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To compare an artificial intelligence (AI)-based prototype and subjective grading for predicting disease severity in patients with emphysema.Our IRB approved HIPAA-compliant study included 113 adults (71±8 years; 47 females, 66 males) who had both non-contrast chest CT and pulmonary function tests performed within a span of 2 months. The disease severity was classified based on the forced expiratory volume in 1 second (FEV1 as % of predicted) into mild, moderate, and severe. 2 thoracic radiologists (RA), blinded to the clinical and AI results, graded severity of emphysema on a 5-point scale suggested by the Fleischner Society for each lobe. The whole lung scores were derived from the summation of lobar scores. Thin-section CT images were processed with the AI-Rad Companion Chest prototype (Siemens Healthineers) to quantify low attenuation areas (LAA- 950 HU) in whole lung and each lobe separately. Bronchial abnormality was assessed by both radiologists and a fully automated software (Philips Healthcare).Both AI (AUC of 0.77; 95% CI: 0.68 - 0.85) and RA (AUC: 0.76, 95% CI: 0.65 - 0.84) emphysema quantification could differentiate mild, moderate, and severe disease based on FEV1. There was a strong positive correlation between AI and RA (r = 0.72 - 0.80; p0.001). The combination of emphysema and bronchial abnormality quantification from radiologists' and AI assessment could differentiate between different severities with AUC of 0.80 - 0.82 and 0.87, respectively.The assessed AI-prototypes can predict the disease severity in patients with emphysema with the same predictive value as the radiologists.

To perform a multicenter assessment of the CT Pneumonia Analysis prototype for predicting disease severity and patient outcome in COVID-19 pneumonia both without and with integration of clinical information. Our IRB-approved observational study included consecutive 241 adult patients (> 18 years; 105 females; 136 males) with RT-PCR-positive COVID-19 pneumonia who underwent non-contrast chest CT at one of the two tertiary care hospitals (site A: Massachusetts General Hospital, USA; site B: Firoozgar Hospital Iran). We recorded patient age, gender, comorbid conditions, laboratory values, intensive care unit (ICU) admission, mechanical ventilation, and final outcome (recovery or death). Two thoracic radiologists reviewed all chest CTs to record type, extent of pulmonary opacities based on the percentage of lobe involved, and severity of respiratory motion artifacts. Thin-section CT images were processed with the prototype (Siemens Healthineers) to obtain quantitative features including lung volumes, volume and percentage of all-type and high-attenuation opacities (≥ −200 HU), and mean HU and standard deviation of opacities within a given lung region. These values are estimated for the total combined lung volume, and separately for each lung and each lung lobe. Multivariable analyses of variance (MANOVA) and multiple logistic regression were performed for data analyses. About 26% of chest CTs (62/241) had moderate to severe motion artifacts. There were no significant differences in the AUCs of quantitative features for predicting disease severity with and without motion artifacts (AUC 0.94–0.97) as well as for predicting patient outcome (AUC 0.7–0.77) (p > 0.5). Combination of the volume of all-attenuation opacities and the percentage of high-attenuation opacities (AUC 0.76–0.82, 95% confidence interval (CI) 0.73–0.82) had higher AUC for predicting ICU admission than the subjective severity scores (AUC 0.69–0.77, 95% CI 0.69–0.81). Despite a high frequency of motion artifacts, quantitative features of pulmonary opacities from chest CT can help differentiate patients with favorable and adverse outcomes.

Background Airspace disease as seen on chest X-rays is an important point in triage for patients initially presenting to the emergency department with suspected COVID-19 infection. The purpose of this study is to evaluate a previously trained interpretable deep learning algorithm for the diagnosis and prognosis of COVID-19 pneumonia from chest X-rays obtained in the ED. Methods This retrospective study included 2456 (50% RT-PCR positive for COVID-19) adult patients who received both a chest X-ray and SARS-CoV-2 RT-PCR test from January 2020 to March of 2021 in the emergency department at a single U.S. institution. A total of 2000 patients were included as an additional training cohort and 456 patients in the randomized internal holdout testing cohort for a previously trained Siemens AI-Radiology Companion deep learning convolutional neural network algorithm. Three cardiothoracic fellowship-trained radiologists systematically evaluated each chest X-ray and generated an airspace disease area-based severity score which was compared against the same score produced by artificial intelligence. The interobserver agreement, diagnostic accuracy, and predictive capability for inpatient outcomes were assessed. Principal statistical tests used in this study include both univariate and multivariate logistic regression. Results Overall ICC was 0.820 (95% CI 0.790–0.840). The diagnostic AUC for SARS-CoV-2 RT-PCR positivity was 0.890 (95% CI 0.861–0.920) for the neural network and 0.936 (95% CI 0.918–0.960) for radiologists. Airspace opacities score by AI alone predicted ICU admission (AUC = 0.870) and mortality (0.829) in all patients. Addition of age and BMI into a multivariate log model improved mortality prediction (AUC = 0.906). Conclusion The deep learning algorithm provides an accurate and interpretable assessment of the disease burden in COVID-19 pneumonia on chest radiographs. The reported severity scores correlate with expert assessment and accurately predicts important clinical outcomes. The algorithm contributes additional prognostic information not currently incorporated into patient management.

PURPOSE: Comparison of deep learning algorithm, radiomics and subjective assessment of chest CT for predicting outcome (death or recovery) and intensive care unit (ICU) admission in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.METHODS: The multicenter, ethical committee-approved, retrospective study included non-contrast-enhanced chest CT of 221 SARS-CoV-2 positive patients from Italy (n = 196 patients; mean age 64 ± 16 years) and Denmark (n = 25; mean age 69 ± 13 years). A thoracic radiologist graded presence, type and extent of pulmonary opacities and severity of motion artifacts in each lung lobe on all chest CTs. Thin-section CT images were processed with CT Pneumonia Analysis Prototype (Siemens Healthineers) which yielded segmentation masks from a deep learning (DL) algorithm to derive features of lung abnormalities such as opacity scores, mean HU, as well as volume and percentage of all-attenuation and high-attenuation (opacities >-200 HU) opacities. Separately, whole lung radiomics were obtained for all CT exams. Analysis of variance and multiple logistic regression were performed for data analysis.RESULTS: Moderate to severe respiratory motion artifacts affected nearly one-quarter of chest CTs in patients. Subjective severity assessment, DL-based features and radiomics predicted patient outcome (AUC 0.76 vs AUC 0.88 vs AUC 0.83) and need for ICU admission (AUC 0.77 vs AUC 0.0.80 vs 0.82). Excluding chest CT with motion artifacts, the performance of DL-based and radiomics features improve for predicting ICU admission.CONCLUSION: DL-based and radiomics features of pulmonary opacities from chest CT were superior to subjective assessment for differentiating patients with favorable and adverse outcomes.

The ability of 3-D reconstruction has been a key element for the modern use of cardiovascular CT. Importantly, complex image reconstruction is performed by several users, including imaging specialist/radiologist and clinical interventionalist/surgeon. Imaging and image review/reconstruction are increasingly part of a stepwise decision-making process, transforming traditional single-observer reading and reporting to a process involving a team of interdisciplinary clinical specialists. This trend is observed in several subspecialties including oncology and cardiovascular medicine. These developments require a new level of data accessibility and performance of imaging systems, including ability to share data within large healthcare systems. It is supported by novel developments of IT architecture, allowing sharing of a centrally stored dataset between multiple peripheral workstations. Connection of scanners and workstations into a network or “cloud” with integration into the entire electronic health record (EHR) allows exchange of information across healthcare systems and supports multidisciplinary teams working on defined clinical workflows. These “cloud” systems are transforming clinical workflows, exemplified by the examples of acute aortic syndromes (AAS) and transcatheter aortic valve replacement (TAVR), where CT imaging has a central role. However, experience is limited, and further evaluation of the appropriate infrastructure including requirement for reliable patient identification between provider organizations and data safety is critical. Eventually the potential clinical impact needs to be evaluated in clinical trials.

Cardiovascular computed tomography (CT) routinely acquires volumetric datasets with large numbers of axial slices. While review of the axial slices remains an important part of the image analysis, a critical step is detailed reconstruction of multiple oblique planes and volumes on an advanced 3D workstation (1). This is performed by a combination of manual and (semi)-automated reconstruction along oblique planes, vascular centerlines, and volumes. This analysis results in a large number of discrete qualitative and quantitative data-points and is increasingly supported by dedicated, “smart” software.