Journal Article

Disease Staging and Prognosis in Smokers Using Deep Learning in Chest Computed Tomography

Vegas-Sánchez-Ferrero, Gonzalo, Onieva Onieva, Jorge, Ross, James C., San José Estépar, Raúl, Díaz, Alejandro, Ash, Samuel Y., Rahaghi, Farbod N., Washko, George R., González, Germán

2018

Overview

Deep learning is a powerful tool that may allow for improved outcome prediction. To determine if deep learning, specifically convolutional neural network (CNN) analysis, could detect and stage chronic obstructive pulmonary disease (COPD) and predict acute respiratory disease (ARD) events and mortality in smokers. A CNN was trained using computed tomography scans from 7,983 COPDGene participants and evaluated using 1,000 nonoverlapping COPDGene participants and 1,672 ECLIPSE participants. Logistic regression (C statistic and the Hosmer-Lemeshow test) was used to assess COPD diagnosis and ARD prediction. Cox regression (C index and the Greenwood-Nam-D'Agnostino test) was used to assess mortality. In COPDGene, the C statistic for the detection of COPD was 0.856. A total of 51.1% of participants in COPDGene were accurately staged and 74.95% were within one stage. In ECLIPSE, 29.4% were accurately staged and 74.6% were within one stage. In COPDGene and ECLIPSE, the C statistics for ARD events were 0.64 and 0.55, respectively, and the Hosmer-Lemeshow P values were 0.502 and 0.380, respectively, suggesting no evidence of poor calibration. In COPDGene and ECLIPSE, CNN predicted mortality with fair discrimination (C indices, 0.72 and 0.60, respectively), and without evidence of poor calibration (Greenwood-Nam-D'Agnostino P values, 0.307 and 0.331, respectively). A deep-learning approach that uses only computed tomography imaging data can identify those smokers who have COPD and predict who are most likely to have ARD events and those with the highest mortality. At a population level CNN analysis may be a powerful tool for risk assessment.

• Publisher: Oxford University Press,American Thoracic Society
• Subject: Aged / Artificial intelligence / Chronic obstructive pulmonary disease / Databases, Factual / Deep Learning / Female / Health risk assessment / Humans / Logistic Models / Male / Medical imaging / Medical prognosis / Medical screening / Middle Aged / Mortality / Original / Predictive Value of Tests / Prognosis / Pulmonary Disease, Chronic Obstructive - diagnostic imaging / Pulmonary Disease, Chronic Obstructive - epidemiology / Pulmonary Disease, Chronic Obstructive - genetics / Respiratory diseases / Respiratory Distress Syndrome - diagnostic imaging / Respiratory Distress Syndrome - epidemiology / Respiratory Distress Syndrome - genetics / Respiratory Function Tests / Risk Assessment / Severity of Illness Index / Smoking - adverse effects / Smoking - epidemiology / Survival Rate / Tomography / Tomography, X-Ray Computed - methods / Tuberculosis