Deep learning-based assessment of coronary artery disease using curved-multiplanar reconstruction: comprehensive evaluation of stenosis, calcification, and plaque
D A E W O N KimAbstract
Introduction
This study developed and validated a deep learning-based image analysis method to detect and quantify coronary artery stenosis, vulnerable plaque, and calcification in Curved-Multiplanar Reconstruction (cMPR) images for aiding pre-operative evaluation of coronary artery disease (CAD).
Methods
A total of 2,978 cMPR scans, were collected based on the data utilized between 2014 and 2022 under Institutional Review Board approval from 2020 October extended through 2023 October. Each cMPR scan was reconstructed to generate 13 images per cMPR using the CT Cardiac Package by TeraRecon Inc. From these, 769 CT images of a time independent test dataset were used for evaluation. 10 years-experienced expert meticulously annotated locations of stenosis and vulnerable plaques to train and test a stenotic segmentation model (SSM) and a vulnerable plaque segmentation model (VPSM) using 2D nnU-Net framework. SSM facilitated the assessment of stenosis positioning and length as well as the determination of CAD diameter profiles through Full Width at Half Maximum analysis, leading to the calculation of a stenosis regression index (SRI). The detection of vulnerable plaques was also performed using VPSM for differentiating normal and vulnerable plaques. Sensitivity and specificity of each slice and patient were primary metrics for evaluation.
Results
A notable correlation of 0.6874 was established between SRI and conventional quantitative angiographic analysis. The correlation of stenosis length quantification was 0.4033. Five expert cardiologists visual scoring for aiding calcification scoring with calcium segmentation averaged 7.277 ± 2.286 on a 10-point scale. For vulnerable plaque detection, the VPSM achieved a sensitivity of 0.929 and a specificity of 0.910.
Conclusion
The automated quantitative image analysis developed in this study demonstrated robust potential for evaluating SRI and for detecting calcification and vulnerable plaque in cMPR scans, showing promise for application in clinical screening environments. This non-invasive, cost-effective, rapid, and user-independent method offers a significant advancement in cMPR screening, providing clinicians with a powerful tool for the detection of CAD stenosis, calcification, and vulnerable plaque.