Automated classification of coronary LEsions fRom coronary computed Tomography angiography scans with an updated deep...

The use of deep learning models for quantitative measurements on coronary computed tomography angiography (CCTA) may reduce inter-reader variability and increase efficiency in clinical reporting. This study aimed to investigate the diagnostic performance of a recently updated deep learning model (CorEx-2.0) for quantifying coronary stenosis, compared separately with two expert CCTA readers as references.

This single-center retrospective study included 50 patients that underwent CCTA to rule out obstructive coronary artery disease between 2017-2022. Two expert CCTA readers and CorEx-2.0 independently assessed all 150 vessels using Coronary Artery Disease-Reporting and Data System (CAD-RADS). Inter-reader agreement analysis and diagnostic performance of CorEx-2.0, compared with each expert reader as references, were evaluated using percent agreement, Cohen's kappa for the binary CAD-RADS classification (CAD-RADS 0-3 versus 4-5) at patient level, and linearly weighted kappa for the 6-group CAD-RADS classification at vessel level.

Overall, 50 patients and 150 vessels were evaluated. Inter-reader agreement using the binary classification at patient level was 91.8% (45/49) with a Cohen's kappa of 0.80. For the 6-group classification at vessel level, inter-reader agreement was 67.6% (100/148) with a linearly weighted kappa of 0.77. CorEx-2.0 showed 100% sensitivity for detecting CAD-RADS ≥ 4 and kappa values of 0.86 versus both readers using the binary classification at patient level. For the 6-group classification at vessel level, CorEx-2.0 demonstrated weighted kappa values of 0.71 versus reader 1 and 0.73 versus reader 2.

CorEx-2.0 identified all patients with severe stenosis (CAD-RADS ≥ 4) compared with expert readers and approached expert reader performance at vessel level (weighted kappa > 0.70).

Question Can deep learning models improve objectivity in coronary stenosis grading and reporting as coronary CT angiography (CTA) workloads rise? Findings The deep learning model (CorEx-2.0) identified all patients with severe stenoses when compared with expert readers and approached expert reader performance at vessel level. Clinical relevance CorEx-2.0 is a reliable tool for identifying patients with severe stenoses (≥ 70%), underscoring the potential of using this deep learning model to prioritize coronary CTA reading by flagging patients at risk of severe obstructive coronary artery disease.