Automatic coronary plaque detection, classification, and stenosis grading using deep learning and radiomics on computed tomography angiography images: a multi-center multi-vendor study

ObjectivesAn automatic system utilizing both the advantages of the neural network and the radiomics was proposed for coronary plaque detection, classification, and stenosis grading.MethodsThis study retrospectively included 505 patients with 127,763 computed tomography angiography (CTA) images from 5 medical center. A convolutional neural network (CNN) model was used to segment the coronary artery, detect the plaque candidate, and extract the image patch with high computation efficiency. The manually designed radiomics feature extractor was utilized to collect plaque patterns, followed by the different classifiers to perform the plaque classification and stenosis grading.ResultsThe CNN model achieved 100% of sensitivity and the highest positive predictive value (83.9%) than U-Net and baseline model in plaque candidate detection. Twenty-six representative radiomics features were selected to construct the classifiers. Among different models, the gradient-boosting decision tree (GBDT) achieved the best performance in plaque classification (accuracy: 87.0%, sensitivity: 83.2%, specificity: 91.4%) and stenosis grading (accuracy: 90.9%, sensitivity: 84.1%, specificity: 95.7%). GBDT also achieved the highest AUC of 0.873 in plaque classification and 0.910 in stenosis grading. The computation time of processing one patient was 56.2 ± 5.7 s which was significantly less than radiologist manual analysis (285.6 ± 134.5 s, p = 0.0001).ConclusionsIn this study, an automatic workflow was proposed to detect and analyze coronary plaques with high accuracy and efficiency, showing the potential in clinical application.Key Points • The proposed automatic system integrated deep learning and radiomics to perform the coronary plaque analysis. • The proposed automatic system achieved high accuracy in both plaque classification and stenosis grading. • The proposed automatic system was five times more efficient than radiologist manual analysis.