Roadmap on the use of artificial intelligence for imaging of vulnerable atherosclerotic plaque in coronary arteries.

Artificial intelligence (AI) is likely to revolutionize the way medical images are analysed and has the potential to improve the identification and analysis of vulnerable or high-risk atherosclerotic plaques in coronary arteries, leading to advances in the treatment of coronary artery disease. However, coronary plaque analysis is challenging owing to cardiac and respiratory motion, as well as the small size of cardiovascular structures. Moreover, the analysis of coronary imaging data is time-consuming, can be performed only by clinicians with dedicated cardiovascular imaging training, and is subject to considerable interreader and intrareader variability. AI has the potential to improve the assessment of images of vulnerable plaque in coronary arteries, but requires robust development, testing and validation. Combining human expertise with AI might facilitate the reliable and valid interpretation of images obtained using CT, MRI, PET, intravascular ultrasonography and optical coherence tomography. In this Roadmap, we review existing evidence on the application of AI to the imaging of vulnerable plaque in coronary arteries and provide consensus recommendations developed by an interdisciplinary group of experts on AI and non-invasive and invasive coronary imaging. We also outline future requirements of AI technology to address bias, uncertainty, explainability and generalizability, which are all essential for the acceptance of AI and its clinical utility in handling the anticipated growing volume of coronary imaging procedures.

Active multitask learning with uncertainty-weighted loss for coronary calcium scoring.

PURPOSE: The coronary artery calcification (CAC) score is an independent marker for the risk of cardiovascular events. Automatic methods for quantifying CAC could reduce workload and assist radiologists in clinical decision-making. However, large annotated datasets are needed for training to achieve very good model performance, which is an expensive process and requires expert knowledge. The number of training data required can be reduced in an active learning scenario, which requires only the most informative samples to be labeled. Multitask learning techniques can improve model performance by joint learning of multiple related tasks and extraction of shared informative features. METHODS: We propose an uncertainty-weighted multitask learning model for coronary calcium scoring in electrocardiogram-gated (ECG-gated), noncontrast-enhanced cardiac calcium scoring CT. The model was trained to solve the two tasks of coronary artery region segmentation (weak labels) and coronary artery calcification segmentation (strong labels) simultaneously in an active learning scenario to improve model performance and reduce the number of samples needed for training. We compared our model with a single-task U-Net and a sequential-task model as well as other state-of-the-art methods. The model was evaluated on 1275 individual patients in three different datasets (DISCHARGE, CADMAN, orCaScore), and the relationship between model performance and various influencing factors (image noise, metal artifacts, motion artifacts, image quality) was analyzed. RESULTS: Joint learning of multiclass coronary artery region segmentation and binary coronary calcium segmentation improved calcium scoring performance. Since shared information can be learned from both tasks for complementary purposes, the model reached optimal performance with only 12% of the training data and one-third of the labeling time in an active learning scenario. We identified image noise as one of the most important factors influencing model performance along with anatomical abnormalities and metal artifacts. CONCLUSIONS: Our multitask learning approach with uncertainty-weighted loss improves calcium scoring performance by joint learning of shared features and reduces labeling costs when trained in an active learning scenario.