Machine learning for endoleak detection after endovascular aortic repair

Sci Rep. 2020 Oct 27;10(1):18343. doi: 10.1038/s41598-020-74936-7.

Abstract

Diagnosis of endoleak following endovascular aortic repair (EVAR) relies on manual review of multi-slice CT angiography (CTA) by physicians which is a tedious and time-consuming process that is susceptible to error. We evaluate the use of a deep neural network for the detection of endoleak on CTA for post-EVAR patients using a novel data efficient training approach. 50 CTAs and 20 CTAs with and without endoleak respectively were identified based on gold standard interpretation by a cardiovascular subspecialty radiologist. The Endoleak Augmentor, a custom designed augmentation method, provided robust training for the machine learning (ML) model. Predicted segmentation maps underwent post-processing to determine the presence of endoleak. The model was tested against 3 blinded general radiologists and 1 blinded subspecialist using a held-out subset (10 positive endoleak CTAs, 10 control CTAs). Model accuracy, precision and recall for endoleak diagnosis were 95%, 90% and 100% relative to reference subspecialist interpretation (AUC = 0.99). Accuracy, precision and recall was 70/70/70% for generalist1, 50/50/90% for generalist2, and 90/83/100% for generalist3. The blinded subspecialist had concordant interpretations for all test cases compared with the reference. In conclusion, our ML-based approach has similar performance for endoleak diagnosis relative to subspecialists and superior performance compared with generalists.

MeSH terms

  • Aged
  • Aorta / diagnostic imaging
  • Aorta / surgery*
  • Computed Tomography Angiography
  • Endoleak / diagnosis*
  • Endoleak / etiology
  • Endovascular Procedures / adverse effects*
  • Female
  • Humans
  • Machine Learning*
  • Male
  • Neural Networks, Computer
  • Reproducibility of Results