Deep Learning-based Approach for Automated Assessment of Interstitial Lung Disease in Systemic Sclerosis on CT Images

Abstract

Purpose: To develop a deep learning algorithm for the automatic assessment of the extent of systemic sclerosis (SSc)-related interstitial lung disease (ILD) on chest CT images.

Materials and methods: This retrospective study included 208 patients with SSc (median age, 57 years; 167 women) evaluated between January 2009 and October 2017. A multicomponent deep neural network (AtlasNet) was trained on 6888 fully annotated CT images (80% for training and 20% for validation) from 17 patients with no, mild, or severe lung disease. The model was tested on a dataset of 400 images from another 20 patients, independently partially annotated by three radiologist readers. The ILD contours from the three readers and the deep learning neural network were compared by using the Dice similarity coefficient (DSC). The correlation between disease extent obtained from the deep learning algorithm and that obtained by using pulmonary function tests (PFTs) was then evaluated in the remaining 171 patients and in an external validation dataset of 31 patients based on the analysis of all slices of the chest CT scan. The Spearman rank correlation coefficient (ρ) was calculated to evaluate the correlation between disease extent and PFT results.

Results: The median DSCs between the readers and the deep learning ILD contours ranged from 0.74 to 0.75, whereas the median DSCs between contours from radiologists ranged from 0.68 to 0.71. The disease extent obtained from the algorithm, by analyzing the whole CT scan, correlated with the diffusion lung capacity for carbon monoxide, total lung capacity, and forced vital capacity (ρ = -0.76, -0.70, and -0.62, respectively; P < .001 for all) in the dataset for the correlation with PFT results. The disease extents correlated with diffusion lung capacity for carbon monoxide, total lung capacity, and forced vital capacity were ρ = -0.65, -0.70, and -0.57, respectively, in the external validation dataset (P < .001 for all).

Conclusion: The developed algorithm performed similarly to radiologists for disease-extent contouring, which correlated with pulmonary function to assess CT images from patients with SSc-related ILD.Supplemental material is available for this article.© RSNA, 2020.

Figure 1:

Flowchart of patient cohort. ILD = interstitial lung disease, PFT = pulmonary function test, SSc = systemic sclerosis.

Figure 2:

Architecture of the AtlasNet framework. ReLU = rectified linear unit.

Figure 3:

Visual representation of the U-Net framework. Conv = conversion, max pool = max pooling, ReLU = rectified linear unit.

Figure 4:

Comparison between automated and manual segmentations in, A, a 52-year-old woman with systemic sclerosis–related interstitial lung disease and, B, a 38-year-old man with systemic sclerosis–related interstitial lung disease. Contouring of these diseased areas was similar as performed by the algorithm and the three radiologists.

Figure 5:

Relationship between systemic sclerosis–related interstitial lung disease extent measured by the algorithm and measurements from pulmonary function tests. DLCO = diffusion lung capacity for carbon monoxide, FVC = forced vital capacity, KCO = carbon monoxide transfer coefficient, TLC = total lung capacity.