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Patel NJ, D'Silva KM, Li MD, Hsu TY, DiIorio M, Fu X, Cook C, Prisco L, Martin L, Vanni KM, Zaccardelli A, Zhang Y, Kalpathy‐Cramer J, Sparks JA, Wallace ZS. Assessing the Severity of COVID-19 Lung Injury in Rheumatic Diseases Versus the General Population Using Deep Learning-Derived Chest Radiograph Scores. Arthritis Care Res (Hoboken) 2022; 75:657-666. [PMID: 35313091 PMCID: PMC9081965 DOI: 10.1002/acr.24883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE COVID-19 patients with rheumatic disease have a higher risk of mechanical ventilation than the general population. The present study was undertaken to assess lung involvement using a validated deep learning algorithm that extracts a quantitative measure of radiographic lung disease severity. METHODS We performed a comparative cohort study of rheumatic disease patients with COVID-19 and ≥1 chest radiograph within ±2 weeks of COVID-19 diagnosis and matched comparators. We used unadjusted and adjusted (for age, Charlson comorbidity index, and interstitial lung disease) quantile regression to compare the maximum pulmonary x-ray severity (PXS) score at the 10th to 90th percentiles between groups. We evaluated the association of severe PXS score (>9) with mechanical ventilation and death using Cox regression. RESULTS We identified 70 patients with rheumatic disease and 463 general population comparators. Maximum PXS scores were similar in the rheumatic disease patients and comparators at the 10th to 60th percentiles but significantly higher among rheumatic disease patients at the 70th to 90th percentiles (90th percentile score of 10.2 versus 9.2; adjusted P = 0.03). Rheumatic disease patients were more likely to have a PXS score of >9 (20% versus 11%; P = 0.02), indicating severe pulmonary disease. Rheumatic disease patients with PXS scores >9 versus ≤9 had higher risk of mechanical ventilation (hazard ratio [HR] 24.1 [95% confidence interval (95% CI) 6.7, 86.9]) and death (HR 8.2 [95% CI 0.7, 90.4]). CONCLUSION Rheumatic disease patients with COVID-19 had more severe radiographic lung involvement than comparators. Higher PXS scores were associated with mechanical ventilation and will be important for future studies leveraging big data to assess COVID-19 outcomes in rheumatic disease patients.
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Affiliation(s)
- Naomi J. Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA
| | - Kristin M. D'Silva
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Matthew D. Li
- Department of Radiology, Massachusetts General HospitalBostonMAUSA
| | - Tiffany Y‐T. Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Michael DiIorio
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Claire Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Lauren Prisco
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Lily Martin
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Kathleen M.M. Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Alessandra Zaccardelli
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | | | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
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4
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Signoroni A, Savardi M, Benini S, Adami N, Leonardi R, Gibellini P, Vaccher F, Ravanelli M, Borghesi A, Maroldi R, Farina D. BS-Net: Learning COVID-19 pneumonia severity on a large chest X-ray dataset. Med Image Anal 2021; 71:102046. [PMID: 33862337 PMCID: PMC8010334 DOI: 10.1016/j.media.2021.102046] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/04/2021] [Accepted: 03/17/2021] [Indexed: 12/22/2022]
Abstract
In this work we design an end-to-end deep learning architecture for predicting, on Chest X-rays images (CXR), a multi-regional score conveying the degree of lung compromise in COVID-19 patients. Such semi-quantitative scoring system, namely Brixia score, is applied in serial monitoring of such patients, showing significant prognostic value, in one of the hospitals that experienced one of the highest pandemic peaks in Italy. To solve such a challenging visual task, we adopt a weakly supervised learning strategy structured to handle different tasks (segmentation, spatial alignment, and score estimation) trained with a “from-the-part-to-the-whole” procedure involving different datasets. In particular, we exploit a clinical dataset of almost 5,000 CXR annotated images collected in the same hospital. Our BS-Net demonstrates self-attentive behavior and a high degree of accuracy in all processing stages. Through inter-rater agreement tests and a gold standard comparison, we show that our solution outperforms single human annotators in rating accuracy and consistency, thus supporting the possibility of using this tool in contexts of computer-assisted monitoring. Highly resolved (super-pixel level) explainability maps are also generated, with an original technique, to visually help the understanding of the network activity on the lung areas. We also consider other scores proposed in literature and provide a comparison with a recently proposed non-specific approach. We eventually test the performance robustness of our model on an assorted public COVID-19 dataset, for which we also provide Brixia score annotations, observing good direct generalization and fine-tuning capabilities that highlight the portability of BS-Net in other clinical settings. The CXR dataset along with the source code and the trained model are publicly released for research purposes.
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Affiliation(s)
- Alberto Signoroni
- Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Mattia Savardi
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Sergio Benini
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Nicola Adami
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Riccardo Leonardi
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Paolo Gibellini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Filippo Vaccher
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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6
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Lang M, Li MD, Jiang KZ, Yoon BC, Mendoza DP, Flores EJ, Rincon SP, Mehan WA, Conklin J, Huang SY, Lang AL, Giao DM, Leslie-Mazwi TM, Kalpathy-Cramer J, Little BP, Buch K. Severity of Chest Imaging is Correlated with Risk of Acute Neuroimaging Findings among Patients with COVID-19. AJNR Am J Neuroradiol 2021; 42:831-837. [PMID: 33541897 DOI: 10.3174/ajnr.a7032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Severe respiratory distress in patients with COVID-19 has been associated with higher rate of neurologic manifestations. Our aim was to investigate whether the severity of chest imaging findings among patients with coronavirus disease 2019 (COVID-19) correlates with the risk of acute neuroimaging findings. MATERIALS AND METHODS This retrospective study included all patients with COVID-19 who received care at our hospital between March 3, 2020, and May 6, 2020, and underwent chest imaging within 10 days of neuroimaging. Chest radiographs were assessed using a previously validated automated neural network algorithm for COVID-19 (Pulmonary X-ray Severity score). Chest CTs were graded using a Chest CT Severity scoring system based on involvement of each lobe. Associations between chest imaging severity scores and acute neuroimaging findings were assessed using multivariable logistic regression. RESULTS Twenty-four of 93 patients (26%) included in the study had positive acute neuroimaging findings, including intracranial hemorrhage (n = 7), infarction (n = 7), leukoencephalopathy (n = 6), or a combination of findings (n = 4). The average length of hospitalization, prevalence of intensive care unit admission, and proportion of patients requiring intubation were significantly greater in patients with acute neuroimaging findings than in patients without them (P < .05 for all). Compared with patients without acute neuroimaging findings, patients with acute neuroimaging findings had significantly higher mean Pulmonary X-ray Severity scores (5.0 [SD, 2.9] versus 9.2 [SD, 3.4], P < .001) and mean Chest CT Severity scores (9.0 [SD, 5.1] versus 12.1 [SD, 5.0], P = .041). The pulmonary x-ray severity score was a significant predictor of acute neuroimaging findings in patients with COVID-19. CONCLUSIONS Patients with COVID-19 and acute neuroimaging findings had more severe findings on chest imaging on both radiographs and CT compared with patients with COVID-19 without acute neuroimaging findings. The severity of findings on chest radiography was a strong predictor of acute neuroimaging findings in patients with COVID-19.
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Affiliation(s)
- M Lang
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M D Li
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Z Jiang
- School of Medicine (K.Z.J.), Baylor College of Medicine, Houston, Texas
| | - B C Yoon
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D P Mendoza
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - E J Flores
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S P Rincon
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - W A Mehan
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - J Conklin
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Y Huang
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A L Lang
- Department of Anesthesia, Critical Care, and Pain Medicine (A.L.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D M Giao
- Harvard Medical School (D.M.G.), Boston, Massachusetts
| | | | - J Kalpathy-Cramer
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - B P Little
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Buch
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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