Performance of deep learning-based autodetection of arterial stenosis on head and neck CT angiography: an independent external validation study.

PURPOSE: To externally validate the performance of automated stenosis detection on head and neck CT angiography (CTA) and investigate the impact factors using an independent bi-center dataset with digital subtraction angiography (DSA) as the ground truth. MATERIAL AND METHODS: Patients who underwent head and neck CTA and DSA between January 2019 and December 2021 were retrospectively included. The degree of stenosis was automatically evaluated using CerebralDoc based on CTA. The performance of CerebralDoc across levels (per-patient, per-region, per-vessel, and per-segment) and thresholds (≥ 50%, ≥ 70%, and = 100%) was evaluated. Logistic regression was performed to identify independent factors associated with false negative results. RESULTS: 296 patients were analyzed. Specificity across levels and thresholds was high, exceeding 92%. The area under the curve ranged from poor (0.615, 95% CI: 0.544, 0.686; at the region-based analysis for stenosis ≥ 70%) to excellent (0.945, 95% CI: 0.905, 0.985; at the patient-based analysis for stenosis ≥ 50%). Sensitivity ranged from 0.714 (95% CI: 0.675, 0.750) at the segment-based analysis for stenosis ≥ 70% to 0.895 (95% CI: 0.849, 0.919) at the patient-based analysis for stenosis ≥ 50%. The multiple logistic regression analysis revealed that false negative results were primarily more likely to specific stenosis locations (particularly the M2 segment and skull base segment of the internal carotid artery) and occlusion. CONCLUSIONS: CerebralDoc has the potential to automated stenosis detection on head and neck CTA, but further efforts are needed to optimize its performance.