Automated detection of pulmonary embolism in CT pulmonary angiograms using an AI-powered algorithm

• DOI: 10.1007/s00330-020-06998-0
• Publication Date: 2020-07-03T21:02:20Z
• Authors: Thomas Weikert; David J. Winkel; Jens Bremerich; Bram Stieltjes; Victor Parmar; Alexander W. Sauter; Gregor Sommer
• Keywords: Male; Computed Tomography Angiography; Contrast Media; Reproducibility of Results; Middle Aged; Sensitivity and Specificity; Pattern Recognition, Automated; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Artificial Intelligence; Image Processing, Computer-Assisted; Humans; False Positive Reactions; Female; Diagnosis, Computer-Assisted; Neural Networks, Computer; Pulmonary Embolism; Tomography, X-Ray Computed; Lung; Algorithms; Aged; Retrospective Studies

To evaluate the performance of an AI-powered algorithm for the automatic detection of pulmonary embolism (PE) on chest computed tomography pulmonary angiograms (CTPAs) on a large dataset.We retrospectively identified all CTPAs conducted at our institution in 2017 (n = 1499). Exams with clinical questions other than PE were excluded from the analysis (n = 34). The remaining exams were classified into positive (n = 232) and negative (n = 1233) for PE based on the final written reports, which defined the reference standard. The fully anonymized 1-mm series in soft tissue reconstruction served as input for the PE detection prototype algorithm that was based on a deep convolutional neural network comprising a Resnet architecture. It was trained and validated on 28,000 CTPAs acquired at other institutions. The result series were reviewed using a web-based feedback platform. Measures of diagnostic performance were calculated on a per patient and a per finding level.The algorithm correctly identified 215 of 232 exams positive for pulmonary embolism (sensitivity 92.7%; 95% confidence interval [CI] 88.3-95.5%) and 1178 of 1233 exams negative for pulmonary embolism (specificity 95.5%; 95% CI 94.2-96.6%). On a per finding level, 1174 of 1352 findings marked as embolus by the algorithm were true emboli. Most of the false positive findings were due to contrast agent-related flow artifacts, pulmonary veins, and lymph nodes.The AI prototype algorithm we tested has a high degree of diagnostic accuracy for the detection of PE on CTPAs. Sensitivity and specificity are balanced, which is a prerequisite for its clinical usefulness.• An AI-based prototype algorithm showed a high degree of diagnostic accuracy for the detection of pulmonary embolism on CTPAs. • It can therefore help clinicians to automatically prioritize exams with a high suspection of pulmonary embolism and serve as secondary reading tool. • By complementing traditional ways of worklist prioritization in radiology departments, this can speed up the diagnostic and therapeutic workup of patients with pulmonary embolism and help to avoid false negative calls.