[en] Purpose: In this study, we propose an artificial intelligence (AI) framework based on three-dimensional convolutional neural networks to classify computed tomography (CT) scans of patients with coronavirus disease 2019 (COVID-19), influenza/community-acquired pneumonia (CAP), and no infection, after automatic segmentation of the lungs and lung abnormalities.
Methods: The AI classification model is based on inflated three-dimensional Inception architecture and was trained and validated on retrospective data of CT images of 667 adult patients (no infection n=188, COVID-19 n=230, influenza/CAP n=249) and 210 adult patients (no infection n=70, COVID-19 n=70, influenza/CAP n=70), respectively. The model's performance was independently evaluated on an internal test set of 273 adult patients (no infection n=55, COVID-19 n= 94, influenza/CAP n=124) and an external validation set from a different centre (305 adult patients: COVID-19 n=169, no infection n=76, influenza/CAP n=60).
Results: The model showed excellent performance in the external validation set with area under the curve of 0.90, 0.92 and 0.92 for COVID-19, influenza/CAP and no infection, respectively. The selection of the input slices based on automatic segmentation of the abnormalities in the lung reduces analysis time (56 s per scan) and computational burden of the model. The Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) score of the proposed model is 47% (15 out of 32 TRIPOD items).
Conclusion: This AI solution provides rapid and accurate diagnosis in patients suspected of COVID-19 infection and influenza.
Disciplines :
Radiology, nuclear medicine & imaging
Author, co-author :
Vaidyanathan, Akshayaa ; Radiomics (Oncoradiomics SA), Liège, Belgium ; The D-Lab, Depts of Precision Medicine, and Radiology and Nuclear Medicine, GROW-School for Oncology, Maastricht University, Maastricht, The Netherlands ; These authors have contributed equally to this work and share first authorship
Guiot, Julien ; Centre Hospitalier Universitaire de Liège - CHU > > Service de pneumologie - allergologie ; These authors have contributed equally to this work and share first authorship
Zerka, Fadila; Radiomics (Oncoradiomics SA), Liège, Belgium ; The D-Lab, Depts of Precision Medicine, and Radiology and Nuclear Medicine, GROW-School for Oncology, Maastricht University, Maastricht, The Netherlands
Van Peufflik, Ingrid; Radiomics (Oncoradiomics SA), Liège, Belgium
Deprez, Louis ; Centre Hospitalier Universitaire de Liège - CHU > > Service médical de radiodiagnostic
Danthine, Denis ; Centre Hospitalier Universitaire de Liège - CHU > > Service médical de médecine nucléaire et imagerie onco
CANIVET, Grégory ; Centre Hospitalier Universitaire de Liège - CHU > > Service des Applications Informatiques (SAI)
Lambin, Philippe ; The D-Lab, Depts of Precision Medicine, and Radiology and Nuclear Medicine, GROW-School for Oncology, Maastricht University, Maastricht, The Netherlands
H2020 - 101005122 - DRAGON - The RapiD and SecuRe AI enhAnced DiaGnosis, Precision Medicine and Patient EmpOwerment Centered Decision Support System for Coronavirus PaNdemics
Funders :
EU - European Union
Funding number :
European Marie Curie grant (PREDICT – ITN, number 766276)
Funding text :
The authors thank Fabio Bottari (Radiomics, Liège, Belgium) for providing medical writing support in accordance with Good Publication Practice (GPP3) guidelines. Support statement: The authors acknowledge financial support from European Marie Curie grant (PREDICT – ITN, number 766276) and the European Union’s Horizon 2020 research and innovation programme under grant agreements DRAGON – 101005122 (call: H2020-JTI-IMI2-2020-21) and iCOVID – 101016131 (call: H2020-SC1-PHE-CORONAVIRUS-2020-2) for the execution of this work. Funding information for this article has been deposited with the Crossref Funder Registry.Support statement: The authors acknowledge financial support from European Marie Curie grant (PREDICT – ITN, number 766276) and the European Union’s Horizon 2020 research and innovation programme under grant agreements DRAGON – 101005122 (call: H2020-JTI-IMI2-2020-21) and iCOVID – 101016131 (call: H2020-SC1-PHE-CORONAVIRUS-2020-2) for the execution of this work. Funding information for this article has been deposited with the Crossref Funder Registry.
Marchiori E, Zanetti G, Hochhegger B, et al. High-resolution computed tomography findings from adult patients with influenza A (H1N1) virus-associated pneumonia. Eur J Radiol 2010; 74: 93–98.
Gao L, Zhang J. Pulmonary high-resolution computed tomography (HRCT) findings of patients with early-stage coronavirus disease 2019 (COVID-19) in Hangzhou, China. Med Sci Monit 2020; 26: e923885.
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–513.
Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–1720.
Bai HX, Hsieh B, Xiong Z, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020; 296: E46–E54.
Litjens G, Kooi T, Bejnordi BE, et al. A survey on deep learning in medical image analysis. Med Image Anal 2017; 42: 60–88.
Xu X, Jiang X, Ma C, et al. A deep learning system to screen novel coronavirus disease 2019 pneumonia. Engineering 2020; 6: 1122–1129.
Ardakani AA, Kanafi AR, Acharya UR, et al. Application of deep learning technique to manage COVID-19 in routine clinical practice using CT images: results of 10 convolutional neural networks. Comput Biol Med 2020; 121: 103795.
Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of COVID-19. N Engl J Med 2020; 382: 2049–2055.
Afshar P, Heidarian S, Enshaei N, et al. COVID-CT-MD, COVID-19 computed tomography scan dataset applicable in machine learning and deep learning. Sci Data 2021; 8: 121.
Buda M, Maki A, Mazurowski MA. A systematic study of the class imbalance problem in convolutional neural networks. Neural Netw 2018; 106: 249–259.
Ilsen B, Vandenbroucke F, Beigelman-Aubry C, et al. Comparative interpretation of CT and standard radiography of the pleura. J Belgian Soc Radiol 2016; 100: 106.
Carreira J, Zisserman A. Quo vadis, action recognition? A new model and the kinetics dataset. 2017 IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 2017; pp. 4724–4733.
Kay W, Carreira J, Simonyan K, et al. The kinetics human action video dataset. arXiv 2017; preprint [https://arxiv.org/abs/1705.06950v1].
Szegedy C, Liu W, Jia Y, et al. Going deeper with convolutions. 2015 IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 2015; pp. 1–9.
Kingma DP, Ba JL. Adam: A Method for Stochastic Optimization. 3rd International Conference for Learning Representations, San Diego, 2015; pp. 1–15.
Collins GS, Reitsma JB, Altman DG, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMC Med 2015; 13: 1.
Ibrahim DM, Elshennawy NM, Sarhan AM. Deep-chest: multi-classification deep learning model for diagnosing COVID-19, pneumonia, and lung cancer chest diseases. Comput Biol Med 2021; 132: 104348.
Li L, Qin L, Xu Z, et al. Using artificial intelligence to detect COVID-19 and community-acquired pneumonia based on pulmonary CT: evaluation of the diagnostic accuracy. Radiology 2020; 296: E65–E71.
Ghaderzadeh M, Asadi F. Deep learning in the detection and diagnosis of COVID-19 using radiology modalities: a systematic review. J Healthc Eng 2021; 2021: 6677314.
Mohammad-Rahimi H, Nadimi M, Ghalyanchi-Langeroudi A, et al. Application of machine learning in diagnosis of COVID-19 through X-ray and CT images: a scoping review. Front Cardiovasc Med 2021; 8: 638011.
Wu Z, Li L, Jin R, et al. Texture feature-based machine learning classifier could assist in the diagnosis of COVID-19. Eur J Radiol 2021; 137: 109602.
Yan T, Wong PK, Ren H, et al. Automatic distinction between COVID-19 and common pneumonia using multi-scale convolutional neural network on chest CT scans. Chaos Solitons Fractals 2020; 140: 110153.
Wang S, Zha Y, Li W, et al. A fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis. Eur Respir J 2020; 56: 2000775.
Wang H, Wang L, Lee EH, et al. Decoding COVID-19 pneumonia: comparison of deep learning and radiomics CT image signatures. Eur J Nucl Med Mol Imaging 2021; 48: 1478–1486.
Liu H, Ren H, Wu Z, et al. CT radiomics facilitates more accurate diagnosis of COVID-19 pneumonia: compared with CO-RADS. J Transl Med 2021; 19: 29.
Zhang K, Liu X, Shen J, et al. Clinically applicable AI system for accurate diagnosis, quantitative measurements, and prognosis of COVID-19 pneumonia using computed tomography. Cell 2020; 181: 1423–1433.
Ozsahin I, Sekeroglu B, Musa MS, et al. Review on diagnosis of COVID-19 from chest CT images using artificial intelligence. Comput Math Methods Med 2020; 2020: 9756518.
Ying X. An overview of overfitting and its solutions. J Phys Conf Ser 2019; 1168: 022022.
Caruana R, Lawrence S, Giles L. Overfitting in neural nets: backpropagation, conjugate gradient, and early stopping. Adv Neural Inf Process Syst 2001; 13: 402–408.
Singh A, Sengupta S, Lakshminarayanan V. Explainable deep learning models in medical image analysis. J Imaging 2020; 6: 52.
Holzinger A, Langs G, Denk H, et al. Causability and explainability of artificial intelligence in medicine. Wiley Interdiscip Rev Data Min Knowl Discov 2019; 9: e1312.
Holzinger A, Biemann C, Pattichis CS, et al. What do we need to build explainable AI systems for the medical domain? ArXiv 2017; preprint [http://arxiv.org/abs/1712.09923].
Holzinger A. Explainable AI and multi-modal causability in medicine. I-Com 2021; 19: 171–179.
Jin C, Chen W, Cao Y, et al. Development and evaluation of an artificial intelligence system for COVID-19 diagnosis. Nat Commun 2020; 11: 5088.
Wang S, Kang B, Ma J, et al. A deep learning algorithm using CT images to screen for Corona virus disease (COVID-19). Eur Radiol 2021; 31: 6096–6104.
Bianco S, Cadene R, Celona L, et al. Benchmark analysis of representative deep neural network architectures. IEEE Access 2018; 6: 64270–64277.
Bressem KK, Adams LC, Erxleben C, et al. Comparing different deep learning architectures for classification of chest radiographs. Sci Rep 2020; 10: 13590.
Gifani P, Shalbaf A, Vafaeezadeh M. Automated detection of COVID-19 using ensemble of transfer learning with deep convolutional neural network based on CT scans. Int J Comput Assist Radiol Surg 2021; 16: 115–123.
El Asnaoui K, Chawki Y. Using X-ray images and deep learning for automated detection of coronavirus disease. J Biomol Struct Dyn 2020; 39: 3615–3626.
Global Action Plan on Antimicrobial Resistance. Microbe Mag 2015; 10: 354–355.
Haque M, McKimm J, Sartelli M, et al. Strategies to prevent healthcare-associated infections: a narrative overview. Risk Manag Healthc Policy 2020; 13: 1765–1780.
Zerka F, Urovi V, Vaidyanathan A, et al. Blockchain for privacy preserving and trustworthy distributed machine learning in multicentric medical imaging (C-DistriM). IEEE Access 2020; 8: 183939–183951.
Zerka F, Barakat S, Walsh S, et al. Systematic review of privacy-preserving distributed machine learning from federated databases in health care. JCO Clin Cancer Inform 2020; 4: 184–200.