小橋 昌司

Bronchopulmonary dysplasia (BPD) in preterm infants is a major concern in neonatal intensive care, necessitating early and accurate detection for improved outcomes. Despite the use of clinical information in previous studies to assess BPD severity, there is a gap in early prediction through imaging techniques. This paper proposed a novel method using convolutional neural networks (CNNs) for the early prediction of BPD from neonatal chest X-rays. We employed two strategies: first, analyzing chest X-ray images taken on specific days post-birth to evaluate day-wise BPD predictive performance using CNN models; and second, aggregating these images to enhance the training dataset. Thirteen specific CNN architectures were evaluated using a five-fold cross-validation method on a dataset acquired at four distinct time points: 3, 7, 14, and 28-days post-birth. The dataset included 115 preterm infants, 51 with BPD and 64 normal, classified based on their condition at 36 weeks of post-menstrual age. MobileNetV2 demonstrated consistent and fairly above-moderate performance among the networks used, with calculated metrics showing an accuracy of 0.665 ± 0.045, an AUC of 0.736 ± 0.053, a recall of 0.635 ± 0.042, a precision of 0.647 ± 0.046, and an F1-score of 0.641 ± 0.042. The results highlight the potential of CNNs in enhancing early diagnostic accuracy for BPD in neonatal patients using chest X-ray images.

Impacted third molar extraction, particularly of mandibular teeth, is a common procedure performed to alleviate pain, infection, and misalignment. Accurate diagnosis and classification of impaction types are crucial for effective treatment planning. This study introduces a novel algorithm for automatically measuring the impaction angles of mandibular third molars (T32 and T17) from orthopantomogram (OPG) images. The proposed method is based on deep learning techniques, including segmentation and key point detection models. It categorizes impactions into Winter’s classification: distoangular, mesioangular, horizontal, vertical, and other on both sides, using the measured angles. The proposed method used 450 OPGs, achieving high mandibular molar segmentation accuracy with dice similarity coefficients (DSC) values of 0.9058–0.9162 and intersection over union (IOU) scores of 0.82–0.84. The object keypoint similarity (OKS) for detecting the four corner points of each molar was 0.82. Angle measurement analysis showed 80% accuracy within ±5° deviation for distoangular impaction of T32 and within ±8° for T17. The F1-scores for mesioangular classifications were 0.88 for T32 and 0.91 for T17, with varying performance in other categories. Nonetheless, the predicted angles aid in identifying impaction types, showcasing the method’s potential to enhance dental diagnostics and treatment planning.

BACKGROUND: Ultrasonography is used to diagnose osteochondritis dissecans (OCD) of the humerus; however, its reliability depends on the technical proficiency of the examiner. Recently, computer-aided diagnosis (CAD) using deep learning has been applied in the field of medical science, and high diagnostic accuracy has been reported. We aimed to develop a deep learning-based CAD system for OCD detection on ultrasound images and to evaluate the accuracy of OCD detection using the CAD system. METHODS: The CAD process comprises 2 steps: humeral capitellum detection using an object-detection algorithm and OCD classification using an image classification network. Four-directional ultrasound images of the elbow of the throwing arm of 196 baseball players (mean age, 11.2 years), including 104 players with normal findings and 92 with OCD, were used for training and validation. An external dataset of 20 baseball players (10 with normal findings and 10 with OCD) was used to evaluate the accuracy of the CAD system. A confusion matrix and the area under the receiver operating characteristic curve (AUC) were used to evaluate the system. RESULTS: Clinical evaluation using the external dataset resulted in high AUCs in all 4 directions: 0.969 for the anterior long axis, 0.966 for the anterior short axis, 0.996 for the posterior long axis, and 0.993 for the posterior short axis. The accuracy of OCD detection thus exceeded 0.9 in all 4 directions. CONCLUSIONS: We propose a deep learning-based CAD system to detect OCD lesions on ultrasound images. The CAD system achieved high accuracy in all 4 directions of the elbow. This CAD system with a deep learning model may be useful for OCD screening during medical checkups to reduce the probability of missing an OCD lesion. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

OBJECTIVE: We evaluated the effect of CHA2DS2-VASc score and prior use of oral anticoagulants (OACs) on endovascular treatment (EVT) in patients with acute ischemic stroke and atrial fibrillation (AF). METHODS: Patients with AF who received EVT in 353 centers in Japan (2018-2020) were included. The outcomes were symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, functional independence, and successful and complete reperfusion. The effects of CHA2DS2-VASc score, its components, and prior use of OACs were assessed via a multiple logistic regression model. RESULTS: Of the 6984 patients, 780 (11.2%) used warfarin and 1168 (16.7%) used direct oral anticoagulants (DOACs) before EVT. Based on the CHA2DS2-VASc score, 6046 (86.6%) presented a high risk (≥2 for males and ≥3 for females) while 938 (13.4%) had intermediate to low risks. Higher CHA2DS2-VASc scores were associated with increased sICH, in-hospital mortality, and decreased functional independence, regardless of prior OACs. For patients with a high-risk category, prior DOACs increased the odds of successful and complete reperfusion (adjusted odds ratio [95% confidence interval (CI)], 1.27 [1.00-1.61] and 1.30 [1.10-1.53]). For those with integrated intermediate to low risks, neither prior warfarin nor DOAC affected the outcomes. Regardless of total CHA2DS2-VASc scores, patients with congestive heart failure or left ventricular dysfunction, hypertension, age >75 years, or female benefited similarly from prior DOAC use. INTERPRETATION: Prior DOAC use for patients with high- and selected intermediate-risk CHA2DS2-VASc scores increased prevalence of successful and complete reperfusion. These findings may provide supplemental evidence to introduce preventive DOAC for patients with AF.

PURPOSE: Carotid endarterectomy (CEA) is a surgical treatment for carotid artery stenosis. After CEA, some patients experience cardiovascular events (myocardial infarction, stroke, etc.); however, the prognostic factor has yet to be revealed. Therefore, this study explores the predictive factors in pathological images and predicts cardiovascular events within one year after CEA using pathological images of carotid plaques and patients' clinical data. METHOD: This paper proposes a two-step method to predict the prognosis of CEA patients. The proposed method first computes the pathological risk score using an anomaly detection model trained using pathological images of patients without cardiovascular events. By concatenating the obtained image-based risk score with a patient's clinical data, a statistical machine learning-based classifier predicts the patient's prognosis. RESULTS: We evaluate the proposed method on a dataset containing 120 patients without cardiovascular events and 21 patients with events. The combination of autoencoder as the anomaly detection model and XGBoost as the classification model obtained the best results: area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, and F1-score were 81.9%, 84.1%, 79.1%, 86.3%, and 76.6%, respectively. These values were superior to those obtained using pathological images or clinical data alone. CONCLUSION: We showed the feasibility of predicting CEA patient's long-term prognosis using pathological images and clinical data. Our results revealed some histopathological features related to cardiovascular events: plaque hemorrhage (thrombus), lymphocytic infiltration, and hemosiderin deposition, which will contribute to developing preventive treatment methods for plaque development and progression.