Automatic characterization of myocardial perfusion imaging polar maps employing deep learning and data augmentation

OBJECTIVETo investigate a deep learning technique, more specifically state-of-the-art convolutional neural networks (CNN), for automatic characterization of polar maps derived from myocardial perfusion imaging (MPI) studies for the diagnosis of coronary artery disease. SUBJECTS AND METHODSStress and rest polar maps corresponding to 216 patient cases from the database of the department of Nuclear Medicine of our institution were analyzed. Both attenuation-corrected (AC) and non-corrected (NAC) images were included. All patients were subjected to invasive coronary angiography within 60 days from MPI. As the initial dataset of this study was small to train a deep learning model from scratch, two strategies were followed. The first is called transfer learning. For this, we employed the state-of-the-art CNN called VGG16, which has been broadly exploited in medical imaging classification tasks. The second strategy involves data augmentation, which is achieved by the rotation of the polar maps, to expand the training set. We evaluated VGG16 with 10-fold cross-validation on the original set of images performing separate experiments for AC and NAC polar maps, as well as for their combination. The results were compared to the standard semi-quantitative polar map analysis based on summed stress and summed difference scores, as well as to the medical experts' diagnostic yield. RESULTSWith reference to the findings of coronary angiography, VGG16 achieved an accuracy of 74.53%, sensitivity 75.00% and specificity 73.43% when the AC and NAC polar maps were incorporated into one single image set. Respective figures of MPI interpretation by experienced Nuclear Medicine physicians were 75.00%, 76.97% and 70.31%. The accuracy of semi-quantitative polar map analysis was lower, 66.20% and 64.81% for AC and NAC technique, respectively. CONCLUSIONThe proposed deep learning model with data augmentation techniques performed better than the conventional semi-quantitative polar map analysis and competed with doctor's expertise in this particular patient cohort and image set. The model could potentially serve as an assisting tool to support interpretation of MPI studies or could be used for teaching purposes.