Multi-Stage Cascaded Deep Learning-Based Model for Acute Aortic Syndrome Detection: A Multisite Validation Study
Journal
Journal of Clinical Medicine
Journal Volume
14
Journal Issue
13
Start Page
4797
ISSN
2077-0383
Date Issued
2025-07-07
Author(s)
Abstract
Background: Acute Aortic Syndrome (AAS), encompassing aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU), presents diagnostic challenges due to its varied manifestations and the critical need for rapid assessment. Methods: We developed a multi-stage deep learning model trained on chest computed tomography angiography (CTA) scans. The model utilizes a U-Net architecture for aortic segmentation, followed by a cascaded classification approach for detecting AD and IMH, and a multiscale CNN for identifying PAU. External validation was conducted on 260 anonymized CTA scans from 14 U.S. clinical sites, encompassing data from four different CT manufacturers. Performance metrics, including sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), were calculated with 95% confidence intervals (CIs) using Wilson’s method. Model performance was compared against predefined benchmarks. Results: The model achieved a sensitivity of 0.94 (95% CI: 0.88–0.97), specificity of 0.93 (95% CI: 0.89–0.97), and an AUC of 0.96 (95% CI: 0.94–0.98) for overall AAS detection, with p-values < 0.001 when compared to the 0.80 benchmark. Subgroup analyses demonstrated consistent performance across different patient demographics, CT manufacturers, slice thicknesses, and anatomical locations. Conclusions: This deep learning model effectively detects the full spectrum of AAS across diverse populations and imaging platforms, suggesting its potential utility in clinical settings to enable faster triage and expedite patient management.
Subjects
AI-based solution for radiology
artificial intelligence
deep learning
emergency radiology
machine learning diagnostic performance
Publisher
MDPI AG
Type
journal article