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In EBioMedicine

BACKGROUND : Although chest radiographs have not been utilised well for classifying stroke subtypes, they could provide a plethora of information on cardioembolic stroke. This study aimed to develop a deep convolutional neural network that could diagnose cardioembolic stroke based on chest radiographs.

METHODS : Overall, 4,064 chest radiographs of consecutive patients with acute ischaemic stroke were collected from a prospectively maintained stroke registry. Chest radiographs were randomly partitioned into training/validation (n = 3,255) and internal test (n = 809) datasets in an 8:2 ratio. A densely connected convolutional network (ASTRO-X) was trained to diagnose cardioembolic stroke based on chest radiographs. The performance of ASTRO-X was evaluated using the area under the receiver operating characteristic curve. Gradient-weighted class activation mapping was used to evaluate the region of focus of ASTRO-X. External testing was performed with 750 chest radiographs of patients with acute ischaemic stroke from 7 hospitals.

FINDINGS : The areas under the receiver operating characteristic curve of ASTRO-X were 0.86 (95% confidence interval [CI], 0.83-0.89) and 0.82 (95% CI, 0.79-0.85) during the internal and multicentre external testing, respectively. The gradient-weighted class activation map demonstrated that ASTRO-X was focused on the area where the left atrium was located. Compared with cases predicted as non-cardioembolism by ASTRO-X, cases predicted as cardioembolism by ASTRO-X had higher left atrial volume index and lower left ventricular ejection fraction in echocardiography.

INTERPRETATION : ASTRO-X, a deep neural network developed to diagnose cardioembolic stroke based on chest radiographs, demonstrated good classification performance and biological plausibility.

Jeong Han-Gil, Kim Beom Joon, Kim Tackeun, Kang Jihoon, Kim Jun Yup, Kim Joonghee, Kim Joon-Tae, Park Jong-Moo, Kim Jae Guk, Hong Jeong-Ho, Lee Kyung Bok, Park Tai Hwan, Kim Dae-Hyun, Oh Chang Wan, Han Moon-Ku, Bae Hee-Joon

2021-Jul-02

Cardioembolism, Chest radiograph, Classification, Deep learning, Stroke