Novel Artificial Intelligence-Driven Infant Meningitis Screening From High-Resolution Ultrasound Imaging.

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Abstract

Infant meningitis can be a life-threatening disease and requires prompt and accurate diagnosis to prevent severe outcomes or death. Gold-standard diagnosis requires lumbar puncture (LP) to obtain and analyze cerebrospinal fluid (CSF). Despite being standard practice, LPs are invasive, pose risks for the patient and often yield negative results, either due to contamination with red blood cells from the puncture itself or because LPs are routinely performed to rule out a life-threatening infection, despite the disease's relatively low incidence. Furthermore, in low-income settings where incidence is the highest, LPs and CSF exams are rarely feasible, and suspected meningitis cases are generally treated empirically. There is a growing need for non-invasive, accurate diagnostic methods. We developed a three-stage deep learning framework using Neosonics ultrasound technology for 30 infants with suspected meningitis and a permeable fontanelle at three Spanish University Hospitals (from 2021 to 2023). In stage 1, 2194 images were processed for quality control using a vessel/non-vessel model, with a focus on vessel identification and manual removal of images exhibiting artifacts such as poor coupling and clutter. This refinement process resulted in a final cohort comprising 16 patients-6 cases (336 images) and 10 controls (445 images), yielding 781 images for the second stage. The second stage involved the use of a deep learning model to classify images based on a white blood cell count threshold (set at 30 cells/mm³) into control or meningitis categories. The third stage integrated explainable artificial intelligence (XAI) methods, such as Grad-CAM visualizations, alongside image statistical analysis, to provide transparency and interpretability of the model's decision-making process in our artificial intelligence-driven screening tool. Our approach achieved 96% accuracy in quality control and 93% precision and 92% accuracy in image-level meningitis detection, with an overall patient-level accuracy of 94%. It identified 6 meningitis cases and 10 controls with 100% sensitivity and 90% specificity, demonstrating only a single misclassification. The use of gradient-weighted class activation mapping-based XAI significantly enhanced diagnostic interpretability, and to further refine our insights we incorporated a statistics-based XAI approach. By analyzing image metrics such as entropy and standard deviation, we identified texture variations in the images attributable to the presence of cells, which improved the interpretability of our diagnostic tool. This study supports the efficacy of a multi-stage deep learning model for non-invasive screening of infant meningitis and its potential to guide the need for LPs. It also highlights the transformative potential of artificial intelligence in medical diagnostic screening for neonatal health care, paving the way for future research and innovations.

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