ABSTRACT
BackgroundChronic obstructive pulmonary disease (COPD) remains underdiagnosed globally. The coronavirus disease 2019 pandemic has also severely restricted spirometry, the primary tool used for COPD diagnosis and severity evaluation, due to concerns of virus transmission. Computed tomography (CT)-based deep learning (DL) approaches have been suggested as a cost-effective alternative for COPD identification within smokers. The present study aims to develop weakly supervised DL models that utilize CT image data for the automated detection and staging of spirometry-defined COPD among natural population.MethodsA large, highly heterogenous dataset was established comprising 1393 participants recruited from outpatient, inpatient and physical examination center settings of 4 large public hospitals in China. CT scans, spirometry data, demographic data, and clinical information of each participant were collected for the purpose of model development and evaluation. An attention-based multi-instance learning (MIL) model for COPD detection was trained using CT scans from 837 participants and evaluated using a test set comprised of data from 278 non-overlapping participants. External validation of the COPD detection was performed with 620 low-dose CT (LDCT) scans acquired from the National Lung Screening Trial (NLST) cohort. A multi-channel 3D residual network was further developed to categorize GOLD stages among confirmed COPD patients and evaluated using 5-fold cross validation. Spirometry tests were used to diagnose COPD, with stages defined according to the GOLD criteria.ResultsThe attention-based MIL model used for COPD detection achieved an area under the receiver operating characteristic curve (AUC) of 0.934 on the test set and 0.866 on the LDCT subset acquired from NLST. The model exhibited high generalizability across distinct scanning devices and slice thicknesses, with an AUC above 0.90. The multi-channel 3D residual network was able to correctly grade 76.4% of COPD patients in the test set (423/553) using the GOLD scale, with a Cohen’s weighted Kappa of 0.619 for the assessment of GOLD categorization .ConclusionThe proposed chest CT-DL approach can automatically identify spirometry-defined COPD and categorize patients according to the GOLD scale, with clinically acceptable performance. As such, this approach may be a powerful novel tool for COPD diagnosis and staging at the population level.