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Yetiş M, Kocaman H, Canlı M, Yıldırım H, Yetiş A, Ceylan İ. Carpal tunnel syndrome prediction with machine learning algorithms using anthropometric and strength-based measurement. PLoS One 2024; 19:e0300044. [PMID: 38630703 PMCID: PMC11023568 DOI: 10.1371/journal.pone.0300044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES Carpal tunnel syndrome (CTS) stands as the most prevalent upper extremity entrapment neuropathy, with a multifaceted etiology encompassing various risk factors. This study aimed to investigate whether anthropometric measurements of the hand, grip strength, and pinch strength could serve as predictive indicators for CTS through machine learning techniques. METHODS Enrollment encompassed patients exhibiting CTS symptoms (n = 56) and asymptomatic healthy controls (n = 56), with confirmation via electrophysiological assessments. Anthropometric measurements of the hand were obtained using a digital caliper, grip strength was gauged via a digital handgrip dynamometer, and pinch strengths were assessed using a pinchmeter. A comprehensive analysis was conducted employing four most common and effective machine learning algorithms, integrating thorough parameter tuning and cross-validation procedures. Additionally, the outcomes of variable importance were presented. RESULTS Among the diverse algorithms, Random Forests (accuracy of 89.474%, F1-score of 0.905, and kappa value of 0.789) and XGBoost (accuracy of 86.842%, F1-score of 0.878, and kappa value of 0.736) emerged as the top-performing choices based on distinct classification metrics. In addition, using variable importance calculations specific to these models, the most important variables were found to be wrist circumference, hand width, hand grip strength, tip pinch, key pinch, and middle finger length. CONCLUSION The findings of this study demonstrated that wrist circumference, hand width, hand grip strength, tip pinch, key pinch, and middle finger length can be utilized as reliable indicators of CTS. Also, the model developed herein, along with the identified crucial variables, could serve as an informative guide for healthcare professionals, enhancing precision and efficacy in CTS prediction.
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Affiliation(s)
- Mehmet Yetiş
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hikmet Kocaman
- Department of Physiotherapy and Rehabilitation / Prosthetics-Orthotics Physiotherapy, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Mehmet Canlı
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hasan Yıldırım
- Department of Mathematics, Faculty of Kamil Özdağ Science, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Aysu Yetiş
- Department of Neurology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Ceylan
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Cipolletta E, Fiorentino MC, Vreju FA, Moccia S, Filippucci E. Editorial: Artificial intelligence in rheumatology and musculoskeletal diseases. Front Med (Lausanne) 2024; 11:1402871. [PMID: 38646556 PMCID: PMC11026684 DOI: 10.3389/fmed.2024.1402871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | | | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Sara Moccia
- Department of Excellence in Robotics and AI, The Biorobotics Institute, Scuola Superiore Sant'anna, Pisa, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Stoel BC, Staring M, Reijnierse M, van der Helm-van Mil AHM. Deep learning in rheumatological image interpretation. Nat Rev Rheumatol 2024; 20:182-195. [PMID: 38332242 DOI: 10.1038/s41584-023-01074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/10/2024]
Abstract
Artificial intelligence techniques, specifically deep learning, have already affected daily life in a wide range of areas. Likewise, initial applications have been explored in rheumatology. Deep learning might not easily surpass the accuracy of classic techniques when performing classification or regression on low-dimensional numerical data. With images as input, however, deep learning has become so successful that it has already outperformed the majority of conventional image-processing techniques developed during the past 50 years. As with any new imaging technology, rheumatologists and radiologists need to consider adapting their arsenal of diagnostic, prognostic and monitoring tools, and even their clinical role and collaborations. This adaptation requires a basic understanding of the technical background of deep learning, to efficiently utilize its benefits but also to recognize its drawbacks and pitfalls, as blindly relying on deep learning might be at odds with its capabilities. To facilitate such an understanding, it is necessary to provide an overview of deep-learning techniques for automatic image analysis in detecting, quantifying, predicting and monitoring rheumatic diseases, and of currently published deep-learning applications in radiological imaging for rheumatology, with critical assessment of possible limitations, errors and confounders, and conceivable consequences for rheumatologists and radiologists in clinical practice.
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Affiliation(s)
- Berend C Stoel
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Marius Staring
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Taha MA, Morren JA. The role of artificial intelligence in electrodiagnostic and neuromuscular medicine: Current state and future directions. Muscle Nerve 2024; 69:260-272. [PMID: 38151482 DOI: 10.1002/mus.28023] [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: 09/07/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/29/2023]
Abstract
The rapid advancements in artificial intelligence (AI), including machine learning (ML), and deep learning (DL) have ushered in a new era of technological breakthroughs in healthcare. These technologies are revolutionizing the way we utilize medical data, enabling improved disease classification, more precise diagnoses, better treatment selection, therapeutic monitoring, and highly accurate prognostication. Different ML and DL models have been used to distinguish between electromyography signals in normal individuals and those with amyotrophic lateral sclerosis and myopathy, with accuracy ranging from 67% to 99.5%. DL models have also been successfully applied in neuromuscular ultrasound, with the use of segmentation techniques achieving diagnostic accuracy of at least 90% for nerve entrapment disorders, and 87% for inflammatory myopathies. Other successful AI applications include prediction of treatment response, and prognostication including prediction of intensive care unit admissions for patients with myasthenia gravis. Despite these remarkable strides, significant knowledge, attitude, and practice gaps persist, including within the field of electrodiagnostic and neuromuscular medicine. In this narrative review, we highlight the fundamental principles of AI and draw parallels with the intricacies of human brain networks. Specifically, we explore the immense potential that AI holds for applications in electrodiagnostic studies, neuromuscular ultrasound, and other aspects of neuromuscular medicine. While there are exciting possibilities for the future, it is essential to acknowledge and understand the limitations of AI and take proactive steps to mitigate these challenges. This collective endeavor holds immense potential for the advancement of healthcare through the strategic and responsible integration of AI technologies.
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Affiliation(s)
- Mohamed A Taha
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John A Morren
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Peng J, Zeng J, Lai M, Huang R, Ni D, Li Z. One-Stop Automated Diagnostic System for Carpal Tunnel Syndrome in Ultrasound Images Using Deep Learning. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:304-314. [PMID: 38044200 DOI: 10.1016/j.ultrasmedbio.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/23/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Ultrasound (US) examination has unique advantages in diagnosing carpal tunnel syndrome (CTS), although identification of the median nerve (MN) and diagnosis of CTS depend heavily on the expertise of examiners. In the aim of alleviating this problem, we developed a one-stop automated CTS diagnosis system (OSA-CTSD) and evaluated its effectiveness as a computer-aided diagnostic tool. METHODS We combined real-time MN delineation, accurate biometric measurements and explainable CTS diagnosis into a unified framework, called OSA-CTSD. We then collected a total of 32,301 static images from US videos of 90 normal wrists and 40 CTS wrists for evaluation using a simplified scanning protocol. RESULTS The proposed model exhibited better segmentation and measurement performance than competing methods, with a Hausdorff distance (95th percentile) score of 7.21 px, average symmetric surface distance score of 2.64 px, Dice score of 85.78% and intersection over union score of 76.00%. In the reader study, it exhibited performance comparable to the average performance of experienced radiologists in classifying CTS and outperformed inexperienced radiologists in terms of classification metrics (e.g., accuracy score 3.59% higher and F1 score 5.85% higher). CONCLUSION Diagnostic performance of the OSA-CTSD was promising, with the advantages of real-time delineation, automation and clinical interpretability. The application of such a tool not only reduces reliance on the expertise of examiners but also can help to promote future standardization of the CTS diagnostic process, benefiting both patients and radiologists.
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Affiliation(s)
- Jiayu Peng
- Department of Ultrasound, Second People's Hospital of Shenzhen, First Affiliated Hospital of Shenzhen University, Shenzhen, China; Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China
| | - Jiajun Zeng
- Guangdong Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China; Medical Ultrasound Image Computing (MUSIC) Lab, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Manlin Lai
- Ultrasound Division, Department of Medical Imaging, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ruobing Huang
- Guangdong Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China; Medical Ultrasound Image Computing (MUSIC) Lab, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Dong Ni
- Guangdong Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China; Medical Ultrasound Image Computing (MUSIC) Lab, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Zhenzhou Li
- Department of Ultrasound, Second People's Hospital of Shenzhen, First Affiliated Hospital of Shenzhen University, Shenzhen, China; Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China.
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Phatak S, Chakraborty S, Goel P. Computer vision detects inflammatory arthritis in standardized smartphone photographs in an Indian patient cohort. Front Med (Lausanne) 2023; 10:1280462. [PMID: 38020147 PMCID: PMC10666644 DOI: 10.3389/fmed.2023.1280462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Computer vision extracts meaning from pixelated images and holds promise in automating various clinical tasks. Convolutional neural networks (CNNs), a deep learning network used therein, have shown promise in analyzing X-ray images and joint photographs. We studied the performance of a CNN on standardized smartphone photographs in detecting inflammation in three hand joints and compared it to a rheumatologist's diagnosis. Methods We enrolled 100 consecutive patients with inflammatory arthritis with an onset period of less than 2 years, excluding those with deformities. Each patient was examined by a rheumatologist, and the presence of synovitis in each joint was recorded. Hand photographs were taken in a standardized manner, anonymized, and cropped to include joints of interest. A ResNet-101 backbone modified for two class outputs (inflamed or not) was used for training. We also tested a hue-augmented dataset. We reported accuracy, sensitivity, and specificity for three joints: wrist, index finger proximal interphalangeal (IFPIP), and middle finger proximal interphalangeal (MFPIP), taking the rheumatologist's opinion as the gold standard. Results The cohort consisted of 100 individuals, of which 22 of them were men, with a mean age of 49.7 (SD 12.9) years. The majority of the cohort (n = 68, 68%) had rheumatoid arthritis. The wrist (125/200, 62.5%), MFPIP (94/200, 47%), and IFPIP (83/200, 41.5%) were the three most commonly inflamed joints. The CNN achieved the highest accuracy, sensitivity, and specificity in detecting synovitis in the MFPIP (83, 77, and 88%, respectively), followed by the IFPIP (74, 74, and 75%, respectively) and the wrist (62, 90, and 21%, respectively). Discussion We have demonstrated that computer vision was able to detect inflammation in three joints of the hand with reasonable accuracy on standardized photographs despite a small dataset. Feature engineering was not required, and the CNN worked despite a diversity in clinical diagnosis. Larger datasets are likely to improve accuracy and help explain the basis of classification. These data suggest a potential use of computer vision in screening and follow-up of inflammatory arthritis.
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Affiliation(s)
| | | | - Pranay Goel
- Indian Institute of Science, Education and Research, Pune, India
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Elseddik M, Alnowaiser K, Mostafa RR, Elashry A, El-Rashidy N, Elgamal S, Aboelfetouh A, El-Bakry H. Deep Learning-Based Approaches for Enhanced Diagnosis and Comprehensive Understanding of Carpal Tunnel Syndrome. Diagnostics (Basel) 2023; 13:3211. [PMID: 37892032 PMCID: PMC10606231 DOI: 10.3390/diagnostics13203211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a prevalent medical condition resulting from compression of the median nerve in the hand, often caused by overuse or age-related factors. In this study, a total of 160 patients participated, including 80 individuals with CTS presenting varying levels of severity across different age groups. Numerous studies have explored the use of machine learning (ML) and deep learning (DL) techniques for CTS diagnosis. However, further research is required to fully leverage the potential of artificial intelligence (AI) technology in CTS diagnosis, addressing the challenges and limitations highlighted in the existing literature. In our work, we propose a novel approach for CTS diagnosis, prediction, and monitoring disease progression. The proposed framework consists of three main layers. Firstly, we employ three distinct DL models for CTS diagnosis. Through our experiments, the proposed approach demonstrates superior performance across multiple evaluation metrics, with an accuracy of 0.969%, precision of 0.982%, and recall of 0.963%. The second layer focuses on predicting the cross-sectional area (CSA) at 1, 3, and 6 months using ML models, aiming to forecast disease progression during therapy. The best-performing model achieves an accuracy of 0.9522, an R2 score of 0.667, a mean absolute error (MAE) of 0.0132, and a median squared error (MdSE) of 0.0639. The highest predictive performance is observed after 6 months. The third layer concentrates on assessing significant changes in the patients' health status through statistical tests, including significance tests, the Kruskal-Wallis test, and a two-way ANOVA test. These tests aim to determine the effect of injections on CTS treatment. The results reveal a highly significant reduction in symptoms, as evidenced by scores from the Symptom Severity Scale and Functional Status Scale, as well as a decrease in CSA after 1, 3, and 6 months following the injection. SHAP is then utilized to provide an understandable explanation of the final prediction. Overall, our study presents a comprehensive approach for CTS diagnosis, prediction, and monitoring, showcasing promising results in terms of accuracy, precision, and recall for CTS diagnosis, as well as effective prediction of disease progression and evaluation of treatment effectiveness through statistical analysis.
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Affiliation(s)
- Marwa Elseddik
- Department of the Robotics and Internet Machines, Faculty of Artificial Intelligence, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
| | - Khaled Alnowaiser
- College of Computer Engineering and Sciences, Prince Sattam bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
| | - Reham R Mostafa
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
- Research Institute of Sciences and Engineering (RISE), University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ahmed Elashry
- Department of Information Systems, Faculty of Computers and Information, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Nora El-Rashidy
- Department of Machine Learning and Information Retrieval, Faculty of Artificial Intelligence, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Shimaa Elgamal
- Department of Neuropsychiatry, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Ahmed Aboelfetouh
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
- Delta Higher Institute for Management and Accounting Information Systems, Mansoura 35511, Egypt
| | - Hazem El-Bakry
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
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Mohammadi A, Torres-Cuenca T, Mirza-Aghazadeh-Attari M, Faeghi F, Acharya UR, Abbasian Ardakani A. Deep Radiomics Features of Median Nerves for Automated Diagnosis of Carpal Tunnel Syndrome With Ultrasound Images: A Multi-Center Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2257-2268. [PMID: 37159483 DOI: 10.1002/jum.16244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/18/2023] [Accepted: 04/16/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Ultrasound is widely used in diagnosing carpal tunnel syndrome (CTS). However, the limitations of ultrasound in CTS detection are the lack of objective measures in the detection of nerve abnormality and the operator-dependent nature of ultrasound imaging. Therefore, in this study, we developed and proposed externally validated artificial intelligence (AI) models based on deep-radiomics features. METHODS We have used 416 median nerves from 2 countries (Iran and Colombia) for the development (112 entrapped and 112 normal nerves from Iran) and validation (26 entrapped and 26 normal nerves from Iran, and 70 entrapped and 70 normal nerves from Columbia) of our models. Ultrasound images were fed to the SqueezNet architecture to extract deep-radiomics features. Then a ReliefF method was used to select the clinically significant features. The selected deep-radiomics features were fed to 9 common machine-learning algorithms to choose the best-performing classifier. The 2 best-performing AI models were then externally validated. RESULTS Our developed model achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.910 (88.46% sensitivity, 88.46% specificity) and 0.908 (84.62% sensitivity, 88.46% specificity) with support vector machine and stochastic gradient descent (SGD), respectively using the internal validation dataset. Furthermore, both models consistently performed well in the external validation dataset, and achieved an AUC of 0.890 (85.71% sensitivity, 82.86% specificity) and 0.890 (84.29% sensitivity and 82.86% specificity), with SVM and SGD models, respectively. CONCLUSION Our proposed AI models fed with deep-radiomics features performed consistently with internal and external datasets. This justifies that our proposed system can be employed for clinical use in hospitals and polyclinics.
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Affiliation(s)
- Afshin Mohammadi
- Department of Radiology, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran
| | - Thomas Torres-Cuenca
- Department of Physical Medicine and Rehabilitation, National University of Colombia, Bogotá, Colombia
| | - Mohammad Mirza-Aghazadeh-Attari
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fariborz Faeghi
- Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - U Rajendra Acharya
- School of Mathematics, Physics and Computing, University of Southern Queensland, Springfield, Queensland, Australia
- Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore
- Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Ali Abbasian Ardakani
- Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yeh CL, Wu CH, Hsiao MY, Kuo PL. Real-Time Automated Segmentation of Median Nerve in Dynamic Ultrasonography Using Deep Learning. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1129-1136. [PMID: 36740461 DOI: 10.1016/j.ultrasmedbio.2022.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The morphological dynamics of the median nerve across the level extracted from dynamic ultrasonography are valuable for the diagnosis and evaluation of carpal tunnel syndrome (CTS), but the data extraction requires tremendous labor to manually segment the nerve across the image sequence. Our aim was to provide visually real-time, automated median nerve segmentation and subsequent data extraction in dynamic ultrasonography. METHODS We proposed a deep-learning model modified from SOLOv2 and tailored for median nerve segmentation. Ensemble strategies combining several state-of-the-art models were also employed to examine whether the segmentation accuracy could be improved. Image data were acquired from nine normal participants and 59 patients with idiopathic CTS. DISCUSSION Our model outperformed several state-of-the-art models with respect to inference speed, whereas the segmentation accuracy was on a par with that achieved by these models. When evaluated on a single 1080Ti GPU card, our model achieved an intersection over union score of 0.855 and Dice coefficient of 0.922 at 28.9 frames/s. The ensemble models slightly improved segmentation accuracy. CONCLUSION Our model has great potential for use in the clinical setting, as the real-time, automated extraction of the morphological dynamics of the median nerve allows clinicians to diagnose and treat CTS as the images are acquired.
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Affiliation(s)
- Cheng-Liang Yeh
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Ling Kuo
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Electrical Engineering Department, National Taiwan University, Taipei, Taiwan.
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Jacobs E, Wainman B, Bowness J. Applying artificial intelligence to the use of ultrasound as an educational tool: A focus on ultrasound-guided regional anesthesia. ANATOMICAL SCIENCES EDUCATION 2023. [PMID: 36880869 DOI: 10.1002/ase.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Emma Jacobs
- Department of Anaesthesia, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Bruce Wainman
- Education Program in Anatomy, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Science, McMaster University, Hamilton, Ontario, Canada
| | - James Bowness
- Department of Anaesthesia, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
- OxSTaR Center, Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Wang JC, Shu YC, Lin CY, Wu WT, Chen LR, Lo YC, Chiu HC, Özçakar L, Chang KV. Application of deep learning algorithms in automatic sonographic localization and segmentation of the median nerve: A systematic review and meta-analysis. Artif Intell Med 2023; 137:102496. [PMID: 36868687 DOI: 10.1016/j.artmed.2023.102496] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/13/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE High-resolution ultrasound is an emerging tool for diagnosing carpal tunnel syndrome caused by the compression of the median nerve at the wrist. This systematic review and meta-analysis aimed to explore and summarize the performance of deep learning algorithms in the automatic sonographic assessment of the median nerve at the carpal tunnel level. METHODS PubMed, Medline, Embase, and Web of Science were searched from the earliest records to May 2022 for studies investigating the utility of deep neural networks in the evaluation of the median nerve in carpal tunnel syndrome. The quality of the included studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies. The outcome variables included precision, recall, accuracy, F-score, and Dice coefficient. RESULTS In total, seven articles were included, comprising 373 participants. The deep learning and related algorithms comprised U-Net, phase-based probabilistic active contour, MaskTrack, ConvLSTM, DeepNerve, DeepSL, ResNet, Feature Pyramid Network, DeepLab, Mask R-CNN, region proposal network, and ROI Align. The pooled values of precision and recall were 0.917 (95 % confidence interval [CI], 0.873-0.961) and 0.940 (95 % CI, 0.892-0.988), respectively. The pooled accuracy and Dice coefficient were 0.924 (95 % CI, 0.840-1.008) and 0.898 (95 % CI, 0.872-0.923), respectively, whereas the summarized F-score was 0.904 (95 % CI, 0.871-0.937). CONCLUSION The deep learning algorithm enables automated localization and segmentation of the median nerve at the carpal tunnel level in ultrasound imaging with acceptable accuracy and precision. Future research is expected to validate the performance of deep learning algorithms in detecting and segmenting the median nerve along its entire length as well as across datasets obtained from various ultrasound manufacturers.
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Affiliation(s)
- Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chung Shu
- Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Che-Yu Lin
- Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lan-Rong Chen
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Yu-Cheng Lo
- Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Chi Chiu
- Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan; Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Shinohara I, Yoshikawa T, Inui A, Mifune Y, Nishimoto H, Mukohara S, Kato T, Furukawa T, Tanaka S, Kusunose M, Hoshino Y, Matsushita T, Kuroda R. Degree of Accuracy With Which Deep Learning for Ultrasound Images Identifies Osteochondritis Dissecans of the Humeral Capitellum. Am J Sports Med 2023; 51:358-366. [PMID: 36622401 DOI: 10.1177/03635465221142280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Medical screening using ultrasonography (US) has been performed on young baseball players for early detection of osteochondritis dissecans (OCD) of the humeral capitellum. Deep learning (DL) and artificial intelligence (AI) techniques are widely adopted in the medical imaging research field. PURPOSE/HYPOTHESIS The purpose of this study was to calculate the diagnostic accuracy using DL for US images of OCD. We hypothesized that using DL for US imaging would improve the prediction accuracy of OCD. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS A total of 40 elbows (mean age of patients, 12.1 years) that were suspected of having OCD at a medical checkup and later confirmed by radiographs and magnetic resonance imaging were included in the study. The affected elbows were used as the OCD group and the contralateral elbows as the control group. From US videos, 100 images per elbow were captured from different angles, and 4000 images of the elbows were prepared for both groups. Of these, 80% were randomly selected by DL models and used as training data; the remaining were used as test data. Transfer learning was conducted using 3 pretrained DL models. The confusion matrix and the area under the receiver operating characteristic curve (AUC) were used to evaluate the model, and the visualization of the areas deemed important by the DL models was also performed. Furthermore, OCD regions were detected using an automatic image recognition model based on DL. RESULTS Classification of the OCD image by the DL model was performed; the best accuracy score was 0.87; the recall was 1.00. AUC was high for all DL models. Visualization of important features showed that AI predicted the presence of OCD by focusing on the irregularity or discontinuity of the surface of subchondral bone. In the detection of OCD task, the mean average precision was 0.83. CONCLUSION The DL on US images identified OCD with high accuracy. The important features detected by the DL models correspond to the areas used by clinicians in screening the US images. The OCD was also detected with high accuracy using the object detection model. The AI model may be used in medical screening for OCD.
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Affiliation(s)
- Issei Shinohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuo Kato
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Furukawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuya Tanaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Kusunose
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.,Investigation performed at Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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13
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Elseddik M, Mostafa RR, Elashry A, El-Rashidy N, El-Sappagh S, Elgamal S, Aboelfetouh A, El-Bakry H. Predicting CTS Diagnosis and Prognosis Based on Machine Learning Techniques. Diagnostics (Basel) 2023; 13:diagnostics13030492. [PMID: 36766597 PMCID: PMC9914125 DOI: 10.3390/diagnostics13030492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a clinical disease that occurs due to compression of the median nerve in the carpal tunnel. The determination of the severity of carpal tunnel syndrome is essential to provide appropriate therapeutic interventions. Machine learning (ML)-based modeling can be used to classify diseases, make decisions, and create new therapeutic interventions. It is also used in medical research to implement predictive models. However, despite the growth in medical research based on ML and Deep Learning (DL), CTS research is still relatively scarce. While a few studies have developed models to predict diagnosis of CTS, no ML model has been presented to classify the severity of CTS based on comprehensive clinical data. Therefore, this study developed new classification models for determining CTS severity using ML algorithms. This study included 80 patients with other diseases that have an overlap in symptoms with CTS, such as cervical radiculopathysasas, de quervian tendinopathy, and peripheral neuropathy, and 80 CTS patients who underwent ultrasonography (US)-guided median nerve hydrodissection. CTS severity was classified into mild, moderate, and severe grades. In our study, we aggregated the data from CTS patients and patients with other diseases that have an overlap in symptoms with CTS, such as cervical radiculopathysasas, de quervian tendinopathy, and peripheral neuropathy. The dataset was randomly split into training and test data, at 70% and 30%, respectively. The proposed model achieved promising results of 0.955%, 0.963%, and 0.919% in terms of classification accuracy, precision, and recall, respectively. In addition, we developed a machine learning model that predicts the probability of a patient improving after the hydro-dissection injection process based on the aggregated data after three different months (one, three, and six). The proposed model achieved accuracy after six months of 0.912%, after three months of 0.901%, and after one month 0.877%. The overall performance for predicting the prognosis after six months outperforms the prediction after one and three months. We utilized statistics tests (significance test, Spearman's correlation test, and two-way ANOVA test) to determine the effect of injection process in CTS treatment. Our data-driven decision support tools can be used to help determine which patients to operate on in order to avoid the associated risks and expenses of surgery.
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Affiliation(s)
- Marwa Elseddik
- Department of the Robotics and Internet Machines, Faculty of Artificial Intelligence, Kafrelsheikh University, Kafr El Sheikh 33516, Egypt
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
| | - Reham R. Mostafa
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Elashry
- Department of Information Systems, Faculty of Computers and Information, Kafrelsheiksh University, Kafr El Sheikh 33516, Egypt
| | - Nora El-Rashidy
- Department of Machine Learning and Information Retrieval, Faculty of Artificial Intelligence, Kafrelsheiksh University, Kafr El Sheikh 33516, Egypt
- Correspondence: (N.E.-R.); (S.E.-S.)
| | - Shaker El-Sappagh
- Faculty of Computer Science and Engineering, Galala University, Suez 43511, Egypt
- Information Systems Department, Faculty of Computers and Artificial Intelligence, Benha University, Banha 13518, Egypt
- Correspondence: (N.E.-R.); (S.E.-S.)
| | - Shimaa Elgamal
- Department of Neuropsychiatry, Faculty of Medicine, Kafrelsheiksh University, Kafr El Sheikh 33516, Egypt
| | - Ahmed Aboelfetouh
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
- Delta Higher Institute for Management and Accounting Information Systems, Mansoura 35511, Egypt
| | - Hazem El-Bakry
- Department of Information Systems, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
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14
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Shinohara I, Inui A, Mifune Y, Nishimoto H, Yamaura K, Mukohara S, Yoshikawa T, Kato T, Furukawa T, Hoshino Y, Matsushita T, Kuroda R. Using deep learning for ultrasound images to diagnose carpal tunnel syndrome with high accuracy. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2052-2059. [PMID: 35868907 DOI: 10.1016/j.ultrasmedbio.2022.05.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/08/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
Recently, deep learning (DL) algorithms have been adapted for the diagnosis of medical images. The purpose of this study was to detect image features using DL without measuring median nerve cross-sectional area (CSA) in ultrasonography (US) images of carpal tunnel syndrome (CTS) and calculate the diagnostic accuracy from the confusion matrix obtained. US images of 50 hands without CTS and 50 hands diagnosed with CTS were used in this study. The short-axis image of the median nerve was visualized, and 5000 images of both groups were prepared. Forty hands in each group were used as training data for the DL algorithm, while the remainder were used as test data. Transfer learning was performed using three pre-trained models. The confusion matrix and receiver operating characteristic curves were used to evaluate diagnostic accuracy. Furthermore, regions where DL was determined to be important were visualized. The highest score had an accuracy of 0.96, precision of 0.99 and recall of 0.94. Visualization of the important features revealed that the DL models focused on the epineurium of the median nerve and the surrounding soft tissue. The proposed technique enables the accurate prediction of CTS without measurement of the CSA.
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Affiliation(s)
- Issei Shinohara
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan.
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Tatsuo Kato
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Takahiro Furukawa
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 5-2, Kusunoki-cho7, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
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15
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Di Cosmo M, Fiorentino MC, Villani FP, Frontoni E, Smerilli G, Filippucci E, Moccia S. A deep learning approach to median nerve evaluation in ultrasound images of carpal tunnel inlet. Med Biol Eng Comput 2022; 60:3255-3264. [PMID: 36152237 PMCID: PMC9537213 DOI: 10.1007/s11517-022-02662-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Abstract
AbstractUltrasound (US) imaging is recognized as a useful support for Carpal Tunnel Syndrome (CTS) assessment through the evaluation of median nerve morphology. However, US is still far to be systematically adopted to evaluate this common entrapment neuropathy, due to US intrinsic challenges, such as its operator dependency and the lack of standard protocols. To support sonographers, the present study proposes a fully-automatic deep learning approach to median nerve segmentation from US images. We collected and annotated a dataset of 246 images acquired in clinical practice involving 103 rheumatic patients, regardless of anatomical variants (bifid nerve, closed vessels). We developed a Mask R-CNN with two additional transposed layers at segmentation head to accurately segment the median nerve directly on transverse US images. We calculated the cross-sectional area (CSA) of the predicted median nerve. Proposed model achieved good performances both in median nerve detection and segmentation: Precision (Prec), Recall (Rec), Mean Average Precision (mAP) and Dice Similarity Coefficient (DSC) values are 0.916 ± 0.245, 0.938 ± 0.233, 0.936 ± 0.235 and 0.868 ± 0.201, respectively. The CSA values measured on true positive predictions were comparable with the sonographer manual measurements with a mean absolute error (MAE) of 0.918 mm2. Experimental results showed the potential of proposed model, which identified and segmented the median nerve section in normal anatomy images, while still struggling when dealing with infrequent anatomical variants. Future research will expand the dataset including a wider spectrum of normal anatomy and pathology to support sonographers in daily practice.
Graphical abstract
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Affiliation(s)
- Mariachiara Di Cosmo
- Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, AN, Italy.
| | - Maria Chiara Fiorentino
- Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, AN, Italy
| | | | - Emanuele Frontoni
- Department of Political Sciences, Communication and International Relations, Università di Macerata, Macerata, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, "Carlo Urbani" Hospital, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, "Carlo Urbani" Hospital, Ancona, Italy
| | - Sara Moccia
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
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16
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Zhou Z, Zhao C, Qiao H, Wang M, Guo Y, Wang Q, Zhang R, Wu H, Dong F, Qi Z, Li J, Tian X, Zeng X, Jiang Y, Xu F, Dai Q, Yang M. RATING: Medical knowledge-guided rheumatoid arthritis assessment from multimodal ultrasound images via deep learning. PATTERNS 2022; 3:100592. [PMID: 36277816 PMCID: PMC9583187 DOI: 10.1016/j.patter.2022.100592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/04/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
Multimodal ultrasound has demonstrated its power in the clinical assessment of rheumatoid arthritis (RA). However, for radiologists, it requires strong experience. In this paper, we propose a rheumatoid arthritis knowledge guided (RATING) system that automatically scores the RA activity and generates interpretable features to assist radiologists' decision-making based on deep learning. RATING leverages the complementary advantages of multimodal ultrasound images and solves the limited training data problem with self-supervised pretraining. RATING outperforms all of the existing methods, achieving an accuracy of 86.1% on a prospective test dataset and 85.0% on an external test dataset. A reader study demonstrates that the RATING system improves the average accuracy of 10 radiologists from 41.4% to 64.0%. As an assistive tool, not only can RATING indicate the possible lesions and enhance the diagnostic performance with multimodal ultrasound but it can also enlighten the road to human-machine collaboration in healthcare. RATING is a medical knowledge-guided deep learning system for RA assessment It leverages diagnostic paradigm and experience to enhance the robustness Self-supervised pretraining ensures reliability even with limited training data A clinical reader study demonstrates its effectiveness in assisting RA assessment
Rheumatoid arthritis (RA) has detrimental outcomes, including increased disability and mortality. To enhance the clinical assessment of RA, we propose a rheumatoid arthritis knowledge guided (RATING) system for scoring RA activity from multimodal ultrasound images. It combines the knowledge of clinical diagnosis with deep learning, serving as an example of designing deep learning systems for handling real clinical problems. We further integrated the system into the clinical decision-making process via human-machine collaboration and demonstrated significant improvements in assessment performance. We expect that our research will illuminate the road to human-machine collaboration and help transform clinical diagnostics and precision medicine in a wider range of biomedical research.
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Affiliation(s)
- Zhanping Zhou
- School of Software, Tsinghua University, Beijing 100084, China
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing 100084, China
| | - Chenyang Zhao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui Qiao
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing 100084, China
- Department of Automation, Tsinghua University, Beijing 100084, China
- Corresponding author
| | - Ming Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuchen Guo
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing 100084, China
| | - Qian Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Corresponding author
| | - Rui Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Huaiyu Wu
- Department of Ultrasound, Second Clinical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People’s Hospital, Shenzhen 518020, China
| | - Fajin Dong
- Department of Ultrasound, Second Clinical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People’s Hospital, Shenzhen 518020, China
| | - Zhenhong Qi
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xinping Tian
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaofeng Zeng
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuxin Jiang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Feng Xu
- School of Software, Tsinghua University, Beijing 100084, China
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing 100084, China
- Corresponding author
| | - Qionghai Dai
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing 100084, China
- Department of Automation, Tsinghua University, Beijing 100084, China
- Corresponding author
| | - Meng Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Corresponding author
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