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Artificial intelligence-powered coronary artery disease diagnosis from SPECT myocardial perfusion imaging: a comprehensive deep learning study.

Hajianfar G, Gharibi O, Sabouri M, Mohebi M, Amini M, Yasemi MJ, Chehreghani M, Maghsudi M, Mansouri Z, Edalat-Javid M, Valavi S, Bitarafan Rajabi A, Salimi Y, Arabi H, Rahmim A, Shiri I, Zaidi H

pubmed logopapersJul 1 2025
Myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) is a well-established modality for noninvasive diagnostic assessment of coronary artery disease (CAD). However, the time-consuming and experience-dependent visual interpretation of SPECT images remains a limitation in the clinic. We aimed to develop advanced models to diagnose CAD using different supervised and semi-supervised deep learning (DL) algorithms and training strategies, including transfer learning and data augmentation, with SPECT-MPI and invasive coronary angiography (ICA) as standard of reference. A total of 940 patients who underwent SPECT-MPI were enrolled (281 patients included ICA). Quantitative perfusion SPECT (QPS) was used to extract polar maps of rest and stress states. We defined two different tasks, including (1) Automated CAD diagnosis with expert reader (ER) assessment of SPECT-MPI as reference, and (2) CAD diagnosis from SPECT-MPI based on reference ICA reports. In task 2, we used 6 strategies for training DL models. We implemented 13 different DL models along with 4 input types with and without data augmentation (WAug and WoAug) to train, validate, and test the DL models (728 models). One hundred patients with ICA as standard of reference (the same patients in task 1) were used to evaluate models per vessel and per patient. Metrics, such as the area under the receiver operating characteristics curve (AUC), accuracy, sensitivity, specificity, precision, and balanced accuracy were reported. DeLong and pairwise Wilcoxon rank sum tests were respectively used to compare models and strategies after 1000 bootstraps on the test data for all models. We also compared the performance of our best DL model to ER's diagnosis. In task 1, DenseNet201 Late Fusion (AUC = 0.89) and ResNet152V2 Late Fusion (AUC = 0.83) models outperformed other models in per-vessel and per-patient analyses, respectively. In task 2, the best models for CAD prediction based on ICA were Strategy 3 (a combination of ER- and ICA-based diagnosis in train data), WoAug InceptionResNetV2 EarlyFusion (AUC = 0.71), and Strategy 5 (semi-supervised approach) WoAug ResNet152V2 EarlyFusion (AUC = 0.77) in per-vessel and per-patient analyses, respectively. Moreover, saliency maps showed that models could be helpful for focusing on relevant spots for decision making. Our study confirmed the potential of DL-based analysis of SPECT-MPI polar maps in CAD diagnosis. In the automation of ER-based diagnosis, models' performance was promising showing accuracy close to expert-level analysis. It demonstrated that using different strategies of data combination, such as including those with and without ICA, along with different training methods, like semi-supervised learning, can increase the performance of DL models. The proposed DL models could be coupled with computer-aided diagnosis systems and be used as an assistant to nuclear medicine physicians to improve their diagnosis and reporting, but only in the LAD territory. Not applicable.

Integrating multi-scale information and diverse prompts in large model SAM-Med2D for accurate left ventricular ejection fraction estimation.

Wu Y, Zhao T, Hu S, Wu Q, Chen Y, Huang X, Zheng Z

pubmed logopapersJul 1 2025
Left ventricular ejection fraction (LVEF) is a critical indicator of cardiac function, aiding in the assessment of heart conditions. Accurate segmentation of the left ventricle (LV) is essential for LVEF calculation. However, current methods are often limited by small datasets and exhibit poor generalization. While leveraging large models can address this issue, many fail to capture multi-scale information and introduce additional burdens on users to generate prompts. To overcome these challenges, we propose LV-SAM, a model based on the large model SAM-Med2D, for accurate LV segmentation. It comprises three key components: an image encoder with a multi-scale adapter (MSAd), a multimodal prompt encoder (MPE), and a multi-scale decoder (MSD). The MSAd extracts multi-scale information at the encoder level and fine-tunes the model, while the MSD employs skip connections to effectively utilize multi-scale information at the decoder level. Additionally, we introduce an automated pipeline for generating self-extracted dense prompts and use a large language model to generate text prompts, reducing the user burden. The MPE processes these prompts, further enhancing model performance. Evaluations on the CAMUS dataset show that LV-SAM outperforms existing SOAT methods in LV segmentation, achieving the lowest MAE of 5.016 in LVEF estimation.

Automated vs manual cardiac MRI planning: a single-center prospective evaluation of reliability and scan times.

Glessgen C, Crowe LA, Wetzl J, Schmidt M, Yoon SS, Vallée JP, Deux JF

pubmed logopapersJul 1 2025
Evaluating the impact of an AI-based automated cardiac MRI (CMR) planning software on procedure errors and scan times compared to manual planning alone. Consecutive patients undergoing non-stress CMR were prospectively enrolled at a single center (August 2023-February 2024) and randomized into manual, or automated scan execution using prototype software. Patients with pacemakers, targeted indications, or inability to consent were excluded. All patients underwent the same CMR protocol with contrast, in breath-hold (BH) or free breathing (FB). Supervising radiologists recorded procedure errors (plane prescription, forgotten views, incorrect propagation of cardiac planes, and field-of-view mismanagement). Scan times and idle phase (non-acquisition portion) were computed from scanner logs. Most data were non-normally distributed and compared using non-parametric tests. Eighty-two patients (mean age, 51.6 years ± 17.5; 56 men) were included. Forty-four patients underwent automated and 38 manual CMRs. The mean rate of procedure errors was significantly (p = 0.01) lower in the automated (0.45) than in the manual group (1.13). The rate of error-free examinations was higher (p = 0.03) in the automated (31/44; 70.5%) than in the manual group (17/38; 44.7%). Automated studies were shorter than manual studies in FB (30.3 vs 36.5 min, p < 0.001) but had similar durations in BH (42.0 vs 43.5 min, p = 0.42). The idle phase was lower in automated studies for FB and BH strategies (both p < 0.001). An AI-based automated software performed CMR at a clinical level with fewer planning errors and improved efficiency compared to manual planning. Question What is the impact of an AI-based automated CMR planning software on procedure errors and scan times compared to manual planning alone? Findings Software-driven examinations were more reliable (71% error-free) than human-planned ones (45% error-free) and showed improved efficiency with reduced idle time. Clinical relevance CMR examinations require extensive technologist training, and continuous attention, and involve many planning steps. A fully automated software reliably acquired non-stress CMR potentially reducing mistake risk and increasing data homogeneity.

Deep learning model for low-dose CT late iodine enhancement imaging and extracellular volume quantification.

Yu Y, Wu D, Lan Z, Dai X, Yang W, Yuan J, Xu Z, Wang J, Tao Z, Ling R, Zhang S, Zhang J

pubmed logopapersJul 1 2025
To develop and validate deep learning (DL)-models that denoise late iodine enhancement (LIE) images and enable accurate extracellular volume (ECV) quantification. This study retrospectively included patients with chest discomfort who underwent CT myocardial perfusion + CT angiography + LIE from two hospitals. Two DL models, residual dense network (RDN) and conditional generative adversarial network (cGAN), were developed and validated. 423 patients were randomly divided into training (182 patients), tuning (48 patients), internal validation (92 patients) and external validation group (101 patients). LIE<sub>single</sub> (single-stack image), LIE<sub>averaging</sub> (averaging multiple-stack images), LIE<sub>RDN</sub> (single-stack image denoised by RDN) and LIE<sub>GAN</sub> (single-stack image denoised by cGAN) were generated. We compared image quality score, signal-to-noise (SNR) and contrast-to-noise (CNR) of four LIE sets. The identifiability of denoised images for positive LIE and increased ECV (> 30%) was assessed. The image quality of LIE<sub>GAN</sub> (SNR: 13.3 ± 1.9; CNR: 4.5 ± 1.1) and LIE<sub>RDN</sub> (SNR: 20.5 ± 4.7; CNR: 7.5 ± 2.3) images was markedly better than that of LIE<sub>single</sub> (SNR: 4.4 ± 0.7; CNR: 1.6 ± 0.4). At per-segment level, the area under the curve (AUC) of LIE<sub>RDN</sub> images for LIE evaluation was significantly improved compared with those of LIE<sub>GAN</sub> and LIE<sub>single</sub> images (p = 0.040 and p < 0.001, respectively). Meanwhile, the AUC and accuracy of ECV<sub>RDN</sub> were significantly higher than those of ECV<sub>GAN</sub> and ECV<sub>single</sub> at per-segment level (p < 0.001 for all). RDN model generated denoised LIE images with markedly higher SNR and CNR than the cGAN-model and original images, which significantly improved the identifiability of visual analysis. Moreover, using denoised single-stack images led to accurate CT-ECV quantification. Question Can the developed models denoise CT-derived late iodine enhancement high images and improve signal-to-noise ratio? Findings The residual dense network model significantly improved the image quality for late iodine enhancement and enabled accurate CT- extracellular volume quantification. Clinical relevance The residual dense network model generates denoised late iodine enhancement images with the highest signal-to-noise ratio and enables accurate quantification of extracellular volume.

Computed Tomography Advancements in Plaque Analysis: From Histology to Comprehensive Plaque Burden Assessment.

Catapano F, Lisi C, Figliozzi S, Scialò V, Politi LS, Francone M

pubmed logopapersJul 1 2025
Advancements in coronary computed tomography angiography (CCTA) facilitated the transition from traditional histological approaches to comprehensive plaque burden assessment. Recent updates in the European Society of Cardiology (ESC) guidelines emphasize CCTA's role in managing chronic coronary syndrome by enabling detailed monitoring of atherosclerotic plaque progression. Limitations of conventional CCTA, such as spatial resolution challenges in accurately characterizing plaque components like thin-cap fibroatheromas and necrotic lipid-rich cores, are addressed with photon-counting detector CT (PCD-CT) technology. PCD-CT offers enhanced spatial resolution and spectral imaging, improving the detection and characterization of high-risk plaque features while reducing artifacts. The integration of artificial intelligence (AI) in plaque analysis enhances diagnostic accuracy through automated plaque characterization and radiomics. These technological advancements support a comprehensive approach to plaque assessment, incorporating hemodynamic evaluations, morphological metrics, and AI-driven analysis, thereby enabling personalized patient care and improved prediction of acute clinical events.

Artificial Intelligence in CT Angiography for the Detection of Coronary Artery Stenosis and Calcified Plaque: A Systematic Review and Meta-analysis.

Du M, He S, Liu J, Yuan L

pubmed logopapersJul 1 2025
We aimed to evaluate the diagnostic performance of artificial intelligence (AI) in detecting coronary artery stenosis and calcified plaque on CT angiography (CTA), comparing its diagnostic performance with that of radiologists. A thorough search of the literature was performed using PubMed, Web of Science, and Embase, focusing on studies published until October 2024. Studies were included if they evaluated AI models in detecting coronary artery stenosis and calcified plaque on CTA. A bivariate random-effects model was employed to determine combined sensitivity and specificity. Study heterogeneity was assessed using I<sup>2</sup> statistics. The risk of bias was assessed using the revised quality assessment of diagnostic accuracy studies-2 tool, and the evidence level was graded using the Grading of Recommendations Assessment, Development and Evalutiuon (GRADE) system. Out of 1071 initially identified studies, 17 studies with 5560 patients and images were ultimately included for the final analysis. For coronary artery stenosis ≥50%, AI showed a sensitivity of 0.92 (95% CI: 0.88-0.95), specificity of 0.87 (95% CI: 0.80-0.92), and AUC of 0.96 (95% CI: 0.94-0.97), outperforming radiologists with sensitivity of 0.85 (95% CI: 0.67-0.94), specificity of 0.84 (95% CI: 0.62-0.94), and AUC of 0.91 (95% CI: 0.89-0.93). For stenosis ≥70%, AI achieved a sensitivity of 0.88 (95% CI: 0.70-0.96), specificity of 0.96 (95% CI: 0.90-0.99), and AUC of 0.98 (95% CI: 0.96-0.99). In calcified plaque detection, AI demonstrated a sensitivity of 0.93 (95% CI: 0.84-0.97), specificity of 0.94 (95% CI: 0.88-0.96), and AUC of 0.98 (95% CI: 0.96-0.99)." AI-based CT demonstrated superior diagnostic performance compared to clinicians in identifying ≥50% stenosis in coronary arteries and showed excellent diagnostic performance in recognizing ≥70% coronary artery stenosis and calcified plaque. However, limitations include retrospective study designs and heterogeneity in CTA technologies. Further external validation through prospective, multicenter trials is required to confirm these findings. The original findings of this research are included in the article. For additional inquiries, please contact the corresponding authors.

Neural networks with personalized training for improved MOLLI T<sub>1</sub> mapping.

Gkatsoni O, Xanthis CG, Johansson S, Heiberg E, Arheden H, Aletras AH

pubmed logopapersJul 1 2025
The aim of this study was to develop a method for personalized training of Deep Neural Networks by means of an MRI simulator to improve MOLLI native T<sub>1</sub> estimates relative to conventional fitting methods. The proposed Personalized Training Neural Network (PTNN) for T<sub>1</sub> mapping was based on a neural network which was trained with simulated MOLLI signals generated for each individual scan, taking into account both the pulse sequence parameters and the heart rate triggers of the specific healthy volunteer. Experimental data from eleven phantoms and ten healthy volunteers were included in the study. In phantom studies, agreement between T<sub>1</sub> reference values and those obtained with the PTNN yielded a statistically significant smaller bias than conventional fitting estimates (-26.69 ± 29.5ms vs. -65.0 ± 33.25ms, p < 0.001). For in vivo studies, T<sub>1</sub> estimates derived from the PTNN yielded higher T<sub>1</sub> values (1152.4 ± 25.8ms myocardium, 1640.7 ± 30.6ms blood) than conventional fitting (1050.8 ± 24.7ms myocardium, 1597.2 ± 39.9ms blood). For PTNN, shortening the acquisition time by eliminating the pause between inversion pulses yielded higher myocardial T<sub>1</sub> values (1162.2 ± 19.7ms with pause vs. 1127.1 ± 19.7ms, p = 0.01 myocardium), (1624.7 ± 33.9ms with pause vs. 1645.4 ± 18.7ms, p = 0.16 blood). For conventional fitting statistically significant differences were found. Compared to T<sub>1</sub> maps derived by conventional fitting, PTNN is a post-processing method that yielded T<sub>1</sub> maps with higher values and better accuracy in phantoms for a physiological range of T<sub>1</sub> and T<sub>2</sub> values. In normal volunteers PTNN yielded higher T<sub>1</sub> values even with a shorter acquisition scheme of eight heartbeats scan time, without deploying new pulse sequences.

Deep Learning and Radiomics Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion using CTA.

Zhou Z, Bo K, Gao Y, Zhang W, Zhang H, Chen Y, Chen Y, Wang H, Zhang N, Huang Y, Mao X, Gao Z, Zhang H, Xu L

pubmed logopapersJul 1 2025
Coronary chronic total occlusion (CTO) and subtotal occlusion (STO) pose diagnostic challenges, differing in treatment strategies. Artificial intelligence and radiomics are promising tools for accurate discrimination. This study aimed to develop deep learning (DL) and radiomics models using coronary computed tomography angiography (CCTA) to differentiate CTO from STO lesions and compare their performance with that of the conventional method. CTO and STO were identified retrospectively from a tertiary hospital and served as training and validation sets for developing and validating the DL and radiomics models to distinguish CTO from STO. An external test cohort was recruited from two additional tertiary hospitals with identical eligibility criteria. All participants underwent CCTA within 1 month before invasive coronary angiography. A total of 581 participants (mean age, 50 years ± 11 [SD]; 474 [81.6%] men) with 600 lesions were enrolled, including 403 CTO and 197 STO lesions. The DL and radiomics models exhibited better discrimination performance than the conventional method, with areas under the curve of 0.908 and 0.860, respectively, vs. 0.794 in the validation set (all p<0.05), and 0.893 and 0.827, respectively, vs. 0.746 in the external test set (all p<0.05). The proposed CCTA-based DL and radiomics models achieved efficient and accurate discrimination of coronary CTO and STO.

Enhanced diagnostic and prognostic assessment of cardiac amyloidosis using combined <sup>11</sup>C-PiB PET/CT and <sup>99m</sup>Tc-DPD scintigraphy.

Hong Z, Spielvogel CP, Xue S, Calabretta R, Jiang Z, Yu J, Kluge K, Haberl D, Nitsche C, Grünert S, Hacker M, Li X

pubmed logopapersJul 1 2025
Cardiac amyloidosis (CA) is a severe condition characterized by amyloid fibril deposition in the myocardium, leading to restrictive cardiomyopathy and heart failure. Differentiating between amyloidosis subtypes is crucial due to distinct treatment strategies. The individual conventional diagnostic methods lack the accuracy needed for effective subtype identification. This study aimed to evaluate the efficacy of combining <sup>11</sup>C-PiB PET/CT and <sup>99m</sup>Tc-DPD scintigraphy in detecting CA and distinguishing between its main subtypes, light chain (AL) and transthyretin (ATTR) amyloidosis while assessing the association of imaging findings with patient prognosis. We retrospectively evaluated the diagnostic efficacy of combining <sup>11</sup>C-PiB PET/CT and <sup>99m</sup>Tc-DPD scintigraphy in a cohort of 50 patients with clinical suspicion of CA. Semi-quantitative imaging markers were extracted from the images. Diagnostic performance was calculated against biopsy results or genetic testing. Both machine learning models and a rationale-based model were developed to detect CA and classify subtypes. Survival prediction over five years was assessed using a random survival forest model. Prognostic value was assessed using Kaplan-Meier estimators and Cox proportional hazards models. The combined imaging approach significantly improved diagnostic accuracy, with <sup>11</sup>C-PiB PET and <sup>99m</sup>Tc-DPD scintigraphy showing complementary strengths in detecting AL and ATTR, respectively. The machine learning model achieved an AUC of 0.94 (95% CI 0.93-0.95) for CA subtype differentiation, while the rationale-based model demonstrated strong diagnostic ability with AUCs of 0.95 (95% CI 0.88-1.00) for ATTR and 0.88 (95% CI 0.770-0.961) for AL. Survival prediction models identified key prognostic markers, with significant stratification of overall mortality based on predicted survival (p value = 0.006; adj HR 2.43 [95% CI 1.03-5.71]). The integration of <sup>11</sup>C-PiB PET/CT and <sup>99m</sup>Tc-DPD scintigraphy, supported by both machine learning and rationale-based models, enhances the diagnostic accuracy and prognostic assessment of cardiac amyloidosis, with significant implications for clinical practice.

Deep learning-based segmentation of T1 and T2 cardiac MRI maps for automated disease detection

Andreea Bianca Popescu, Andreas Seitz, Heiko Mahrholdt, Jens Wetzl, Athira Jacob, Lucian Mihai Itu, Constantin Suciu, Teodora Chitiboi

arxiv logopreprintJul 1 2025
Objectives Parametric tissue mapping enables quantitative cardiac tissue characterization but is limited by inter-observer variability during manual delineation. Traditional approaches relying on average relaxation values and single cutoffs may oversimplify myocardial complexity. This study evaluates whether deep learning (DL) can achieve segmentation accuracy comparable to inter-observer variability, explores the utility of statistical features beyond mean T1/T2 values, and assesses whether machine learning (ML) combining multiple features enhances disease detection. Materials & Methods T1 and T2 maps were manually segmented. The test subset was independently annotated by two observers, and inter-observer variability was assessed. A DL model was trained to segment left ventricle blood pool and myocardium. Average (A), lower quartile (LQ), median (M), and upper quartile (UQ) were computed for the myocardial pixels and employed in classification by applying cutoffs or in ML. Dice similarity coefficient (DICE) and mean absolute percentage error evaluated segmentation performance. Bland-Altman plots assessed inter-user and model-observer agreement. Receiver operating characteristic analysis determined optimal cutoffs. Pearson correlation compared features from model and manual segmentations. F1-score, precision, and recall evaluated classification performance. Wilcoxon test assessed differences between classification methods, with p < 0.05 considered statistically significant. Results 144 subjects were split into training (100), validation (15) and evaluation (29) subsets. Segmentation model achieved a DICE of 85.4%, surpassing inter-observer agreement. Random forest applied to all features increased F1-score (92.7%, p < 0.001). Conclusion DL facilitates segmentation of T1/ T2 maps. Combining multiple features with ML improves disease detection.
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