A. Torresin

Giulia Zorzi, Luca Berta, Stefano Carrazza et al.

Purpose: to optimize a pipeline of clinical data gathering and CT images processing implemented during the COVID-19 pandemic crisis and to develop artificial intelligence model for different of viral pneumonia. Methods: 1028 chest CT image of patients with positive swab were segmented automatically for lung extraction. A Gaussian model developed in Python language was applied to calculate quantitative metrics (QM) describing well-aerated and ill portions of the lungs from the histogram distribution of lung CT numbers in both lungs of each image and in four geometrical subdivision. Furthermore, radiomic features (RF) of first and second order were extracted from bilateral lungs using PyRadiomic tools. QM and RF were used to develop 4 different Multi-Layer Perceptron (MLP) classifier to discriminate images of patients with COVID (n=646) and non-COVID (n=382) viral pneumonia. Results: The Gaussian model applied to lung CT histogram correctly described healthy parenchyma 94% of the patients. The resulting accuracy of the models for COVID diagnosis were in the range 0.76-0.87, as the integral of the receiver operating curve. The best diagnostic performances were associated to the model based on RF of first and second order, with 21 relevant features after LASSO regression and an accuracy of 0.81$\pm$0.02 after 4-fold cross validation Conclusions: Despite these results were obtained with CT images from a single center, a platform for extracting useful quantitative metrics from CT images was developed and optimized. Four artificial intelligence-based models for classifying patients with COVID and non-COVID viral pneumonia were developed and compared showing overall good diagnostic performances

L. Berta, C. De Mattia, F. Rizzetto et al.

Quantitative metrics in lung computed tomography (CT) images have been widely used, often without a clear connection with physiology. This work proposes a patient-independent model for the estimation of well-aerated volume of lungs in CT images (WAVE). A Gaussian fit, with mean (Mu.f) and width (Sigma.f) values, was applied to the lower CT histogram data points of the lung to provide the estimation of the well-aerated lung volume (WAVE.f). Independence from CT reconstruction parameters and respiratory cycle was analysed using healthy lung CT images and 4DCT acquisitions. The Gaussian metrics and first order radiomic features calculated for a third cohort of COVID-19 patients were compared with those relative to healthy lungs. Each lung was further segmented in 24 subregions and a new biomarker derived from Gaussian fit parameter Mu.f was proposed to represent the local density changes. WAVE.f resulted independent from the respiratory motion in 80% of the cases. Differences of 1%, 2% and up to 14% resulted comparing a moderate iterative strength and FBP algorithm, 1 and 3 mm of slice thickness and different reconstruction kernel. Healthy subjects were significantly different from COVID-19 patients for all the metrics calculated. Graphical representation of the local biomarker provides spatial and quantitative information in a single 2D picture. Unlike other metrics based on fixed histogram thresholds, this model is able to consider the inter-and intra-subject variability. In addition, it defines a local biomarker to quantify the severity of the disease, independently of the observer.