Abstract Background Artificial intelligence (AI) systems, in particular neural networks (NN), have been developed to detect lesions in wireless capsule endoscopy (WCE) in patients with Crohn’s disease (CD) in order to ease their reading. Despite acceptable performance on individual images, these tools do not analyze entire videos and require a large amount of labeled data. Active learning (AL) methods have already been used, proving their ability to limit labeling cost without reducing NN performance. The aim of this study was to evaluate several AL models in order to train an AI system able to differentiate normal and pathological entire videos with a limited labeled dataset. Methods Firstly, 76 WCEs of CD patients were used to automate the detection of the first and last image of the small bowel. They were identified by an expert and then used for training, validation and test of a NN. The model associated with the Viterbi algorithm predicted boundaries location and was compared with expert annotations. Secondly, 4286 images from the Crohn-IPI database¹ were used to train another NN to classify pathological or normal images. An image was considered pathological if it contained erythema, oedema, ulceration or stenosis. Four AL models with several selection criteria² were tested on a limited labeled dataset and their classification performance (normal/pathological image) was evaluated. Finally, 42 WCEs were used to assess performance of a pre-trained AL model to predict the normal or pathological nature of entire videos. Results Overall, the model detected the pylorus compared with experts with a median deviation (IQR) of 3 images (66.5) and the last ileal image with a median deviation of 98 images (336). A history of ileocolic resection non-significantly impaired the last ileal image location, with a median difference of 203 images (812, p=0.59). None of the four AL models showed superiority in classifying pathological or normal image, with a sensitivity of 60% and a specificity of 98%. Finally, the AL pre-trained NN assessed the pathological/normal status of entire videos with a sensitivity of 83% and a specificity of 50%. Conclusion Our study suggests the feasibility and efficiency of NN to identify the first and last image of the small bowel on CD patients WCE. Performances of the four AL models were similar but remained sufficient given the small amount of labeled data used. Prediction of the pathological/normal status of entire videos by AI systems seems feasible, but requires optimization to obtain acceptable results for current practice. 1. De Maissin A et al. Multi-expert annotation of Crohn's disease(...) neural network, Endosc IntOpen(2021) 2. Wang K et al. Cost-Effective Active Learning for Deep Image Classification, IEEE (...) Technology(2017)
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