학술논문
Deep Learning Analysis of Chest Radiographs to Triage Patients with Acute Chest Pain Syndrome.
Document Type
Academic Journal
Author
Kolossváry M; From the Cardiovascular Imaging Research Center (M.K., V.K.R., M.T.L.) and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114; Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.); Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.); and Cleerly Health, Denver, Colo (U.H.).; Raghu VK; From the Cardiovascular Imaging Research Center (M.K., V.K.R., M.T.L.) and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114; Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.); Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.); and Cleerly Health, Denver, Colo (U.H.).; Nagurney JT; From the Cardiovascular Imaging Research Center (M.K., V.K.R., M.T.L.) and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114; Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.); Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.); and Cleerly Health, Denver, Colo (U.H.).; Hoffmann U; From the Cardiovascular Imaging Research Center (M.K., V.K.R., M.T.L.) and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114; Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.); Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.); and Cleerly Health, Denver, Colo (U.H.).; Lu MT; From the Cardiovascular Imaging Research Center (M.K., V.K.R., M.T.L.) and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114; Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.); Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.); and Cleerly Health, Denver, Colo (U.H.).
Source
Publisher: Radiological Society of North America Country of Publication: United States NLM ID: 0401260 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-1315 (Electronic) Linking ISSN: 00338419 NLM ISO Abbreviation: Radiology Subsets: MEDLINE
Subject
Language
English
Abstract
Background Patients presenting to the emergency department (ED) with acute chest pain (ACP) syndrome undergo additional testing to exclude acute coronary syndrome (ACS), pulmonary embolism (PE), or aortic dissection (AD), often yielding negative results. Purpose To assess whether deep learning (DL) analysis of the initial chest radiograph may help triage patients with ACP syndrome more efficiently. Materials and Methods This retrospective study used electronic health records of patients with ACP syndrome at presentation who underwent a combination of chest radiography and additional cardiovascular or pulmonary imaging or stress tests at two hospitals (Massachusetts General Hospital [MGH], Brigham and Women's Hospital [BWH]) between January 2005 and December 2015. A DL model was trained on 23 005 patients from MGH to predict a 30-day composite end point of ACS, PE, AD, and all-cause mortality based on chest radiographs. Area under the receiver operating characteristic curve (AUC) was used to compare performance between models (model 1: age + sex; model 2: model 1 + conventional troponin or d-dimer positivity; model 3: model 2 + DL predictions) in internal and external test sets from MGH and BWH, respectively. Results At MGH, 5750 patients (mean age, 59 years ± 17 [SD]; 3329 men, 2421 women) were evaluated. Model 3, which included DL predictions, significantly improved discrimination of those with the composite outcome compared with models 2 and 1 (AUC, 0.85 [95% CI: 0.84, 0.86] vs 0.76 [95% CI: 0.74, 0.77] vs 0.62 [95% CI: 0.60 0.64], respectively; P < .001 for all). When using a sensitivity threshold of 99%, 14% (813 of 5750) of patients could be deferred from cardiovascular or pulmonary testing for differential diagnosis of ACP syndrome using model 3 compared with 2% (98 of 5750) of patients using model 2 ( P < .001). Model 3 maintained its diagnostic performance in different age, sex, race, and ethnicity groups. In external validation at BWH (22 764 patients; mean age, 57 years ± 17; 11 470 women), trends were similar and improved after fine tuning. Conclusion Deep learning analysis of chest radiographs may facilitate more efficient triage of patients with acute chest pain syndrome in the emergency department. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Goo in this issue.