AI-based diagnosis of acute aortic syndrome from noncontrast CT.
Authors
Affiliations (28)
Affiliations (28)
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
- DAMO Academy, Alibaba Group, Hangzhou, China.
- Hupan Laboratory, Hangzhou, China.
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China.
- Department of Vascular Surgery, Ningbo No.2 Hospital, Ningbo, China.
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing, China.
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
- Department of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
- Department of Vascular Surgery, Shaoxing Central Hospital, Shaoxing, China.
- Polytechnic Institute of Zhejiang University, Hangzhou, China.
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Taizhou, China.
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
- Department of Emergency, The Second People's Hospital of Chun'an County, Hangzhou, China.
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- DAMO Academy, Alibaba Group, New York, NY, USA.
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. [email protected].
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing, China. [email protected].
- Department of Radiology, Shanghai Changhai Hospital, Shanghai, China. [email protected].
- Department of Radiology, Shanghai Changhai Hospital, Shanghai, China. [email protected].
- Department of Vascular Surgery, Shaoxing Central Hospital, Shaoxing, China. [email protected].
- Department of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China. [email protected].
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China. [email protected].
- DAMO Academy, Alibaba Group, Hangzhou, China. [email protected].
- Hupan Laboratory, Hangzhou, China. [email protected].
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. [email protected].
- Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. [email protected].
Abstract
The accurate and timely diagnosis of acute aortic syndrome (AAS) in patients presenting with acute chest pain remains a clinical challenge. Aortic computed tomography (CT) angiography is the imaging protocol of choice in patients with suspected AAS. However, due to economic and workflow constraints in China, the majority of suspected patients initially undergo noncontrast CT as the initial imaging testing, and CT angiography is reserved for those at higher risk. Although noncontrast CT can reveal specific signs indicative of AAS, its diagnostic efficacy when used alone has not been well characterized. Here we present an artificial intelligence-based warning system, iAorta, using noncontrast CT for AAS identification in China, which demonstrates remarkably high accuracy and provides clinicians with interpretable warnings. iAorta was evaluated through a comprehensive step-wise study. In the multicenter retrospective study (n = 20,750), iAorta achieved a mean area under the receiver operating curve of 0.958 (95% confidence interval 0.950-0.967). In the large-scale real-world study (n = 137,525), iAorta demonstrated consistently high performance across various noncontrast CT protocols, achieving a sensitivity of 0.913-0.942 and a specificity of 0.991-0.993. In the prospective comparative study (n = 13,846), iAorta demonstrated the capability to significantly shorten the time to correct diagnostic pathway for patients with initial false suspicion from an average of 219.7 (115-325) min to 61.6 (43-89) min. Furthermore, for the prospective pilot deployment that we conducted, iAorta correctly identified 21 out of 22 patients with AAS among 15,584 consecutive patients presenting with acute chest pain and under noncontrast CT protocol in the emergency department. For these 21 AAS-positive patients, the average time to diagnosis was 102.1 (75-133) min. Finally, iAorta may help prevent delayed or missed diagnoses of AAS in settings where noncontrast CT remains the only feasible initial imaging modality-such as in resource-limited regions or in patients who cannot receive, or did not receive, intravenous contrast.