"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. ©RSNA, 2024.

The newly publicly available University of California San Francisco Preoperative Diffuse Glioma MRI dataset, consisting of 501 patients with grade 2–4 diffuse gliomas, includes standardized 3-T thr... Supplemental material is available for this article. Keywords: Informatics, MR Diffusion Tensor Imaging, MR Perfusion, MR Imaging, Neuro-Oncology, CNS, Brain/Brain Stem, Oncology, Radiogenomics, Ra...

Pneumothorax can precipitate a life-threatening emergency due to lung collapse and respiratory or circulatory distress. Pneumothorax is typically detected on chest X-ray; however, treatment is reliant on timely review of radiographs. Since current imaging volumes may result in long worklists of radiographs awaiting review, an automated method of prioritizing X-rays with pneumothorax may reduce time to treatment. Our objective was to create a large human-annotated dataset of chest X-rays containing pneumothorax and to train deep convolutional networks to screen for potentially emergent moderate or large pneumothorax at the time of image acquisition. In all, 13,292 frontal chest X-rays (3,107 with pneumothorax) were visually annotated by radiologists. This dataset was used to train and evaluate multiple network architectures. Images showing large- or moderate-sized pneumothorax were considered positive, and those with trace or no pneumothorax were considered negative. Images showing small pneumothorax were excluded from training. Using an internal validation set (n = 1,993), we selected the 2 top-performing models; these models were then evaluated on a held-out internal test set based on area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and positive predictive value (PPV). The final internal test was performed initially on a subset with small pneumothorax excluded (as in training; n = 1,701), then on the full test set (n = 1,990), with small pneumothorax included as positive. External evaluation was performed using the National Institutes of Health (NIH) ChestX-ray14 set, a public dataset labeled for chest pathology based on text reports. All images labeled with pneumothorax were considered positive, because the NIH set does not classify pneumothorax by size. In internal testing, our “high sensitivity model” produced a sensitivity of 0.84 (95% CI 0.78–0.90), specificity of 0.90 (95% CI 0.89–0.92), and AUC of 0.94 for the test subset with small pneumothorax excluded. Our “high specificity model” showed sensitivity of 0.80 (95% CI 0.72–0.86), specificity of 0.97 (95% CI 0.96–0.98), and AUC of 0.96 for this set. PPVs were 0.45 (95% CI 0.39–0.51) and 0.71 (95% CI 0.63–0.77), respectively. Internal testing on the full set showed expected decreased performance (sensitivity 0.55, specificity 0.90, and AUC 0.82 for high sensitivity model and sensitivity 0.45, specificity 0.97, and AUC 0.86 for high specificity model). External testing using the NIH dataset showed some further performance decline (sensitivity 0.28–0.49, specificity 0.85–0.97, and AUC 0.75 for both). Due to labeling differences between internal and external datasets, these findings represent a preliminary step towards external validation. We trained automated classifiers to detect moderate and large pneumothorax in frontal chest X-rays at high levels of performance on held-out test data. These models may provide a high specificity screening solution to detect moderate or large pneumothorax on images collected when human review might be delayed, such as overnight. They are not intended for unsupervised diagnosis of all pneumothoraces, as many small pneumothoraces (and some larger ones) are not detected by the algorithm. Implementation studies are warranted to develop appropriate, effective clinician alerts for the potentially critical finding of pneumothorax, and to assess their impact on reducing time to treatment.

This dataset is composed of annotations of the five hemorrhage subtypes (subarachnoid, intraventricular, subdural, epidural, and intraparenchymal hemorrhage) typically encountered at brain CT.

Coronary artery disease (CAD), the most common manifestation of cardiovascular disease, remains the most common cause of mortality in the United States. Risk assessment is key for primary prevention of coronary events and coronary artery calcium (CAC) scoring using computed tomography (CT) is one such non-invasive tool. Despite the proven clinical value of CAC, the current clinical practice implementation for CAC has limitations such as the lack of insurance coverage for the test, need for capital-intensive CT machines, specialized imaging protocols, and accredited 3D imaging labs for analysis (including personnel and software). Perhaps the greatest gap is the millions of patients who undergo routine chest CT exams and demonstrate coronary artery calcification, but their presence is not often reported or quantitation is not feasible. We present two deep learning models that automate CAC scoring demonstrating advantages in automated scoring for both dedicated gated coronary CT exams and routine non-gated chest CTs performed for other reasons to allow opportunistic screening. First, we trained a gated coronary CT model for CAC scoring that showed near perfect agreement (mean difference in scores = −2.86; Cohen’s Kappa = 0.89, P < 0.0001) with current conventional manual scoring on a retrospective dataset of 79 patients and was found to perform the task faster (average time for automated CAC scoring using a graphics processing unit (GPU) was 3.5 ± 2.1 s vs. 261 s for manual scoring) in a prospective trial of 55 patients with little difference in scores compared to three technologists (mean difference in scores = 3.24, 5.12, and 5.48, respectively). Then using CAC scores from paired gated coronary CT as a reference standard, we trained a deep learning model on our internal data and a cohort from the Multi-Ethnic Study of Atherosclerosis (MESA) study (total training n = 341, Stanford test n = 42, MESA test n = 46) to perform CAC scoring on routine non-gated chest CT exams with validation on external datasets (total n = 303) obtained from four geographically disparate health systems. On identifying patients with any CAC (i.e., CAC ≥ 1), sensitivity and PPV was high across all datasets (ranges: 80–100% and 87–100%, respectively). For CAC ≥ 100 on routine non-gated chest CTs, which is the latest recommended threshold to initiate statin therapy, our model showed sensitivities of 71–94% and positive predictive values in the range of 88–100% across all the sites. Adoption of this model could allow more patients to be screened with CAC scoring, potentially allowing opportunistic early preventive interventions.