Deep learning for pulmonary embolism detection on computed tomography pulmonary angiogram: a systematic review and meta-analysis

Shelly Soffer,Eyal Klang,Hayit Greenspana,Eli Konen,Orit Shimon,Yiftach Barash,Noa Cahan

doi:10.1038/s41598-021-95249-3

Abstract

Computed tomographic pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis. However, this diagnosis is susceptible to misdiagnosis. In this study, we aimed to perform a systematic review of current literature applying deep learning for the diagnosis of PE on CTPA. MEDLINE/PUBMED were searched for studies that reported on the accuracy of deep learning algorithms for PE on CTPA. The risk of bias was evaluated using the QUADAS-2 tool. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curves were plotted. Seven studies met our inclusion criteria. A total of 36,847 CTPA studies were analyzed. All studies were retrospective. Five studies provided enough data to calculate summary estimates. The pooled sensitivity and specificity for PE detection were 0.88 (95% CI 0.803–0.927) and 0.86 (95% CI 0.756–0.924), respectively. Most studies had a high risk of bias. Our study suggests that deep learning models can detect PE on CTPA with satisfactory sensitivity and an acceptable number of false positive cases. Yet, these are only preliminary retrospective works, indicating the need for future research to determine the clinical impact of automated PE detection on patient care. Deep learning models are gradually being implemented in hospital systems, and it is important to understand the strengths and limitations of these algorithms.

Highlights

Computed tomographic pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis
We present a short description of artificial intelligence (AI) fundamentals followed by a literature review evaluating studies that analyzed deep learning algorithms for PE on CTPA
The presented deep learning models provide an automatic approach for identifying PE on CTPA with a pooled sensitivity of 0.88 and specificity of 0.86

Summary

Introduction

Computed tomographic pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis. Our study suggests that deep learning models can detect PE on CTPA with satisfactory sensitivity and an acceptable number of false positive cases. These are only preliminary retrospective works, indicating the need for future research to determine the clinical impact of automated PE detection on patient care.

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Methods

Conclusion