Integration of clinical and imaging data to predict the presence of coronary artery disease with the use of neural networks

In Brief Aim To establish proof of the principle that a computer-based neural network method can be employed that will enhance diagnostic accuracy vis-à-vis image analysis alone in the interpretation of treadmill exercise tests performed in conjunction with myocardial perfusion imaging. Materials and methods One-hundred-and-two patients underwent myocardial perfusion imaging in association with the standard Bruce protocol. Twenty objective parameters describing each patient's exercise physiology, general clinical status and image appearance were used to train an artificial neural network. Classification accuracy of the neural network and clinical interpretation was determined by coronary angiography. We evaluated the ability of the neural network to integrate clinical, exercise and imaging data to determine the likelihood of coronary artery disease and compared these results with an optimized method of clinical image interpretation, which made use of all available clinical, angiographic and stress test data. Results The artificial neural network had a sensitivity of 88% and a specificity of 65% for detection of ischemic heart disease and was comparable to that of the optimized clinical method (sensitivity 80%, specificity 69%). Incorporation of clinical and exercise data significantly improved the predictive accuracy of the network compared to a network based on image data alone (P<0.05). Conclusion The results show a computer-based neural network can perform as well as expert readers working under optimal conditions including full knowledge of the patient's clinical, prior angiographic and stress test data. Thus, the method is promising as a diagnostic aid to the recognition of ischemic heart disease in the clinical setting of treadmill exercise testing in conjunction with myocardial perfusion imaging. A computer-based artificial intelligence neural network was developed to integrate clinical, exercise and imaging data from radionuclide stress testing and thereby obtain an objective, reliable, reproducible method for interpretation of these tests which could be used by anyone with a personal computer. The artificial intelligence method showed a sensitivity of 88% and a specificity of 65% for the diagnosis of ischemic heart disease and was comparable to that of our standard clinical method (sensitivity 80%, specificity 69%), which employs dual expert readers with full access to all relevant clinical information. Incorporation of clinical/exercise data significantly improved predictive accuracy of the network over that of a network constructed using image data alone (Z=2.26, p<05). Finally, the neural network performed as well as the expert readers in the diagnosis of 1, 2 and 3 vessel disease and in identification of the specific coronary vessel(s) involved.