Introduction: Biomarker computation using deep-learning often relies on a two-step process, where the deep learning algorithm segments the region of interest and then the biomarker is measured. We propose an alternative paradigm, where the biomarker is estimated directly using a regression network. We showcase this image-tobiomarker paradigm using two biomarkers: the estimation of bone mineral density (BMD) and the estimation of lung percentage of emphysema from CT scans. Materials and methods: We use a large database of 9,925 CT scans to train, validate and test the network for which reference standard BMD and percentage emphysema have been already computed. First, the 3D dataset is reduced to a set of canonical 2D slices where the organ of interest is visible (either spine for BMD or lungs for emphysema). This data reduction is performed using an automatic object detector. Second, The regression neural network is composed of three convolutional layers, followed by a fully connected and an output layer. The network is optimized using a momentum optimizer with an exponential decay rate, using the root mean squared error as cost function. Results: The Pearson correlation coefficients obtained against the reference standards are r = 0.940 (p < 0.00001) and r = 0.976 (p < 0.00001) for BMD and percentage emphysema respectively. Conclusions: The deep-learning regression architecture can learn biomarkers from images directly, without indicating the structures of interest. This approach simplifies the development of biomarker extraction algorithms. The proposed data reduction based on object detectors conveys enough information to compute the biomarkers of interest.
Many automatic image analysis algorithms in medical imaging require a good initialization to work properly. A similar problem occurs in many imaging-based clinical workflows, which depend on anatomical landmarks. The localization of anatomic structures based on a defined context provides with a solution to that problem, which turns out to be more challenging in medical imaging where labeled images are difficult to obtain. We propose a two-stage process to detect and regress 2D bounding boxes of predefined anatomical structures based on a 2D surrounding context. First, we use a deep convolutional neural network (DCNN) architecture to detect the optimal slice where an anatomical structure is present, based on relevant landmark features. After this detection, we employ a similar architecture to perform a 2D regression with the aim of proposing a bounding box where the structure is encompassed. We trained and tested our system for 57 anatomical structures defined in axial, sagittal and coronal planes with a dataset of 504 labeled Computed Tomography (CT) scans. We compared our method with a well-known object detection algorithm (Viola Jones) and with the inter-rater error for two human experts. Despite the relatively small number of scans and the exhaustive number of structures analyzed, our method obtained promising and consistent results, which proves our architecture very generalizable to other anatomical structures.
Introduction: The Agatston score is a well-established metric of cardiovascular disease related to clinical outcomes. It is computed from CT scans by a) measuring the volume and intensity of the atherosclerotic plaques and b) aggregating such information in an index. Objective: To generate a convolutional neural network that inputs a non-contrast chest CT scan and outputs the Agatston score associated with it directly, without a prior segmentation of Coronary Artery Calcifications (CAC). Materials and methods: We use a database of 5973 non-contrast non-ECG gated chest CT scans where the Agatston score has been manually computed. The heart of each scan is cropped automatically using an object detector. The database is split in 4973 cases for training and 1000 for testing. We train a 3D deep convolutional neural network to regress the Agatston score directly from the extracted hearts. Results: The proposed method yields a Pearson correlation coefficient of r = 0.93; p ≤ 0.0001 against manual reference standard in the 1000 test cases. It further stratifies correctly 72.6% of the cases with respect to standard risk groups. This compares to more complex state-of-the-art methods based on prior segmentations of the CACs, which achieve r = 0.94 in ECG-gated pulmonary CT. Conclusions: A convolutional neural network can regress the Agatston score from the image of the heart directly, without a prior segmentation of the CACs. This is a new and simpler paradigm in the Agatston score computation that yields similar results to the state-of-the-art literature.
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