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Clinical Deployment of Explainable Artificial Intelligence of SPECT for Diagnosis of Coronary Artery Disease

冠状动脉疾病 计算机辅助设计 医学 接收机工作特性 曲线下面积 心肌灌注成像 灌注 单光子发射计算机断层摄影术 心脏病学 内科学 放射科 核医学 工程类 工程制图
作者
Yuka Otaki,Ananya Singh,Paul Kavanagh,Robert J.H. Miller,Tejas Parekh,Balaji Tamarappoo,Tali Sharir,Andrew J. Einstein,Mathews B. Fish,Terrence D. Ruddy,Philipp A. Kaufmann,Albert J. Sinusas,Edward J. Miller,Timothy M. Bateman,Sharmila Dorbala,Marcelo Di Carli,Sebastien Cadet,Joanna X. Liang,Damini Dey,Daniel S. Berman,Piotr J. Slomka
出处
期刊:Jacc-cardiovascular Imaging [Elsevier]
卷期号:15 (6): 1091-1102 被引量:58
标识
DOI:10.1016/j.jcmg.2021.04.030
摘要

Explainable artificial intelligence (AI) can be integrated within standard clinical software to facilitate the acceptance of the diagnostic findings during clinical interpretation.This study sought to develop and evaluate a novel, general purpose, explainable deep learning model (coronary artery disease-deep learning [CAD-DL]) for the detection of obstructive CAD following single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).A total of 3,578 patients with suspected CAD undergoing SPECT MPI and invasive coronary angiography within a 6-month interval from 9 centers were studied. CAD-DL computes the probability of obstructive CAD from stress myocardial perfusion, wall motion, and wall thickening maps, as well as left ventricular volumes, age, and sex. Myocardial regions contributing to the CAD-DL prediction are highlighted to explain the findings to the physician. A clinical prototype was integrated using a standard clinical workstation. Diagnostic performance by CAD-DL was compared to automated quantitative total perfusion deficit (TPD) and reader diagnosis.In total, 2,247 patients (63%) had obstructive CAD. In 10-fold repeated testing, the area under the receiver-operating characteristic curve (AUC) (95% CI) was higher according to CAD-DL (AUC: 0.83 [95% CI: 0.82-0.85]) than stress TPD (AUC: 0.78 [95% CI: 0.77-0.80]) or reader diagnosis (AUC: 0.71 [95% CI: 0.69-0.72]; P < 0.0001 for both). In external testing, the AUC in 555 patients was higher according to CAD-DL (AUC: 0.80 [95% CI: 0.76-0.84]) than stress TPD (AUC: 0.73 [95% CI: 0.69-0.77]) or reader diagnosis (AUC: 0.65 [95% CI: 0.61-0.69]; P < 0.001 for all). The present model can be integrated within standard clinical software and generates results rapidly (<12 seconds on a standard clinical workstation) and therefore could readily be incorporated into a typical clinical workflow.The deep-learning model significantly surpasses the diagnostic accuracy of standard quantitative analysis and clinical visual reading for MPI. Explainable artificial intelligence can be integrated within standard clinical software to facilitate acceptance of artificial intelligence diagnosis of CAD following MPI.
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