Differentiation of eosinophilic and non-eosinophilic chronic rhinosinusitis on preoperative computed tomography using deep learning

Artificial intelligence optimizes the standardized diagnosis and treatment of chronic sinusitis

Background

Standardised management of chronic sinusitis (CRS) is a challenging but vital area of research. Not only is accurate diagnosis and individualised treatment plans required, but post-treatment chronic disease management is also indispensable. With the development of artificial intelligence (AI), more "AI + medical" application models are emerging. Many AI-assisted systems have been applied to the diagnosis and treatment of CRS, providing valuable solutions for clinical practice.

Objective

This study summarises the research progress of various AI-assisted systems applied to the clinical diagnosis and treatment of CRS, focusing on their role in imaging and pathological diagnosis and prognostic prediction and treatment.

Methods

We used PubMed, Web of Science, and other Internet search engines with "artificial intelligence"、"machine learning" and "chronic sinusitis" as the keywords to conduct a literature search for studies from the last 7 years. We included literature eligible for AI application to CRS diagnosis and treatment in our study, excluded literature outside this scope, and categorized it according to its clinical application to CRS diagnosis, treatment, and prognosis prediction. We provide an overview and summary of current advances in AI to optimize the diagnosis and treatment of CRS, as well as difficulties and challenges in promoting standardization of clinical diagnosis and treatment in this area.

Results

Through applications in CRS imaging and pathology diagnosis, personalised medicine and prognosis prediction, AI can significantly reduce turnaround times, lower diagnostic costs and accurately predict disease outcomes. However, a number of challenges remain. These include a lack of AI product standards, standardised data, difficulties in collaboration between different healthcare providers, and the non-interpretability of AI systems. There may also be data privacy issues involved. Therefore, more research and improvements are needed to realise the full potential of AI in the diagnosis and treatment of CRS.

Conclusion

Our findings inform the clinical diagnosis and treatment of CRS and the development of AI-assisted clinical diagnosis and treatment systems. We provide recommendations for AI to drive standardisation of CRS diagnosis and treatment.

Artificial intelligence in otorhinolaryngology: current trends and application areas

PURPOSE

This study aims to perform a bibliometric analysis of scientific research on the use of artificial intelligence (AI) in the field of Otorhinolaryngology (ORL), with a specific focus on identifying emerging AI trend topics within this discipline.

METHODS

A total of 498 articles on AI in ORL, published between 1982 and 2024, were retrieved from the Web of Science database. Various bibliometric techniques, including trend keyword analysis and factor analysis, were applied to analyze the data.

RESULTS

The most prolific journal was the European Archives of Oto-Rhino-Laryngology (n = 67). The USA (n = 200) and China (n = 61) were the most productive countries in AI-related ORL research. The most productive institutions were Harvard University / Harvard Medical School (n = 71). The leading authors in this field were Lechien JR. (n = 18) and Rameau A. (n = 17). The most frequently used keywords in the AI research were cochlear implant, head and neck cancer, magnetic resonance imaging (MRI), hearing loss, patient education, diagnosis, radiomics, surgery, hearing aids, laryngology ve otitis media. Recent trends in otorhinolaryngology research reflect a dynamic focus, progressing from hearing-related technologies such as hearing aids and cochlear implants in earlier years, to diagnostic innovations like audiometry, psychoacoustics, and narrow band imaging. The emphasis has recently shifted toward advanced applications of MRI, radiomics, and computed tomography (CT) for conditions such as head and neck cancer, chronic rhinosinusitis, laryngology, and otitis media. Additionally, increasing attention has been given to patient education, quality of life, and prognosis, underscoring a holistic approach to diagnosis, surgery, and treatment in otorhinolaryngology.

CONCLUSION

AI has significantly impacted the field of ORL, especially in diagnostic imaging and therapeutic planning. With advancements in MRI and CT-based technologies, AI has proven to enhance disease detection and management. The future of AI in ORL suggests a promising path toward improving clinical decision-making, patient care, and healthcare efficiency.

A preliminary review of the utility of artificial intelligence to detect eosinophilic chronic rhinosinusitis

KEY POINTS

While typically diagnosed with biopsy, ECRS may be predicted preoperatively with the use of AI. Various AI models have been used, with pooled sensitivity of 0.857 and specificity of 0.850. We found no statistically significant difference between the accuracy of various AI models.

A multi-view fusion lightweight network for CRSwNPs prediction on CT images

Accurate preoperative differentiation of the chronic rhinosinusitis (CRS) endotype between eosinophilic CRS (eCRS) and non-eosinophilic CRS (non-eCRS) is an important topic in predicting postoperative outcomes and administering personalized treatment. To this end, we have constructed a sinus CT dataset, which comprises CT scan data and pathological biopsy results from 192 patients of chronic rhinosinusitis with nasal polyps (CRSwNP), treated at the Second Affiliated Hospital of Shantou University Medical College between 2020 and 2022. To differentiate CRSwNP endotype on preoperative CT and improve efficiency at the same time, we developed a multi-view fusion model that contains a mini-architecture with each network of 10 layers by modifying the deep residual neural network. The proposed model is trained on a training set and evaluated on a test set. The multi-view deep learning fusion model achieved the area under the receiver-operating characteristics curve (AUC) of 0.991, accuracy of 0.965 and F1-Score of 0.970 in test set. We compared the performance of the mini-architecture with other lightweight networks on the same Sinus CT dataset. The experimental results demonstrate that the developed ResMini architecture contribute to competitive CRSwNP endotype identification modeling in terms of accuracy and parameter number.

Deep learning in computed tomography to predict endotype in chronic rhinosinusitis with nasal polyps

BACKGROUND

As treatment strategies differ according to endotype, rhinologists must accurately determine the endotype in patients affected by chronic rhinosinusitis with nasal polyps (CRSwNP) for the appropriate management. In this study, we aim to construct a novel deep learning model using paranasal sinus computed tomography (CT) to predict the endotype in patients with CRSwNP.

METHODS

We included patients diagnosed with CRSwNP between January 1, 2020, and April 31, 2023. The endotype of patients with CRSwNP in this study was classified as eosinophilic or non-eosinophilic. Sinus CT images (29,993 images) were retrospectively collected, including the axial, coronal, and sagittal planes, and randomly divided into training, validation, and testing sets. A residual network-18 was used to construct the deep learning model based on these images. Loss functions, accuracy functions, confusion matrices, and receiver operating characteristic curves were used to assess the predictive performance of the model. Gradient-weighted class activation mapping was performed to visualize and interpret the operating principles of the model.

RESULTS

Among 251 included patients, 86 and 165 had eosinophilic or non-eosinophilic CRSwNP, respectively. The median (interquartile range) patient age was 49 years (37-58 years), and 153 (61.0%) were male. The deep learning model showed good discriminative performance in the training and validation sets, with areas under the curves of 0.993 and 0.966, respectively. To confirm the model generalizability, the receiver operating characteristic curve in the testing set showed good discriminative performance, with an area under the curve of 0.963. The Kappa scores of the confusion matrices in the training, validation, and testing sets were 0.985, 0.928, and 0.922, respectively. Finally, the constructed deep learning model was used to predict the endotype of all patients, resulting in an area under the curve of 0.962.

CONCLUSIONS

The deep learning model developed in this study may provide a novel noninvasive method for rhinologists to evaluate endotypes in patients with CRSwNP and help develop precise treatment strategies.

Deep Learning Techniques and Imaging in Otorhinolaryngology-A State-of-the-Art Review

Over the last decades, the field of medicine has witnessed significant progress in artificial intelligence (AI), the Internet of Medical Things (IoMT), and deep learning (DL) systems. Otorhinolaryngology, and imaging in its various subspecialties, has not remained untouched by this transformative trend. As the medical landscape evolves, the integration of these technologies becomes imperative in augmenting patient care, fostering innovation, and actively participating in the ever-evolving synergy between computer vision techniques in otorhinolaryngology and AI. To that end, we conducted a thorough search on MEDLINE for papers published until June 2023, utilizing the keywords 'otorhinolaryngology', 'imaging', 'computer vision', 'artificial intelligence', and 'deep learning', and at the same time conducted manual searching in the references section of the articles included in our manuscript. Our search culminated in the retrieval of 121 related articles, which were subsequently subdivided into the following categories: imaging in head and neck, otology, and rhinology. Our objective is to provide a comprehensive introduction to this burgeoning field, tailored for both experienced specialists and aspiring residents in the domain of deep learning algorithms in imaging techniques in otorhinolaryngology.

Advances in Image-Based Artificial Intelligence in Otorhinolaryngology-Head and Neck Surgery: A Systematic Review

OBJECTIVE

To update the literature and provide a systematic review of image-based artificial intelligence (AI) applications in otolaryngology, highlight its advances, and propose future challenges.

DATA SOURCES

Web of Science, Embase, PubMed, and Cochrane Library.

REVIEW METHODS

Studies written in English, published between January 2020 and December 2022. Two independent authors screened the search results, extracted data, and assessed studies.

RESULTS

Overall, 686 studies were identified. After screening titles and abstracts, 325 full-text studies were assessed for eligibility, and 78 studies were included in this systematic review. The studies originated from 16 countries. Among these countries, the top 3 were China (n = 29), Korea (n = 8), the United States, and Japan (n = 7 each). The most common area was otology (n = 35), followed by rhinology (n = 20), pharyngology (n = 18), and head and neck surgery (n = 5). Most applications of AI in otology, rhinology, pharyngology, and head and neck surgery mainly included chronic otitis media (n = 9), nasal polyps (n = 4), laryngeal cancer (n = 12), and head and neck squamous cell carcinoma (n = 3), respectively. The overall performance of AI in accuracy, the area under the curve, sensitivity, and specificity were 88.39 ± 9.78%, 91.91 ± 6.70%, 86.93 ± 11.59%, and 88.62 ± 14.03%, respectively.

CONCLUSION

This state-of-the-art review aimed to highlight the increasing applications of image-based AI in otorhinolaryngology head and neck surgery. The following steps will entail multicentre collaboration to ensure data reliability, ongoing optimization of AI algorithms, and integration into real-world clinical practice. Future studies should consider 3-dimensional (3D)-based AI, such as 3D surgical AI.