A Fully Automatic AI-based CT Image Analysis System for Accurate Detection, Diagnosis, and Quantitative Severity Evaluation of Pulmonary Tuberculosis
Abstract Background: Accurate and rapid diagnosis of pulmonary tuberculosis (TB) plays a crucial role in timely prevention and appropriate medical treatment to the disease. This study aims to develop and evaluate an artificial intelligence (AI)-based fully automated CT image analysis system for detection, diagnosis, and burden quantification of pulmonary TB.Methods: From December 2007 to September 2020, 892 chest CT scans from pathogen-confirmed TB patients were retrospectively included. A deep learning based cascading framework was connected to create a processing pipeline. To train and validate the model, 1921 lesions were manually labeled, classified by six categories of critical imaging features, and visually scored for the lesion involvement as the ground truth. “TB score” was calculated by the network-activation map to assess the disease burden quantitively. Independent test datasets from two additional hospitals and NIH TB Portal were used to validate externally the performance of the AI model.Results: CT scans from 526 participants (mean age, 48.5 years±16.5; 206 women) were analyzed. The lung lesion detection subsystem yielded a mean average precision of 0.68 on the validation cohort. In the independent datasets, the overall classification accuracy for six pulmonary critical imaging findings indicative of TB were 81.08%-91.05%. A moderate to strong correlation was demonstrated between the AI model quantified “TB score” and the radiologist-estimated CT score.Conclusion: This end-to-end AI system based on chest CT can achieve human-level diagnostic performance, and holds great potential for early management and medical resource optimization of patients with pulmonary TB in clinical practice.