradigm change toward precision cardiovascular medicine in the near future. The promise application of AI in cardiovascular medicine is immense; however, failure to recognize and ignorance of the challenges may overshadow its potential clinical impact. AI can facilitate every stage in cardiology in the imaging process, from acquisition and reconstruction, to segmentation, measurement, interpretation, and subsequent clinical pathways. Along with new possibilities, new threats arise, acknowledging and understanding them is as important as understanding the machine learning (ML) methodology itself. Therefore, attention is also paid to the current opinions and guidelines regarding the validation and safety of AI. This paper provides a outline for clinicians on relevant aspects of AI and machine learning, selection of applications and methods in cardiology to date, and identifies how cardiovascular medicine could incorporate AI in the future. With progress continuing in this emerging technology, the impact for cardiovascular medicine is highlighted to provide insight for the practicing clinician and to identify potential patient benefits.
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Affiliation(s)
- Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China.
| | - Xian Liu
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
| | - Xin Huang
- Department of Anesthesiology, West China Hospital of Medicine, Sichuan University, Chengdu, Sichuan 610017, China
| | - Xiaowei Wang
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
| | - Long Mao
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
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Panagiotidis E, Papachristou K, Makridou A, Zoglopitou LA, Paschali A, Kalathas T, Chatzimarkou M, Chatzipavlidou V. Review of artificial intelligence clinical applications in Nuclear Medicine. Nucl Med Commun 2024; 45:24-34. [PMID: 37901920 DOI: 10.1097/mnm.0000000000001786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
This paper provides an in-depth analysis of the clinical applications of artificial intelligence (AI) in Nuclear Medicine, focusing on three key areas: neurology, cardiology, and oncology. Beginning with neurology, specifically Alzheimer's disease and Parkinson's disease, the paper examines reviews on diagnosis and treatment planning. The same pattern is followed in cardiology studies. In the final section on oncology, the paper explores the various AI applications in multiple cancer types, including lung, head and neck, lymphoma, and pancreatic cancer.
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Affiliation(s)
| | | | - Anna Makridou
- Medical Physics Department, Cancer Hospital of Thessaloniki 'Theagenio', Thessaloniki, Greece
| | | | - Anna Paschali
- Nuclear Medicine Department, Cancer Hospital of Thessaloniki 'Theagenio' and
| | - Theodoros Kalathas
- Nuclear Medicine Department, Cancer Hospital of Thessaloniki 'Theagenio' and
| | - Michael Chatzimarkou
- Medical Physics Department, Cancer Hospital of Thessaloniki 'Theagenio', Thessaloniki, Greece
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Kolasa K, Admassu B, Hołownia-Voloskova M, Kędzior KJ, Poirrier JE, Perni S. Systematic reviews of machine learning in healthcare: a literature review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:63-115. [PMID: 37955147 DOI: 10.1080/14737167.2023.2279107] [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: 07/17/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The increasing availability of data and computing power has made machine learning (ML) a viable approach to faster, more efficient healthcare delivery. METHODS A systematic literature review (SLR) of published SLRs evaluating ML applications in healthcare settings published between1 January 2010 and 27 March 2023 was conducted. RESULTS In total 220 SLRs covering 10,462 ML algorithms were reviewed. The main application of AI in medicine related to the clinical prediction and disease prognosis in oncology and neurology with the use of imaging data. Accuracy, specificity, and sensitivity were provided in 56%, 28%, and 25% SLRs respectively. Internal and external validation was reported in 53% and less than 1% of the cases respectively. The most common modeling approach was neural networks (2,454 ML algorithms), followed by support vector machine and random forest/decision trees (1,578 and 1,522 ML algorithms, respectively). EXPERT OPINION The review indicated considerable reporting gaps in terms of the ML's performance, both internal and external validation. Greater accessibility to healthcare data for developers can ensure the faster adoption of ML algorithms into clinical practice.
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Affiliation(s)
- Katarzyna Kolasa
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
| | - Bisrat Admassu
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
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Amini M, Pursamimi M, Hajianfar G, Salimi Y, Saberi A, Mehri-Kakavand G, Nazari M, Ghorbani M, Shalbaf A, Shiri I, Zaidi H. Machine learning-based diagnosis and risk classification of coronary artery disease using myocardial perfusion imaging SPECT: A radiomics study. Sci Rep 2023; 13:14920. [PMID: 37691039 PMCID: PMC10493219 DOI: 10.1038/s41598-023-42142-w] [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: 04/04/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Abstract
This study aimed to investigate the diagnostic performance of machine learning-based radiomics analysis to diagnose coronary artery disease status and risk from rest/stress Myocardial Perfusion Imaging (MPI) single-photon emission computed tomography (SPECT). A total of 395 patients suspicious of coronary artery disease who underwent 2-day stress-rest protocol MPI SPECT were enrolled in this study. The left ventricle myocardium, excluding the cardiac cavity, was manually delineated on rest and stress images to define a volume of interest. Added to clinical features (age, sex, family history, diabetes status, smoking, and ejection fraction), a total of 118 radiomics features, were extracted from rest and stress MPI SPECT images to establish different feature sets, including Rest-, Stress-, Delta-, and Combined-radiomics (all together) feature sets. The data were randomly divided into 80% and 20% subsets for training and testing, respectively. The performance of classifiers built from combinations of three feature selections, and nine machine learning algorithms was evaluated for two different diagnostic tasks, including 1) normal/abnormal (no CAD vs. CAD) classification, and 2) low-risk/high-risk CAD classification. Different metrics, including the area under the ROC curve (AUC), accuracy (ACC), sensitivity (SEN), and specificity (SPE), were reported for models' evaluation. Overall, models built on the Stress feature set (compared to other feature sets), and models to diagnose the second task (compared to task 1 models) revealed better performance. The Stress-mRMR-KNN (feature set-feature selection-classifier) reached the highest performance for task 1 with AUC, ACC, SEN, and SPE equal to 0.61, 0.63, 0.64, and 0.6, respectively. The Stress-Boruta-GB model achieved the highest performance for task 2 with AUC, ACC, SEN, and SPE of 0.79, 0.76, 0.75, and 0.76, respectively. Diabetes status from the clinical feature family, and dependence count non-uniformity normalized, from the NGLDM family, which is representative of non-uniformity in the region of interest were the most frequently selected features from stress feature set for CAD risk classification. This study revealed promising results for CAD risk classification using machine learning models built on MPI SPECT radiomics. The proposed models are helpful to alleviate the labor-intensive MPI SPECT interpretation process regarding CAD status and can potentially expedite the diagnostic process.
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Affiliation(s)
- Mehdi Amini
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Mohamad Pursamimi
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghasem Hajianfar
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Yazdan Salimi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Abdollah Saberi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Ghazal Mehri-Kakavand
- Department of Medical Physics, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mostafa Nazari
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Ghorbani
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland.
- University Research and Innovation Center, Obuda University, Budapest, Hungary.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University of Medical Center Groningen, Groningen, The Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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Apostolopoulos ID, Papandrianos NI, Feleki A, Moustakidis S, Papageorgiou EI. Deep learning-enhanced nuclear medicine SPECT imaging applied to cardiac studies. EJNMMI Phys 2023; 10:6. [PMID: 36705775 PMCID: PMC9883373 DOI: 10.1186/s40658-022-00522-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023] Open
Abstract
Deep learning (DL) has a growing popularity and is a well-established method of artificial intelligence for data processing, especially for images and videos. Its applications in nuclear medicine are broad and include, among others, disease classification, image reconstruction, and image de-noising. Positron emission tomography (PET) and single-photon emission computerized tomography (SPECT) are major image acquisition technologies in nuclear medicine. Though several studies have been conducted to apply DL in many nuclear medicine domains, such as cancer detection and classification, few studies have employed such methods for cardiovascular disease applications. The present paper reviews recent DL approaches focused on cardiac SPECT imaging. Extensive research identified fifty-five related studies, which are discussed. The review distinguishes between major application domains, including cardiovascular disease diagnosis, SPECT attenuation correction, image denoising, full-count image estimation, and image reconstruction. In addition, major findings and dominant techniques employed for the mentioned task are revealed. Current limitations of DL approaches and future research directions are discussed.
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Affiliation(s)
- Ioannis D. Apostolopoulos
- grid.11047.330000 0004 0576 5395Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece ,grid.410558.d0000 0001 0035 6670Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece
| | - Nikolaos I. Papandrianos
- grid.410558.d0000 0001 0035 6670Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece
| | - Anna Feleki
- grid.410558.d0000 0001 0035 6670Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece
| | - Serafeim Moustakidis
- grid.410558.d0000 0001 0035 6670Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece ,AIDEAS OÜ, 10117 Tallinn, Estonia
| | - Elpiniki I. Papageorgiou
- grid.410558.d0000 0001 0035 6670Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece
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Liu B, Chang H, Yang D, Yang F, Wang Q, Deng Y, Li L, Lv W, Zhang B, Yu L, Burkhoff D, He K. A deep learning framework assisted echocardiography with diagnosis, lesion localization, phenogrouping heterogeneous disease, and anomaly detection. Sci Rep 2023; 13:3. [PMID: 36593284 PMCID: PMC9807607 DOI: 10.1038/s41598-022-27211-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Echocardiography is the first-line diagnostic technique for heart diseases. Although artificial intelligence techniques have made great improvements in the analysis of echocardiography, the major limitations remain to be the built neural networks are normally adapted to a few diseases and specific equipment. Here, we present an end-to-end deep learning framework named AIEchoDx that differentiates four common cardiovascular diseases (Atrial Septal Defect, Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, prior Myocardial Infarction) from normal subjects with performance comparable to that of consensus of three senior cardiologists in AUCs (99.50% vs 99.26%, 98.75% vs 92.75%, 99.57% vs 97.21%, 98.52% vs 84.20%, and 98.70% vs 89.41%), respectively. Meanwhile, AIEchoDx accurately recognizes critical lesion regions of interest along with each disease by visualizing the decision-making process. Furthermore, our analysis indicates that heterogeneous diseases, like dilated cardiomyopathy, could be classified into two phenogroups with distinct clinical characteristics. Finally, AIEchoDx performs efficiently as an anomaly detection tool when applying handheld device-produced videos. Together, AIEchoDx provides a potential diagnostic assistant tool in either cart-based echocardiography equipment or handheld echocardiography device for primary and point-of-care medical personnel with high diagnostic performance, and the application of lesion region identification and heterogeneous disease phenogrouping, which may broaden the application of artificial intelligence in echocardiography.
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Affiliation(s)
- Bohan Liu
- grid.414252.40000 0004 1761 8894Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Beijing Key Laboratory of Precision Medicine for Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China
| | - Hao Chang
- grid.47100.320000000419368710Department of Genetics, Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT 06510 USA
| | - Dong Yang
- grid.494629.40000 0004 8008 9315Key Laboratory of Growth Regulation and Translation Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024 China
| | - Feifei Yang
- grid.414252.40000 0004 1761 8894Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Beijing Key Laboratory of Precision Medicine for Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China ,grid.414252.40000 0004 1761 8894Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100037 China
| | - Qiushuang Wang
- grid.414252.40000 0004 1761 8894Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Beijing Key Laboratory of Precision Medicine for Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China ,grid.414252.40000 0004 1761 8894Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100037 China
| | - Yujiao Deng
- grid.414252.40000 0004 1761 8894Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Beijing Key Laboratory of Precision Medicine for Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China ,grid.414252.40000 0004 1761 8894Department of Ultrasound Diagnosis, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
| | - Lijun Li
- grid.414252.40000 0004 1761 8894Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
| | - Wenqing Lv
- grid.414373.60000 0004 1758 1243Department of Cardiology, Beijing Tongren Hospital, Beijing, 100176 China
| | - Bo Zhang
- Department of Ultrasound, Chinese PLA 923 Hospital, Nanning, 530021 China
| | - Liheng Yu
- grid.414252.40000 0004 1761 8894Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Beijing Key Laboratory of Precision Medicine for Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China
| | - Daniel Burkhoff
- grid.414252.40000 0004 1761 8894Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Beijing Key Laboratory of Precision Medicine for Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China ,grid.21729.3f0000000419368729Division of Cardiology, Columbia University, New York City, NY 10027 USA
| | - Kunlun He
- grid.414252.40000 0004 1761 8894Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Beijing Key Laboratory of Precision Medicine for Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China
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Aquino YSJ, Rogers WA, Braunack-Mayer A, Frazer H, Win KT, Houssami N, Degeling C, Semsarian C, Carter SM. Utopia versus dystopia: Professional perspectives on the impact of healthcare artificial intelligence on clinical roles and skills. Int J Med Inform 2023; 169:104903. [PMID: 36343512 DOI: 10.1016/j.ijmedinf.2022.104903] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/23/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alongside the promise of improving clinical work, advances in healthcare artificial intelligence (AI) raise concerns about the risk of deskilling clinicians. This purpose of this study is to examine the issue of deskilling from the perspective of diverse group of professional stakeholders with knowledge and/or experiences in the development, deployment and regulation of healthcare AI. METHODS We conducted qualitative, semi-structured interviews with 72 professionals with AI expertise and/or professional or clinical expertise who were involved in development, deployment and/or regulation of healthcare AI. Data analysis using combined constructivist grounded theory and framework approach was performed concurrently with data collection. FINDINGS Our analysis showed participants had diverse views on three contentious issues regarding AI and deskilling. The first involved competing views about the proper extent of AI-enabled automation in healthcare work, and which clinical tasks should or should not be automated. We identified a cluster of characteristics of tasks that were considered more suitable for automation. The second involved expectations about the impact of AI on clinical skills, and whether AI-enabled automation would lead to worse or better quality of healthcare. The third tension implicitly contrasted two models of healthcare work: a human-centric model and a technology-centric model. These models assumed different values and priorities for healthcare work and its relationship to AI-enabled automation. CONCLUSION Our study shows that a diverse group of professional stakeholders involved in healthcare AI development, acquisition, deployment and regulation are attentive to the potential impact of healthcare AI on clinical skills, but have different views about the nature and valence (positive or negative) of this impact. Detailed engagement with different types of professional stakeholders allowed us to identify relevant concepts and values that could guide decisions about AI algorithm development and deployment.
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Affiliation(s)
- Yves Saint James Aquino
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, NSW, Australia.
| | - Wendy A Rogers
- Department of Philosophy and School of Medicine, Macquarie University, NSW, Australia
| | - Annette Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, NSW, Australia
| | - Helen Frazer
- St Vincent's Hospital, Melbourne, VIC, Australia
| | - Khin Than Win
- Centre for Persuasive Technology and Society, School of Computing and Information Technology, University of Wollongong, NSW, Australia
| | - Nehmat Houssami
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia; The Daffodil Centre, The University of Sydney, Joint Venture with Cancer Council NSW, Australia
| | - Christopher Degeling
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, NSW, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, NSW, Australia
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10
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Papandrianos NI, Apostolopoulos ID, Feleki A, Moustakidis S, Kokkinos K, Papageorgiou EI. AI-based classification algorithms in SPECT myocardial perfusion imaging for cardiovascular diagnosis: a review. Nucl Med Commun 2023; 44:1-11. [PMID: 36514926 DOI: 10.1097/mnm.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the last few years, deep learning has made a breakthrough and established its position in machine learning classification problems in medical image analysis. Deep learning has recently displayed remarkable applicability in a range of different medical applications, as well as in nuclear cardiology. This paper implements a literature review protocol and reports the latest advances in artificial intelligence (AI)-based classification in SPECT myocardial perfusion imaging in heart disease diagnosis. The representative and most recent works are reported to demonstrate the use of AI and deep learning technologies in medical image analysis in nuclear cardiology for cardiovascular diagnosis. This review also analyses the primary outcomes of the presented research studies and suggests future directions focusing on the explainability of the deployed deep-learning systems in clinical practice.
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Affiliation(s)
| | | | - Anna Feleki
- Department of Energy Systems, University of Thessaly, Larisa, Greece
| | - Serafeim Moustakidis
- Department of Energy Systems, University of Thessaly, Larisa, Greece
- AIDEAS OÜ, Tallinn, Estonia
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11
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Ko CL, Lin SS, Huang CW, Chang YH, Ko KY, Cheng MF, Wang SY, Chen CM, Wu YW. Polar map-free 3D deep learning algorithm to predict obstructive coronary artery disease with myocardial perfusion CZT-SPECT. Eur J Nucl Med Mol Imaging 2023; 50:376-386. [PMID: 36102963 DOI: 10.1007/s00259-022-05953-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/23/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Deep learning (DL) models have been shown to outperform total perfusion deficit (TPD) quantification in predicting obstructive coronary artery disease (CAD) from myocardial perfusion imaging (MPI). However, previously published methods have depended on polar maps, required manual correction, and normal database. In this study, we propose a polar map-free 3D DL algorithm to predict obstructive disease. METHODS We included 1861 subjects who underwent MPI using cadmium-zinc-telluride camera and subsequent coronary angiography. The subjects were divided into parameterization and external validation groups. We implemented a fully automatic algorithm to segment myocardium, perform registration, and apply normalization. We further flattened the image based on spherical coordinate system transformation. The proposed model consisted of a component to predict patent arteries and a component to predict disease in each vessel. The model was cross-validated in the parameterization group, and then further tested using the external validation group. The performance was assessed by area under receiver operating characteristic curves (AUCs) and compared with TPD. RESULTS Our algorithm preprocessed all images accurately as confirmed by visual inspection. In patient-based analysis, the AUC of the proposed model was significantly higher than that for stress-TPD (0.84 vs 0.76, p < 0.01). In vessel-based analysis, the proposed model also outperformed regional stress-TPD (AUC = 0.80 vs 0.72, p < 0.01). The addition of quantitative images did not improve the performance. CONCLUSIONS Our proposed polar map-free 3D DL algorithm to predict obstructive CAD from MPI outperformed TPD and did not require manual correction or a normal database.
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Affiliation(s)
- Chi-Lun Ko
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shau-Syuan Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Cheng-Wen Huang
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Yu-Hui Chang
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yin Ko
- Department of Nuclear Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chung-Ming Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan.
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12
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Su TY, Chen JJ, Chen WS, Chang YH, Lu HHS. Deep learning for myocardial ischemia auxiliary diagnosis using CZT SPECT myocardial perfusion imaging. J Chin Med Assoc 2023; 86:122-130. [PMID: 36306391 DOI: 10.1097/jcma.0000000000000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The World Health Organization reported that cardiovascular disease is the most common cause of death worldwide. On average, one person dies of heart disease every 26 min worldwide. Deep learning approaches are characterized by the appropriate combination of abnormal features based on numerous annotated images. The constructed convolutional neural network (CNN) model can identify normal states of reversible and irreversible myocardial defects and alert physicians for further diagnosis. METHODS Cadmium zinc telluride single-photon emission computed tomography myocardial perfusion resting-state images were collected at Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan, and were analyzed with a deep learning convolutional neural network to classify myocardial perfusion images for coronary heart diseases. RESULTS In these grey-scale images, the heart blood flow distribution was the most crucial feature. The deep learning technique of You Only Look Once was used to determine the myocardial defect area and crop the images. After surrounding noise had been eliminated, a three-dimensional CNN model was used to identify patients with coronary heart diseases. The prediction area under the curve, accuracy, sensitivity, and specificity was 90.97, 87.08, 86.49, and 87.41%, respectively. CONCLUSION Our prototype system can considerably reduce the time required for image interpretation and improve the quality of medical care. It can assist clinical experts by offering accurate coronary heart disease diagnosis in practice.
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Affiliation(s)
- Ting-Yi Su
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
| | - Jui-Jen Chen
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Wei-Shiang Chen
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Henry Horng-Shing Lu
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
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13
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Lou YS, Lin CS, Fang WH, Lee CC, Wang CH, Lin C. Development and validation of a dynamic deep learning algorithm using electrocardiogram to predict dyskalaemias in patients with multiple visits. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 4:22-32. [PMID: 36743876 PMCID: PMC9890087 DOI: 10.1093/ehjdh/ztac072] [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: 04/06/2022] [Revised: 10/26/2022] [Indexed: 11/23/2022]
Abstract
Aims Deep learning models (DLMs) have shown superiority in electrocardiogram (ECG) analysis and have been applied to diagnose dyskalaemias. However, no study has explored the performance of DLM-enabled ECG in continuous follow-up scenarios. Therefore, we proposed a dynamic revision of DLM-enabled ECG to use personal pre-annotated ECGs to enhance the accuracy in patients with multiple visits. Methods and results We retrospectively collected 168 450 ECGs with corresponding serum potassium (K+) levels from 103 091 patients as development samples. In the internal/external validation sets, the numbers of ECGs with corresponding K+ were 37 246/47 604 from 13 555/20 058 patients. Our dynamic revision method showed better performance than the traditional direct prediction for diagnosing hypokalaemia [area under the receiver operating characteristic curve (AUC) = 0.730/0.720-0.788/0.778] and hyperkalaemia (AUC = 0.884/0.888-0.915/0.908) in patients with multiple visits. Conclusion Our method has shown a distinguishable improvement in DLMs for diagnosing dyskalaemias in patients with multiple visits, and we also proved its application in ejection fraction prediction, which could further improve daily clinical practice.
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Affiliation(s)
- Yu-Sheng Lou
- Graduate Institutes of Life Sciences, National Defense Medical Center, No.161, Min-Chun E. Rd., Sec. 6, Neihu, Taipei 114, Taiwan, Republic of China,School of Public Health, National Defense Medical Center, No. 161, Min-Chun E. Rd., Section 6, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center,, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng- Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China,Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Min-Chun E. Rd., Section 6, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chin Lin
- Corresponding author. Tel: +886 2 87923100 #18574, Fax: +886 2 87923147,
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Wang X, Wang J, Wang W, Zhu M, Guo H, Ding J, Sun J, Zhu D, Duan Y, Chen X, Zhang P, Wu Z, He K. Using artificial intelligence in the development of diagnostic models of coronary artery disease with imaging markers: A scoping review. Front Cardiovasc Med 2022; 9:945451. [PMID: 36267636 PMCID: PMC9577031 DOI: 10.3389/fcvm.2022.945451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Coronary artery disease (CAD) is a progressive disease of the blood vessels supplying the heart, which leads to coronary artery stenosis or obstruction and is life-threatening. Early diagnosis of CAD is essential for timely intervention. Imaging tests are widely used in diagnosing CAD, and artificial intelligence (AI) technology is used to shed light on the development of new imaging diagnostic markers. Objective We aim to investigate and summarize how AI algorithms are used in the development of diagnostic models of CAD with imaging markers. Methods This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. Eligible articles were searched in PubMed and Embase. Based on the predefined included criteria, articles on coronary heart disease were selected for this scoping review. Data extraction was independently conducted by two reviewers, and a narrative synthesis approach was used in the analysis. Results A total of 46 articles were included in the scoping review. The most common types of imaging methods complemented by AI included single-photon emission computed tomography (15/46, 32.6%) and coronary computed tomography angiography (15/46, 32.6%). Deep learning (DL) (41/46, 89.2%) algorithms were used more often than machine learning algorithms (5/46, 10.8%). The models yielded good model performance in terms of accuracy, sensitivity, specificity, and AUC. However, most of the primary studies used a relatively small sample (n < 500) in model development, and only few studies (4/46, 8.7%) carried out external validation of the AI model. Conclusion As non-invasive diagnostic methods, imaging markers integrated with AI have exhibited considerable potential in the diagnosis of CAD. External validation of model performance and evaluation of clinical use aid in the confirmation of the added value of markers in practice. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306638], identifier [CRD42022306638].
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Affiliation(s)
- Xiao Wang
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Junfeng Wang
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Wenjun Wang
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Mingxiang Zhu
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Hua Guo
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Junyu Ding
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Jin Sun
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Di Zhu
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yongjie Duan
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Xu Chen
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Peifang Zhang
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Zhenzhou Wu
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Kunlun He
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China,Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Chinese PLA General Hospital, Beijing, China,Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China,*Correspondence: Kunlun He, ; orcid.org/0000-0002-3335-5700
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15
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An Explainable Classification Method of SPECT Myocardial Perfusion Images in Nuclear Cardiology Using Deep Learning and Grad-CAM. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: This study targets the development of an explainable deep learning methodology for the automatic classification of coronary artery disease, utilizing SPECT MPI images. Deep learning is currently judged as non-transparent due to the model’s complex non-linear structure, and thus, it is considered a «black box», making it hard to gain a comprehensive understanding of its internal processes and explain its behavior. Existing explainable artificial intelligence tools can provide insights into the internal functionality of deep learning and especially of convolutional neural networks, allowing transparency and interpretation. Methods: This study seeks to address the identification of patients’ CAD status (infarction, ischemia or normal) by developing an explainable deep learning pipeline in the form of a handcrafted convolutional neural network. The proposed RGB-CNN model utilizes various pre- and post-processing tools and deploys a state-of-the-art explainability tool to produce more interpretable predictions in decision making. The dataset includes cases from 625 patients as stress and rest representations, comprising 127 infarction, 241 ischemic, and 257 normal cases previously classified by a doctor. The imaging dataset was split into 20% for testing and 80% for training, of which 15% was further used for validation purposes. Data augmentation was employed to increase generalization. The efficacy of the well-known Grad-CAM-based color visualization approach was also evaluated in this research to provide predictions with interpretability in the detection of infarction and ischemia in SPECT MPI images, counterbalancing any lack of rationale in the results extracted by the CNNs. Results: The proposed model achieved 93.3% accuracy and 94.58% AUC, demonstrating efficient performance and stability. Grad-CAM has shown to be a valuable tool for explaining CNN-based judgments in SPECT MPI images, allowing nuclear physicians to make fast and confident judgments by using the visual explanations offered. Conclusions: Prediction results indicate a robust and efficient model based on the deep learning methodology which is proposed for CAD diagnosis in nuclear medicine.
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16
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Nakajima K, Saito S, Chen Z, Komatsu J, Maruyama K, Shirasaki N, Watanabe S, Inaki A, Ono K, Kinuya S. Diagnosis of Parkinson syndrome and Lewy-body disease using 123I-ioflupane images and a model with image features based on machine learning. Ann Nucl Med 2022; 36:765-776. [PMID: 35798937 PMCID: PMC9304062 DOI: 10.1007/s12149-022-01759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES 123I-ioflupane has been clinically applied to dopamine transporter imaging and visual interpretation assisted by region-of-interest (ROI)-based parameters. We aimed to build a multivariable model incorporating machine learning (ML) that could accurately differentiate abnormal profiles on 123I-ioflupane images and diagnose Parkinson syndrome or disease and dementia with Lewy bodies (PS/PD/DLB). METHODS We assessed 123I-ioflupane images from 239 patients with suspected neurodegenerative diseases or dementia and classified them as having PS/PD/DLB or non-PS/PD/DLB. The image features of high or low uptake (F1), symmetry or asymmetry (F2), and comma- or dot-like patterns of caudate and putamen uptake (F3) were analyzed on 137 images from one hospital for training. Direct judgement of normal or abnormal profiles (F4) was also examined. Machine learning methods included logistic regression (LR), k-nearest neighbors (kNNs), and gradient boosted trees (GBTs) that were assessed using fourfold cross-validation. We generated the following multivariable models for the test database (n = 102 from another hospital): Model 1, ROI-based measurements of specific binding ratios and asymmetry indices; Model 2, ML-based judgement of abnormalities (F4); and Model 3, features F1, F2 and F3, plus patient age. Diagnostic accuracy was compared using areas under receiver-operating characteristics curves (AUC). RESULTS The AUC was high with all ML methods (0.92-0.96) for high or low uptake. The AUC was the highest for symmetry or asymmetry with the kNN method (AUC 0.75) and the comma-dot feature with the GBT method (AUC 0.94). Based on the test data set, the diagnostic accuracy for a diagnosis of PS/PD/DLB was 0.86 ± 0.04 (SE), 0.87 ± 0.04, and 0.93 ± 0.02 for Models 1, 2 and 3, respectively. The AUC was optimal for Model 3, and significantly differed between Models 3 and 1 (p = 0.027), and 3 and 2 (p = 0.029). CONCLUSIONS Image features such as high or low uptake, symmetry or asymmetry, and comma- or dot-like profiles can be determined using ML. The diagnostic accuracy of differentiating PS/PD/DLB was the highest for the multivariate model with three features and age compared with the conventional ROI-based method.
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Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Japan.
| | - Shintaro Saito
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan
| | - Zhuoqing Chen
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan
| | - Junji Komatsu
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Koji Maruyama
- Wolfram Research Inc., Champaign, IL, USA
- Department of Chemistry and Materials Science, Osaka City University, Osaka, Japan
| | - Naoki Shirasaki
- Department of Neurosurgery, Kaga Medical Center, Kaga, Japan
| | - Satoru Watanabe
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Anri Inaki
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan
| | - Kenjiro Ono
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan
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Koulaouzidis G, Jadczyk T, Iakovidis DK, Koulaouzidis A, Bisnaire M, Charisopoulou D. Artificial Intelligence in Cardiology-A Narrative Review of Current Status. J Clin Med 2022; 11:jcm11133910. [PMID: 35807195 PMCID: PMC9267740 DOI: 10.3390/jcm11133910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
Artificial intelligence (AI) is an integral part of clinical decision support systems (CDSS), offering methods to approximate human reasoning and computationally infer decisions. Such methods are generally based on medical knowledge, either directly encoded with rules or automatically extracted from medical data using machine learning (ML). ML techniques, such as Artificial Neural Networks (ANNs) and support vector machines (SVMs), are based on mathematical models with parameters that can be optimally tuned using appropriate algorithms. The ever-increasing computational capacity of today’s computer systems enables more complex ML systems with millions of parameters, bringing AI closer to human intelligence. With this objective, the term deep learning (DL) has been introduced to characterize ML based on deep ANN (DNN) architectures with multiple layers of artificial neurons. Despite all of these promises, the impact of AI in current clinical practice is still limited. However, this could change shortly, as the significantly increased papers in AI, machine learning and deep learning in cardiology show. We highlight the significant achievements of recent years in nearly all areas of cardiology and underscore the mounting evidence suggesting how AI will take a central stage in the field.
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Affiliation(s)
- George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University (PMU), 70-204 Szczecin, Poland;
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-551 Katowice, Poland;
- International Clinical Research Center, St. Anne’s University Hospital Brno, 656 91 Brno, Czech Republic
| | - Dimitris K. Iakovidis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 40500 Lamia, Greece;
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University (PMU), 70-204 Szczecin, Poland
- Department of Medicine, OUH Svendborg Sygehus, 5700 Svendborg, Denmark
- Surgical Research Unit, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark (SDU), 5000 Odense, Denmark
- Correspondence:
| | - Marc Bisnaire
- Cardiology Research and Scientific Advancements, UVA Research, Toronto, ON L3R 3Z3, Canada;
| | - Dafni Charisopoulou
- Academic Centre for Congenital Heart Disease, 6500 HB Nijmegen, The Netherlands;
- Amalia Children’s Hospital, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
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Papandrianos NI, Feleki A, Papageorgiou EI, Martini C. Deep Learning-Based Automated Diagnosis for Coronary Artery Disease Using SPECT-MPI Images. J Clin Med 2022; 11:jcm11133918. [PMID: 35807203 PMCID: PMC9267142 DOI: 10.3390/jcm11133918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a long-established estimation methodology for medical diagnosis using image classification illustrating conditions in coronary artery disease. For these procedures, convolutional neural networks have proven to be very beneficial in achieving near-optimal accuracy for the automatic classification of SPECT images. (2) Methods: This research addresses the supervised learning-based ideal observer image classification utilizing an RGB-CNN model in heart images to diagnose CAD. For comparison purposes, we employ VGG-16 and DenseNet-121 pre-trained networks that are indulged in an image dataset representing stress and rest mode heart states acquired by SPECT. In experimentally evaluating the method, we explore a wide repertoire of deep learning network setups in conjunction with various robust evaluation and exploitation metrics. Additionally, to overcome the image dataset cardinality restrictions, we take advantage of the data augmentation technique expanding the set into an adequate number. Further evaluation of the model was performed via 10-fold cross-validation to ensure our model's reliability. (3) Results: The proposed RGB-CNN model achieved an accuracy of 91.86%, while VGG-16 and DenseNet-121 reached 88.54% and 86.11%, respectively. (4) Conclusions: The abovementioned experiments verify that the newly developed deep learning models may be of great assistance in nuclear medicine and clinical decision-making.
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Affiliation(s)
- Nikolaos I. Papandrianos
- Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece; (A.F.); (E.I.P.)
- Correspondence: ; Tel.: +30-693-6064613
| | - Anna Feleki
- Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece; (A.F.); (E.I.P.)
| | - Elpiniki I. Papageorgiou
- Department of Energy Systems, University of Thessaly, Gaiopolis Campus, 41500 Larisa, Greece; (A.F.); (E.I.P.)
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, Via Gramsci 14, 43125 Parma, Italy;
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Maggiore Hospital, Via Gramsci 14, 43125 Parma, Italy
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Prediction of multivessel coronary artery disease and candidates for stress-only imaging using multivariable models with myocardial perfusion imaging. Ann Nucl Med 2022; 36:674-683. [PMID: 35661104 PMCID: PMC9226096 DOI: 10.1007/s12149-022-01751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
Purpose Selecting patients with coronary multivessel disease (MVD) or no stenosis using myocardial perfusion imaging (MPI) is challenging. We aimed to create a model to predict MVD using a combination of quantitative MPI values and background factors of patients. We also assessed whether patients in the same database could be selected who do not require rest studies (stress-only imaging). Methods We analyzed data from 1001 patients who had been assessed by stress MPI at 12 centers and 463 patients who had not undergone revascularization in Japan. Quantitative values based on MPI were obtained using cardioREPO software, which included myocardial perfusion defect scores, left ventricular ejection fractions and volumes. Factors in MPI and clinical backgrounds that could predict MVD were investigated using univariate and multivariate analyses. We also investigated whether stress data alone could predict patients without coronary stenosis to identify candidates for stress-only imaging. Results We selected summed stress score (SSS), rest end-diastolic volume, and hypertension to create a predictive model for MVD. A logistic regression model was created with an area under the receiver operating characteristics curve (AUC) of 0.825. To more specifically predict coronary three-vessel disease, the AUC was 0.847 when SSS, diabetes, and hypertension were selected. The mean probabilities of abnormality based on the MVD prediction model were 12%, 24%, 40%, and 51% for no-, one-, two-, and three-vessel disease, respectively (p < 0.0001). For the model to select patients with stress-only imaging, the AUC was 0.78 when the model was created using SSS, stress end-systolic volume and the number of risk factors (diabetes, hypertension, chronic kidney disease, and a history of smoking). Conclusion A model analysis combining myocardial SPECT and clinical data can predict MVD, and can select patients for stress-only tests. Our models should prove useful for clinical applications.
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Teuho J, Schultz J, Klén R, Knuuti J, Saraste A, Ono N, Kanaya S. Classification of ischemia from myocardial polar maps in 15O-H 2O cardiac perfusion imaging using a convolutional neural network. Sci Rep 2022; 12:2839. [PMID: 35181681 PMCID: PMC8857225 DOI: 10.1038/s41598-022-06604-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
We implemented a two-dimensional convolutional neural network (CNN) for classification of polar maps extracted from Carimas (Turku PET Centre, Finland) software used for myocardial perfusion analysis. 138 polar maps from 15O–H2O stress perfusion study in JPEG format from patients classified as ischemic or non-ischemic based on finding obstructive coronary artery disease (CAD) on invasive coronary artery angiography were used. The CNN was evaluated against the clinical interpretation. The classification accuracy was evaluated with: accuracy (ACC), area under the receiver operating characteristic curve (AUC), F1 score (F1S), sensitivity (SEN), specificity (SPE) and precision (PRE). The CNN had a median ACC of 0.8261, AUC of 0.8058, F1S of 0.7647, SEN of 0.6500, SPE of 0.9615 and PRE of 0.9286. In comparison, clinical interpretation had ACC of 0.8696, AUC of 0.8558, F1S of 0.8333, SEN of 0.7500, SPE of 0.9615 and PRE of 0.9375. The CNN classified only 2 cases differently than the clinical interpretation. The clinical interpretation and CNN had similar accuracy in classifying false positives and true negatives. Classification of ischemia is feasible in 15O–H2O stress perfusion imaging using JPEG polar maps alone with a custom CNN and may be useful for the detection of obstructive CAD.
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Affiliation(s)
- Jarmo Teuho
- Data Science Center, Nara University of Science and Technology, Nara, Japan. .,Turku PET Centre, University of Turku, Turku, Finland. .,Turku PET Centre, Turku University Hospital, Turku, Finland.
| | - Jussi Schultz
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Riku Klén
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital, Turku, Finland.,Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Naoaki Ono
- Data Science Center, Nara University of Science and Technology, Nara, Japan.,Department of Science and Technology, Nara University of Science and Technology, Nara, Japan
| | - Shigehiko Kanaya
- Department of Science and Technology, Nara University of Science and Technology, Nara, Japan
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21
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Nakajima K, Nakata T, Doi T, Tada H, Maruyama K. Machine learning-based risk model using 123I-metaiodobenzylguanidine to differentially predict modes of cardiac death in heart failure. J Nucl Cardiol 2022; 29:190-201. [PMID: 32410060 PMCID: PMC8873155 DOI: 10.1007/s12350-020-02173-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac sympathetic dysfunction is closely associated with cardiac mortality in patients with chronic heart failure (CHF). We analyzed the ability of machine learning incorporating 123I-metaiodobenzylguanidine (MIBG) to differentially predict risk of life-threatening arrhythmic events (ArE) and heart failure death (HFD). METHODS AND RESULTS A model was created based on patients with documented 2-year outcomes of CHF (n = 526; age, 66 ± 14 years). Classifiers were trained using 13 variables including age, gender, NYHA functional class, left ventricular ejection fraction and planar 123I-MIBG heart-to-mediastinum ratio (HMR). ArE comprised arrhythmic death and appropriate therapy with an implantable cardioverter defibrillator. The probability of ArE and HFD at 2 years was separately calculated based on appropriate classifiers. The probability of HFD significantly increased as HMR decreased when any variables were combined. However, the probability of arrhythmic events was maximal when HMR was intermediate (1.5-2.0 for patients with NYHA class III). Actual rates of ArE were 3% (10/379) and 18% (27/147) in patients at low- (≤ 11%) and high- (> 11%) risk of developing ArE (P < .0001), respectively, whereas those of HFD were 2% (6/328) and 49% (98/198) in patients at low-(≤ 15%) and high-(> 15%) risk of HFD (P < .0001). CONCLUSION A risk model based on machine learning using clinical variables and 123I-MIBG differentially predicted ArE and HFD as causes of cardiac death.
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Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8640, Japan.
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate-Goryoukaku Hospital, Hakodate, Japan
| | - Takahiro Doi
- Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hayato Tada
- Department of Cardiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Koji Maruyama
- Wolfram Research Inc., Tokyo, Japan
- Department of Chemistry and Materials Science, Osaka City University, Osaka, Japan
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22
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Deep learning applications in myocardial perfusion imaging, a systematic review and meta-analysis. INFORMATICS IN MEDICINE UNLOCKED 2022; 32:101055. [PMID: 36187893 PMCID: PMC9514037 DOI: 10.1016/j.imu.2022.101055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
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23
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de Souza Filho EM, Fernandes FDA, Wiefels C, de Carvalho LND, Dos Santos TF, Dos Santos AASMD, Mesquita ET, Seixas FL, Chow BJW, Mesquita CT, Gismondi RA. Machine Learning Algorithms to Distinguish Myocardial Perfusion SPECT Polar Maps. Front Cardiovasc Med 2021; 8:741667. [PMID: 34901207 PMCID: PMC8660123 DOI: 10.3389/fcvm.2021.741667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/29/2021] [Indexed: 12/18/2022] Open
Abstract
Myocardial perfusion imaging (MPI) plays an important role in patients with suspected and documented coronary artery disease (CAD). Machine Learning (ML) algorithms have been developed for many medical applications with excellent performance. This study used ML algorithms to discern normal and abnormal gated Single Photon Emission Computed Tomography (SPECT) images. We analyzed one thousand and seven polar maps from a database of patients referred to a university hospital for clinically indicated MPI between January 2016 and December 2018. These studies were reported and evaluated by two different expert readers. The image features were extracted from a specific type of polar map segmentation based on horizontal and vertical slices. A senior expert reading was the comparator (gold standard). We used cross-validation to divide the dataset into training and testing subsets, using data augmentation in the training set, and evaluated 04 ML models. All models had accuracy >90% and area under the receiver operating characteristics curve (AUC) >0.80 except for Adaptive Boosting (AUC = 0.77), while all precision and sensitivity obtained were >96 and 92%, respectively. Random Forest had the best performance (AUC: 0.853; accuracy: 0,938; precision: 0.968; sensitivity: 0.963). ML algorithms performed very well in image classification. These models were capable of distinguishing polar maps remarkably into normal and abnormal.
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Affiliation(s)
- Erito Marques de Souza Filho
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Languages and Technologies, Universidade Federal Rural do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando de Amorim Fernandes
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Nuclear Medicine, Hospital Universitário Antônio Pedro/EBSERH, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Christiane Wiefels
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Cardiac Image, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Tadeu Francisco Dos Santos
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | | | - Evandro Tinoco Mesquita
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Flávio Luiz Seixas
- Institute of Computing, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Benjamin J W Chow
- Department of Cardiac Image, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Claudio Tinoco Mesquita
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Nuclear Medicine, Hospital Pró-Cardíaco, Americas Serviços Medicos, Rio de Janeiro, Brazil
| | - Ronaldo Altenburg Gismondi
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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24
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Wang F, Xu W, Lv W, Du D, Feng H, Zhang X, Wang S, Chen W, Lu L. Evaluation of the diagnostic value of joint PET myocardial perfusion and metabolic imaging for vascular stenosis in patients with obstructive coronary artery disease. J Nucl Cardiol 2021; 28:3070-3080. [PMID: 32440989 DOI: 10.1007/s12350-020-02160-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To investigate the diagnostic value of joint PET myocardial perfusion and metabolic imaging for vascular stenosis in patients with suspected obstructive coronary artery disease (CAD). METHODS Eighty-eight patients (53 and 35 applied for training and validation, respectively) with suspected obstructive CAD were referred to 13N-NH3 PET/CT myocardial perfusion imaging (MPI) and 18F-FDG PET/CT myocardial metabolic imaging (MMI) with available coronary angiography for analysis. One semi-quantitative indicator summed rest score (SRS) and five quantitative indicators, namely, perfusion defect extent (EXT), total perfusion deficit (TPD), myocardial blood flow (MBF), scar degree (SCR), and metabolism-perfusion mismatch (MIS), were extracted from the PET rest MPI and MMI scans. Different combinations of indicators and seven machine learning methods were used to construct diagnostic models. Diagnostic performance was evaluated using the sum of four metrics (noted as sumScore), namely, area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. RESULTS In univariate analysis, MIS outperformed other individual indicators in terms of sumScore (2.816-3.042 vs 2.138-2.908). In multivariate analysis, support vector machine (SVM) consisting of three indicators (MBF, SCR, and MIS) achieved the best performance (AUC 0.856, accuracy 0.810, sensitivity 0.838, specificity 0.757, and sumScore 3.261). This model consistently achieved significantly higher AUC compared with the SRS method for four specific subgroups (0.897, 0.839, 0.875, and 0.949 vs 0.775, 0.606, 0.713, and 0.744; P = 0.041, 0.005, 0.034 0.003, respectively). CONCLUSIONS The joint evaluation of PET rest MPI and MMI could improve the diagnostic performance for obstructive CAD. The multivariate model (MBF, SCR, and MIS) combined with SVM outperformed other methods.
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Affiliation(s)
- Fanghu Wang
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, Guangdong, China
| | - Weiping Xu
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Wenbing Lv
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, Guangdong, China
| | - Dongyang Du
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, Guangdong, China
| | - Hui Feng
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, Guangdong, China
| | - Xiaochun Zhang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Shuxia Wang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China.
| | - Wufan Chen
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, Guangdong, China.
| | - Lijun Lu
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, Guangdong, China.
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Abstract
Rapid development of artificial intelligence (AI) is gaining grounds in medicine. Its huge impact and inevitable necessity are also reflected in cardiovascular imaging. Although AI would probably never replace doctors, it can significantly support and improve their productivity and diagnostic performance. Many algorithms have already proven useful at all stages of the cardiac imaging chain. Their crucial practical applications include classification, automatic quantification, notification, diagnosis, and risk prediction. Consequently, more reproducible and repeatable studies are obtained, and personalized reports may be available to any patient. Utilization of AI also increases patient safety and decreases healthcare costs. Furthermore, AI is particularly useful for beginners in the field of cardiac imaging as it provides anatomic guidance and interpretation of complex imaging results. In contrast, lack of interpretability and explainability in AI carries a risk of harmful recommendations. This review was aimed at summarizing AI principles, essential execution requirements, and challenges as well as its recent applications in cardiovascular imaging.
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26
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Hsiao YJ, Wen YC, Lai WY, Lin YY, Yang YP, Chien Y, Yarmishyn AA, Hwang DK, Lin TC, Chang YC, Lin TY, Chang KJ, Chiou SH, Jheng YC. Application of artificial intelligence-driven endoscopic screening and diagnosis of gastric cancer. World J Gastroenterol 2021; 27:2979-2993. [PMID: 34168402 PMCID: PMC8192292 DOI: 10.3748/wjg.v27.i22.2979] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/10/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
The landscape of gastrointestinal endoscopy continues to evolve as new technologies and techniques become available. The advent of image-enhanced and magnifying endoscopies has highlighted the step toward perfecting endoscopic screening and diagnosis of gastric lesions. Simultaneously, with the development of convolutional neural network, artificial intelligence (AI) has made unprecedented breakthroughs in medical imaging, including the ongoing trials of computer-aided detection of colorectal polyps and gastrointestinal bleeding. In the past demi-decade, applications of AI systems in gastric cancer have also emerged. With AI’s efficient computational power and learning capacities, endoscopists can improve their diagnostic accuracies and avoid the missing or mischaracterization of gastric neoplastic changes. So far, several AI systems that incorporated both traditional and novel endoscopy technologies have been developed for various purposes, with most systems achieving an accuracy of more than 80%. However, their feasibility, effectiveness, and safety in clinical practice remain to be seen as there have been no clinical trials yet. Nonetheless, AI-assisted endoscopies shed light on more accurate and sensitive ways for early detection, treatment guidance and prognosis prediction of gastric lesions. This review summarizes the current status of various AI applications in gastric cancer and pinpoints directions for future research and clinical practice implementation from a clinical perspective.
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Affiliation(s)
- Yu-Jer Hsiao
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yuan-Chih Wen
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Wei-Yi Lai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Pharmacology, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yi-Ying Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Pharmacology, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yi-Ping Yang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Critical Center, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yueh Chien
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | | | - De-Kuang Hwang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei 112201, Taiwan
| | - Tai-Chi Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei 112201, Taiwan
| | - Yun-Chia Chang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Ting-Yi Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Department of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Kao-Jung Chang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Shih-Hwa Chiou
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Institute of Pharmacology, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Ying-Chun Jheng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Big Data Center, Taipei Veterans General Hospital, Taipei 112201, Taiwan
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27
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Nabi W, Bansal A, Xu B. Applications of artificial intelligence and machine learning approaches in echocardiography. Echocardiography 2021; 38:982-992. [PMID: 33982820 DOI: 10.1111/echo.15048] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 12/16/2022] Open
Abstract
Artificial intelligence and machine learning approaches have become increasingly applied in the field of echocardiography to streamline diagnostic and prognostic assessments, and to support treatment decisions. Artificial intelligence and machine learning have been applied to aid image acquisition and automation. They have also been applied to the integration of clinical and imaging data. Applications of artificial intelligence and machine learning approaches in echocardiography in conjunction with health information databases may be promising in improving the classification and treatment of many cardiac conditions. This review article provides an overview of the applications of artificial intelligence and machine learning approaches in echocardiography.
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Affiliation(s)
- Wafa Nabi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Agam Bansal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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28
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Yin L, Cao Z, Wang K, Tian J, Yang X, Zhang J. A review of the application of machine learning in molecular imaging. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:825. [PMID: 34268438 PMCID: PMC8246214 DOI: 10.21037/atm-20-5877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022]
Abstract
Molecular imaging (MI) is a science that uses imaging methods to reflect the changes of molecular level in living state and conduct qualitative and quantitative studies on its biological behaviors in imaging. Optical molecular imaging (OMI) and nuclear medical imaging are two key research fields of MI. OMI technology refers to the optical information generated by the imaging target (such as tumors) due to drug intervention and other reasons. By collecting the optical information, researchers can track the motion trajectory of the imaging target at the molecular level. Owing to its high specificity and sensitivity, OMI has been widely used in preclinical research and clinical surgery. Nuclear medical imaging mainly detects ionizing radiation emitted by radioactive substances. It can provide molecular information for early diagnosis, effective treatment and basic research of diseases, which has become one of the frontiers and hot topics in the field of medicine in the world today. Both OMI and nuclear medical imaging technology require a lot of data processing and analysis. In recent years, artificial intelligence technology, especially neural network-based machine learning (ML) technology, has been widely used in MI because of its powerful data processing capability. It provides a feasible strategy to deal with large and complex data for the requirement of MI. In this review, we will focus on the applications of ML methods in OMI and nuclear medical imaging.
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Affiliation(s)
- Lin Yin
- Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Zhen Cao
- Peking University First Hospital, Beijing, China
| | - Kun Wang
- Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Xing Yang
- Peking University First Hospital, Beijing, China
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29
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Shao W, Rowe SP, Du Y. Artificial intelligence in single photon emission computed tomography (SPECT) imaging: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:820. [PMID: 34268433 PMCID: PMC8246162 DOI: 10.21037/atm-20-5988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/08/2021] [Indexed: 12/26/2022]
Abstract
Artificial intelligence (AI) has been widely applied to medical imaging. The use of AI for emission computed tomography, particularly single-photon emission computed tomography (SPECT) emerged nearly 30 years ago but has been accelerated in recent years due to the development of AI technology. In this review, we will describe and discuss the progress of AI technology in SPECT imaging. The applications of AI are dispersed in disease prediction and diagnosis, post-reconstruction image denoising, attenuation map generation, and image reconstruction. These applications are relevant to many disease categories such as the neurological disorders, kidney failure, cancer, heart disease, etc. This review summarizes these applications so that SPECT researchers can have a reference overview of the role of AI in current SPECT studies. For each application, we followed the timeline to present the evolution of AI’s usage and offered insights on how AI was combined with the knowledge of underlying physics as well as traditional non-learning techniques. Ultimately, AI applications are critical to the progress of modern SPECT technology because they provide compensations for many deficiencies in conventional SPECT imaging methods and demonstrate unparalleled success. Nonetheless, AI also has its own challenges and limitations in the medical field, including SPECT imaging. These fundamental questions are discussed, and possible future directions and countermeasures are suggested.
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Affiliation(s)
- Wenyi Shao
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Steven P Rowe
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Yong Du
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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30
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Machine Learning Quantitation of Cardiovascular and Cerebrovascular Disease: A Systematic Review of Clinical Applications. Diagnostics (Basel) 2021; 11:diagnostics11030551. [PMID: 33808677 PMCID: PMC8003459 DOI: 10.3390/diagnostics11030551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
Research into machine learning (ML) for clinical vascular analysis, such as those useful for stroke and coronary artery disease, varies greatly between imaging modalities and vascular regions. Limited accessibility to large diverse patient imaging datasets, as well as a lack of transparency in specific methods, are obstacles to further development. This paper reviews the current status of quantitative vascular ML, identifying advantages and disadvantages common to all imaging modalities. Literature from the past 8 years was systematically collected from MEDLINE® and Scopus database searches in January 2021. Papers satisfying all search criteria, including a minimum of 50 patients, were further analysed and extracted of relevant data, for a total of 47 publications. Current ML image segmentation, disease risk prediction, and pathology quantitation methods have shown sensitivities and specificities over 70%, compared to expert manual analysis or invasive quantitation. Despite this, inconsistencies in methodology and the reporting of results have prevented inter-model comparison, impeding the identification of approaches with the greatest potential. The clinical potential of this technology has been well demonstrated in Computed Tomography of coronary artery disease, but remains practically limited in other modalities and body regions, particularly due to a lack of routine invasive reference measurements and patient datasets.
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Usefulness of an artificial neural network for a beginner to achieve similar interpretations to an expert when examining myocardial perfusion images. Int J Cardiovasc Imaging 2021; 37:2337-2343. [PMID: 33704588 PMCID: PMC8286930 DOI: 10.1007/s10554-021-02209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/01/2021] [Indexed: 11/11/2022]
Abstract
This study examined whether using an artificial neural network (ANN) helps beginners in diagnostic cardiac imaging to achieve similar results to experts when interpreting stress myocardial perfusion imaging (MPI). One hundred and thirty-eight patients underwent stress MPI with Tc-labeled agents. An expert and a beginner interpreted stress/rest MPI with or without the ANN and the results were compared. The myocardium was divided into 5 regions (the apex; septum; anterior; lateral, and inferior regions), and the defect score of myocardial blood flow was evaluated from 0 to 4, and SSS, SRS, and SDS were calculated. The ANN effect, defined as the difference in each of these scores between with and without the ANN, was calculated to investigate the influence of ANN on the interpreters' performance. We classified 2 groups (insignificant perfusion group and significant perfusion group) and compared them. In the same way, classified 2 groups (insignificant ischemia group and significant ischemia group) and compared them. Besides, we classified 2 groups (normal vessels group and multi-vessels group) and compared them. The ANN effect was smaller for the expert than for the beginner. Besides, the ANN effect for insignificant perfusion group, insignificant ischemia group and multi-vessels group were smaller for the expert than for the beginner. On the other hand, the ANN effect for significant perfusion group, significant ischemia group and normal vessels group were no significant. When interpreting MPI, beginners may achieve similar results to experts by using an ANN. Thus, interpreting MPI with ANN may be useful for beginners. Furthermore, when beginners interpret insignificant perfusion group, insignificant ischemia group and multi-vessel group, beginners may achieve similar results to experts by using an ANN.
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Diagnostic accuracy of stress-only myocardial perfusion SPECT improved by deep learning. Eur J Nucl Med Mol Imaging 2021; 48:2793-2800. [PMID: 33511425 DOI: 10.1007/s00259-021-05202-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Deep convolutional neural networks (CNN) for single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has been used to improve the diagnostic accuracy of coronary artery disease (CAD). This study was to design and evaluate a deep learning (DL) approach to automatic diagnosis of myocardial perfusion abnormalities from stress-only MPI. METHODS The new DL approach developed for this study was compared to a conventional quantitative perfusion defect size (DS) method. A total of 37,243 patients (51.5% males) undergone stress 99mTc-Tetrofosmin or 99mTc-Sestamibi MPI were selected retrospectively from Yale New Haven Hospital. Patients were dichotomized as studies with normal (75.4%) or abnormal (24.6%) myocardial perfusion based on final diagnoses of clinical nuclear cardiologists. Stress myocardial perfusion defect size was calculated using Yale quantitative analytic software. A deep CNN was trained using the circumferential count profile maps derived from SPECT MPI and was evaluated for the diagnosis of perfusion abnormality with a 5-fold cross-validation approach. In each fold, 27,933, 1862 and 7448 patients were used as training, validation and testing datasets, respectively. The area under the receiver-operating characteristic curve (AUC) was calculated and analyzed for all patients as well as for the eight sub-groups classified based on patient genders, quantitative algorithms, radioactive tracers and SPECT cameras. RESULTS The AUC value resulted from the DL method was significantly higher than that from the DS method (0.872 ± 0.002 vs. 0.838 ± 0.003, p < 0.01). Across the eight sub-groups, the DL method provided more consistent AUC values in terms of smaller standard deviation and higher diagnostic accuracy and specificity, but slightly lower sensitivity than the DS method (AUC: 0.865 ± 0.010 vs. 0.838 ± 0.019, Accuracy: 82.7% ± 2.5% vs. 78.5% ± 3.6%, Specificity: 84.9% ± 3.7% vs. 77.5% ± 6.5%, Sensitivity: 74.4% ± 4.2% vs. 79.8% ± 5.8%). CONCLUSIONS The incorporation of deep learning for stress-only MPI has a considerable potential to improve the diagnostic accuracy and consistency in the detection of myocardial perfusion abnormalities.
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Assen MV, Vonder M, Pelgrim GJ, Von Knebel Doeberitz PL, Vliegenthart R. Computed tomography for myocardial characterization in ischemic heart disease: a state-of-the-art review. Eur Radiol Exp 2020; 4:36. [PMID: 32548777 PMCID: PMC7297926 DOI: 10.1186/s41747-020-00158-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/30/2020] [Indexed: 12/21/2022] Open
Abstract
This review provides an overview of the currently available computed tomography (CT) techniques for myocardial tissue characterization in ischemic heart disease, including CT perfusion and late iodine enhancement. CT myocardial perfusion imaging can be performed with static and dynamic protocols for the detection of ischemia and infarction using either single- or dual-energy CT modes. Late iodine enhancement may be used for the analysis of myocardial infarction. The accuracy of these CT techniques is highly dependent on the imaging protocol, including acquisition timing and contrast administration. Additionally, the options for qualitative and quantitative analysis and the accuracy of each technique are discussed.
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Affiliation(s)
- M van Assen
- University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 EZ, Groningen, The Netherlands.
| | - M Vonder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G J Pelgrim
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P L Von Knebel Doeberitz
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - R Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Applications of artificial intelligence in multimodality cardiovascular imaging: A state-of-the-art review. Prog Cardiovasc Dis 2020; 63:367-376. [DOI: 10.1016/j.pcad.2020.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 02/06/2023]
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Martin-Isla C, Campello VM, Izquierdo C, Raisi-Estabragh Z, Baeßler B, Petersen SE, Lekadir K. Image-Based Cardiac Diagnosis With Machine Learning: A Review. Front Cardiovasc Med 2020; 7:1. [PMID: 32039241 PMCID: PMC6992607 DOI: 10.3389/fcvm.2020.00001] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/06/2020] [Indexed: 01/28/2023] Open
Abstract
Cardiac imaging plays an important role in the diagnosis of cardiovascular disease (CVD). Until now, its role has been limited to visual and quantitative assessment of cardiac structure and function. However, with the advent of big data and machine learning, new opportunities are emerging to build artificial intelligence tools that will directly assist the clinician in the diagnosis of CVDs. This paper presents a thorough review of recent works in this field and provide the reader with a detailed presentation of the machine learning methods that can be further exploited to enable more automated, precise and early diagnosis of most CVDs.
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Affiliation(s)
- Carlos Martin-Isla
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Victor M Campello
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Cristian Izquierdo
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Zahra Raisi-Estabragh
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Bettina Baeßler
- Department of Diagnostic & Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Karim Lekadir
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
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Lim LJ, Tison GH, Delling FN. Artificial Intelligence in Cardiovascular Imaging. Methodist Debakey Cardiovasc J 2020; 16:138-145. [PMID: 32670474 PMCID: PMC7350824 DOI: 10.14797/mdcj-16-2-138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The number of cardiovascular imaging studies is growing exponentially, and so is the need to improve clinical workflow efficiency and avoid missed diagnoses. With the availability and use of large datasets, artificial intelligence (AI) has the potential to improve patient care at every stage of the imaging chain. Current literature indicates that in the short-term, AI has the capacity to reduce human error and save time in the clinical workflow through automated segmentation of cardiac structures. In the future, AI may expand the informational value of diagnostic images based on images alone or a combination of images and clinical variables, thus facilitating disease detection, prognosis, and decision making. This review describes the role of AI, specifically machine learning, in multimodality imaging, including echocardiography, nuclear imaging, computed tomography, and cardiac magnetic resonance, and highlights current uses of AI as well as potential challenges to its widespread implementation.
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Affiliation(s)
- Lisa J. Lim
- UNIVERSITY OF CALIFORNIA SAN FRANCISCO, SAN FRANCISCO, CALIFORNIA
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Shrestha S, Sengupta PP. Machine learning for nuclear cardiology: The way forward. J Nucl Cardiol 2019; 26:1755-1758. [PMID: 29679221 PMCID: PMC7061628 DOI: 10.1007/s12350-018-1284-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Sirish Shrestha
- WVU Heart & Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506-8059, USA
| | - Partho P Sengupta
- WVU Heart & Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506-8059, USA.
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The primary use of artificial intelligence in cardiovascular diseases: what kind of potential role does artificial intelligence play in future medicine? JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:585-591. [PMID: 31555325 PMCID: PMC6748906 DOI: 10.11909/j.issn.1671-5411.2019.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Currie GM. Intelligent Imaging: Artificial Intelligence Augmented Nuclear Medicine. J Nucl Med Technol 2019; 47:217-222. [DOI: 10.2967/jnmt.119.232462] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022] Open
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Siegersma KR, Leiner T, Chew DP, Appelman Y, Hofstra L, Verjans JW. Artificial intelligence in cardiovascular imaging: state of the art and implications for the imaging cardiologist. Neth Heart J 2019; 27:403-413. [PMID: 31399886 PMCID: PMC6712136 DOI: 10.1007/s12471-019-01311-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Healthcare, conceivably more than any other area of human endeavour, has the greatest potential to be affected by artificial intelligence (AI). This potential has been shown by several reports that demonstrate equal or superhuman performance in medical tasks that aim to improve efficiency, diagnosis and prognosis. This review focuses on the state of the art of AI applications in cardiovascular imaging. It provides an overview of the current applications and studies performed, including the potential value, implications, limitations and future directions of AI in cardiovascular imaging.It is envisioned that AI will dramatically change the way doctors practise medicine. In the short term, it will assist physicians with easy tasks, such as automating measurements, making predictions based on big data, and putting clinical findings into an evidence-based context. In the long term, AI will not only assist doctors, it has the potential to significantly improve access to health and well-being data for patients and their caretakers. This empowers patients. From a physician's perspective, reliable AI assistance will be available to support clinical decision-making. Although cardiovascular studies implementing AI are increasing in number, the applications have only just started to penetrate contemporary clinical care.
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Affiliation(s)
- K R Siegersma
- Department of Cardiology, location VUmc, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,Department of Experimental Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - D P Chew
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Y Appelman
- Department of Cardiology, location VUmc, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - L Hofstra
- Department of Cardiology, location VUmc, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,Cardiologie Centra Nederland, Amsterdam, The Netherlands
| | - J W Verjans
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia. .,Australian Institute for Machine Learning, University of Adelaide, Adelaide, SA, Australia. .,Dept of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Becker A. Artificial intelligence in medicine: What is it doing for us today? HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Artificial Intelligence in Nuclear Cardiology: Adding Value to Prognostication. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9490-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ability of artificial intelligence to diagnose coronary artery stenosis using hybrid images of coronary computed tomography angiography and myocardial perfusion SPECT. Eur J Hybrid Imaging 2019; 3:4. [PMID: 34191159 PMCID: PMC8212308 DOI: 10.1186/s41824-019-0052-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detecting culprit coronary arteries in patients with ischemia using only myocardial perfusion single-photon emission computed tomography (SPECT) can be challenging. This study aimed to improve the detection of culprit regions using an artificial neural network (ANN) to analyze hybrid images of coronary computed tomography angiography (CCTA) and myocardial perfusion SPECT. METHODS This study enrolled 59 patients with stable coronary artery disease (CAD) who had been assessed by coronary angiography within 60 days of myocardial perfusion SPECT. Two nuclear medicine physicians interpreted the myocardial perfusion SPECT and hybrid images with four grades of confidence, then drew regions on polar maps to identify culprit coronary arteries. The gold standard was determined by the consensus of two other nuclear cardiology specialist based on coronary angiography findings and clinical information. The ability to detect culprit coronary arteries was compared among experienced nuclear cardiologists and the ANN. Receiver operating characteristics (ROC) curves were analyzed and areas under the ROC curves (AUC) were determined. RESULTS Using hybrid images, observer A detected CAD in the right (RCA), left anterior descending (LAD), and left circumflex (LCX) coronary arteries with 83.6%, 89.3%, and 94.4% accuracy, respectively and observer B did so with 72.9%, 84.2%, and 89.3%, respectively. The ANN was 79.1%, 89.8%, and 89.3% accurate for each coronary artery. Diagnostic accuracy was comparable between the ANN and experienced nuclear medicine physicians. The AUC was significantly improved using hybrid images in the RCA region (observer A: from 0.715 to 0.835, p = 0.0031; observer B: from 0.771 to 0.843, p = 0.042). To detect culprit coronary arteries in perfusion defects of the inferior wall without using hybrid images was problematic because the perfused areas of the LCX and RCA varied among individuals. CONCLUSIONS Hybrid images of CCTA and myocardial perfusion SPECT are useful for detecting culprit coronary arteries. Diagnoses using artificial intelligence are comparable to that by nuclear medicine physicians.
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Juarez-Orozco LE, Martinez-Manzanera O, Storti AE, Knuuti J. Machine Learning in the Evaluation of Myocardial Ischemia Through Nuclear Cardiology. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9480-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shibutani T, Nakajima K, Wakabayashi H, Mori H, Matsuo S, Yoneyama H, Konishi T, Okuda K, Onoguchi M, Kinuya S. Accuracy of an artificial neural network for detecting a regional abnormality in myocardial perfusion SPECT. Ann Nucl Med 2018; 33:86-92. [DOI: 10.1007/s12149-018-1306-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
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Abstract
Purpose An artificial neural network (ANN) has been applied to detect myocardial perfusion defects and ischemia. The present study compares the diagnostic accuracy of a more recent ANN version (1.1) with the initial version 1.0. Methods We examined 106 patients (age, 77 ± 10 years) with coronary angiographic findings, comprising multi-vessel disease (≥ 50% stenosis) (52%) or old myocardial infarction (27%), or who had undergone coronary revascularization (30%). The ANN versions 1.0 and 1.1 were trained in Sweden (n = 1051) and Japan (n = 1001), respectively, using 99mTc-methoxyisobutylisonitrile myocardial perfusion images. The ANN probabilities (from 0.0 to 1.0) of stress defects and ischemia were calculated in candidate regions of abnormalities. The diagnostic accuracy was compared using receiver-operating characteristics (ROC) analysis and the calculated area under the ROC curve (AUC) using expert interpretation as the gold standard. Results Although the AUC for stress defects was 0.95 and 0.93 (p = 0.27) for versions 1.1 and 1.0, respectively, that for detecting ischemia was significantly improved in version 1.1 (p = 0.0055): AUC 0.96 for version 1.1 (sensitivity 87%, specificity 96%) vs. 0.89 for version 1.0 (sensitivity 78%, specificity 97%). The improvement in the AUC shown by version 1.1 was also significant for patients with neither coronary revascularization nor old myocardial infarction (p = 0.0093): AUC = 0.98 for version 1.1 (sensitivity 88%, specificity 100%) and 0.88 for version 1.0 (sensitivity 76%, specificity 100%). Intermediate ANN probability between 0.1 and 0.7 was more often calculated by version 1.1 compared with version 1.0, which contributed to the improved diagnostic accuracy. The diagnostic accuracy of the new version was also improved in patients with either single-vessel disease or no stenosis (n = 47; AUC, 0.81 vs. 0.66 vs. p = 0.0060) when coronary stenosis was used as a gold standard. Conclusion The diagnostic ability of the ANN version 1.1 was improved by retraining using the Japanese database, particularly for identifying ischemia.
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