Wenchao Guo

Minfeng Xu, Chen-Chen Fan, Yan-Jie Zhou et al.

Cardiovascular diseases (CVD) remain a leading health concern and contribute significantly to global mortality rates. While clinical advancements have led to a decline in CVD mortality, accurately identifying individuals who could benefit from preventive interventions remains an unsolved challenge in preventive cardiology. Current CVD risk prediction models, recommended by guidelines, are based on limited traditional risk factors or use CT imaging to acquire quantitative biomarkers, and still have limitations in predictive accuracy and applicability. On the other hand, end-to-end trained CVD risk prediction methods leveraging deep learning on CT images often fail to provide transparent and explainable decision grounds for assisting physicians. In this work, we proposed a novel joint representation that integrates discrete quantitative biomarkers and continuous deep features extracted from chest CT scans. Our approach initiated with a deep CVD risk classification model by capturing comprehensive continuous deep learning features while jointly obtaining currently clinical-established quantitative biomarkers via segmentation models. In the feature joint representation stage, we use an instance-wise feature-gated mechanism to align the continuous and discrete features, followed by a soft instance-wise feature interaction mechanism fostering independent and effective feature interaction for the final CVD risk prediction. Our method substantially improves CVD risk predictive performance and offers individual contribution analysis of each biomarker, which is important in assisting physicians' decision-making processes. We validated our method on a public chest low-dose CT dataset and a private external chest standard-dose CT patient cohort of 17,207 CT volumes from 6,393 unique subjects, and demonstrated superior predictive performance, achieving AUCs of 0.875 and 0.843, respectively.

Yujian Hu, Yilang Xiang, Yan-Jie Zhou et al.

The accurate and timely diagnosis of acute aortic syndromes (AAS) in patients presenting with acute chest pain remains a clinical challenge. Aortic CT angiography (CTA) is the imaging protocol of choice in patients with suspected AAS. However, due to economic and workflow constraints in China, the majority of suspected patients initially undergo non-contrast CT as the initial imaging testing, and CTA is reserved for those at higher risk. In this work, we present an artificial intelligence-based warning system, iAorta, using non-contrast CT for AAS identification in China, which demonstrates remarkably high accuracy and provides clinicians with interpretable warnings. iAorta was evaluated through a comprehensive step-wise study. In the multi-center retrospective study (n = 20,750), iAorta achieved a mean area under the receiver operating curve (AUC) of 0.958 (95% CI 0.950-0.967). In the large-scale real-world study (n = 137,525), iAorta demonstrated consistently high performance across various non-contrast CT protocols, achieving a sensitivity of 0.913-0.942 and a specificity of 0.991-0.993. In the prospective comparative study (n = 13,846), iAorta demonstrated the capability to significantly shorten the time to correct diagnostic pathway. For the prospective pilot deployment that we conducted, iAorta correctly identified 21 out of 22 patients with AAS among 15,584 consecutive patients presenting with acute chest pain and under non-contrast CT protocol in the emergency department (ED) and enabled the average diagnostic time of these 21 AAS positive patients to be 102.1 (75-133) mins. Last, the iAorta can help avoid delayed or missed diagnosis of AAS in settings where non-contrast CT remains the unavoidable the initial or only imaging test in resource-constrained regions and in patients who cannot or did not receive intravenous contrast.