A systematic review on deep learning-enabled coronary CT angiography for plaque and stenosis quantification and cardiac risk prediction

Background: Coronary artery disease (CAD) is a major worldwide health concern, contributing significantly to the global burden of cardiovascular diseases (CVDs). According to the 2023 World Health Organization (WHO) report, CVDs account for approximately 17.9 million deaths annually. This emphasizies the need for advanced diagnostic tools such as coronary computed tomography angiography (CCTA). The incorporation of deep learning (DL) technologies could significantly improve CCTA analysis by automating the quantification of plaque and stenosis, thus enhancing the precision of cardiac risk assessments. A recent meta-analysis highlights the evolving role of CCTA in patient management, showing that CCTA-guided diagnosis and management reduced adverse cardiac events and improved event-free survival in patients with stable and acute coronary syndromes. Methods: An extensive literature search was carried out across various electronic databases, such as MEDLINE, Embase, and the Cochrane Library. This search utilized a specific strategy that included both Medical Subject Headings (MeSH) terms and pertinent keywords. The review adhered to PRISMA guidelines and focused on studies published between 2019 and 2024 that employed deep learning (DL) for coronary computed tomography angiography (CCTA) in patients aged 18 years or older. After implementing specific inclusion and exclusion criteria, a total of 10 articles were selected for systematic evaluation regarding quality and bias. Results: This systematic review included a total of 10 studies, demonstrating the high diagnostic performance and predictive capabilities of various deep learning models compared to different imaging modalities. This analysis highlights the effectiveness of these models in enhancing diagnostic accuracy in imaging techniques. Notably, strong correlations were observed between DL-derived measurements and intravascular ultrasound findings, enhancing clinical decision-making and risk stratification for CAD. Conclusion: Deep learning-enabled CCTA represents a promising advancement in the quantification of coronary plaques and stenosis, facilitating improved cardiac risk prediction and enhancing clinical workflow efficiency. Despite variability in study designs and potential biases, the findings support the integration of DL technologies into routine clinical practice for better patient outcomes in CAD management.