Artificial intelligence in veterinary diagnostic imaging: Perspectives and limitations.

The field of veterinary diagnostic imaging is undergoing significant transformation with the integration of artificial intelligence (AI) tools. This manuscript provides an overview of the current state and future prospects of AI in veterinary diagnostic imaging. The manuscript delves into various applications of AI across different imaging modalities, such as radiology, ultrasound, computed tomography, and magnetic resonance imaging. Examples of AI applications in each modality are provided, ranging from orthopaedics to internal medicine, cardiology, and more. Notable studies are discussed, demonstrating AI's potential for improved accuracy in detecting and classifying various abnormalities. The ethical considerations of using AI in veterinary diagnostics are also explored, highlighting the need for transparent AI development, accurate training data, awareness of the limitations of AI models, and the importance of maintaining human expertise in the decision-making process. The manuscript underscores the significance of AI as a decision support tool rather than a replacement for human judgement. In conclusion, this comprehensive manuscript offers an assessment of the current landscape and future potential of AI in veterinary diagnostic imaging. It provides insights into the benefits and challenges of integrating AI into clinical practice while emphasizing the critical role of ethics and human expertise in ensuring the wellbeing of veterinary patients.

Improving the classification of veterinary thoracic radiographs through inter-species and inter-pathology self-supervised pre-training of deep learning models.

The analysis of veterinary radiographic imaging data is an essential step in the diagnosis of many thoracic lesions. Given the limited time that physicians can devote to a single patient, it would be valuable to implement an automated system to help clinicians make faster but still accurate diagnoses. Currently, most of such systems are based on supervised deep learning approaches. However, the problem with these solutions is that they need a large database of labeled data. Access to such data is often limited, as it requires a great investment of both time and money. Therefore, in this work we present a solution that allows higher classification scores to be obtained using knowledge transfer from inter-species and inter-pathology self-supervised learning methods. Before training the network for classification, pretraining of the model was performed using self-supervised learning approaches on publicly available unlabeled radiographic data of human and dog images, which allowed substantially increasing the number of images for this phase. The self-supervised learning approaches included the Beta Variational Autoencoder, the Soft-Introspective Variational Autoencoder, and a Simple Framework for Contrastive Learning of Visual Representations. After the initial pretraining, fine-tuning was performed for the collected veterinary dataset using 20% of the available data. Next, a latent space exploration was performed for each model after which the encoding part of the model was fine-tuned again, this time in a supervised manner for classification. Simple Framework for Contrastive Learning of Visual Representations proved to be the most beneficial pretraining method. Therefore, it was for this method that experiments with various fine-tuning methods were carried out. We achieved a mean ROC AUC score of 0.77 and 0.66, respectively, for the laterolateral and dorsoventral projection datasets. The results show significant improvement compared to using the model without any pretraining approach.

An AI-based algorithm for the automatic evaluation of image quality in canine thoracic radiographs.

The aim of this study was to develop and test an artificial intelligence (AI)-based algorithm for detecting common technical errors in canine thoracic radiography. The algorithm was trained using a database of thoracic radiographs from three veterinary clinics in Italy, which were evaluated for image quality by three experienced veterinary diagnostic imagers. The algorithm was designed to classify the images as correct or having one or more of the following errors: rotation, underexposure, overexposure, incorrect limb positioning, incorrect neck positioning, blurriness, cut-off, or the presence of foreign objects, or medical devices. The algorithm was able to correctly identify errors in thoracic radiographs with an overall accuracy of 81.5% in latero-lateral and 75.7% in sagittal images. The most accurately identified errors were limb mispositioning and underexposure both in latero-lateral and sagittal images. The accuracy of the developed model in the classification of technically correct radiographs was fair in latero-lateral and good in sagittal images. The authors conclude that their AI-based algorithm is a promising tool for improving the accuracy of radiographic interpretation by identifying technical errors in canine thoracic radiographs.

Contrast-enhanced ultrasound features of adrenal lesions in dogs.

BACKGROUND: The contrast-enhanced ultrasound (CEUS) features of adrenal lesions are poorly reported in veterinary literature. METHODS: Qualitative and quantitative B-mode ultrasound and CEUS features of 186 benign (adenoma) and malignant (adenocarcinoma and pheochromocytoma) adrenal lesions were evaluated. RESULTS: Adenocarcinomas (n = 72) and pheochromocytomas (n = 32) had mixed echogenicity with B-mode, and a non-homogeneous aspect with a diffused or peripheral enhancement pattern, hypoperfused areas, intralesional microcirculation and non-homogeneous wash-out with CEUS. Adenomas (n = 82) had mixed echogenicity, isoechogenicity or hypoechogenicity with B-mode, and a homogeneous or non-homogeneous aspect with a diffused enhancement pattern, hypoperfused areas, intralesional microcirculation and homogeneous wash-out with CEUS. With CEUS, a non-homogeneous aspect and the presence of hypoperfused areas and intralesional microcirculation can be used to distinguish between malignant (adenocarcinoma and pheochromocytoma) and benign (adenoma) adrenal lesions. LIMITATIONS: Lesions were characterised only by means of cytology. CONCLUSIONS: CEUS examination is a valuable tool for distinction between benign and malignant adrenal lesions and can potentially differentiate pheochromocytomas from adenocarcinomas and adenomas. However, cytology and histology are necessary to obtain the final diagnosis.

Contrast-enhanced ultrasound features of focal pancreatic lesions in cats.

A large overlap in the ultrasound (US) features of focal pancreatic lesions (FPLs) in cats is reported. Furthermore, only a small number of studies describing the contrast-enhanced ultrasound (CEUS) features of FPLs in cats have been conducted today. The aim of this study is to describe the B-mode US and CEUS features of FPLs in cats. Ninety-eight cats cytologically diagnosed with FPL were included. The lesions were classified as adenocarcinoma (n = 40), lymphoma (n = 11), nodular hyperplasia (n = 17), other benign lesion (OBL) (n = 20), cyst (n = 4) or other malignant lesion (OML) (n = 6). Several qualitative and quantitative B-mode and CEUS features were described in each case. OMLs and cysts were not included in the statistical analysis. A decision tree to classify the lesions based on their B-mode and CEUS features was developed. The overall accuracy of the cross-validation of the decision tree was 0.74 (95% CI: 0.63-0.83). The developed decision tree had a very high sensitivity and specificity for nodular hyperplasia (1 and 0.94, respectively) as well as good sensitivity and specificity for both adenocarcinomas (0.85 and 0.77, respectively) and OBLs also (0.70 and 0.93, respectively). The algorithm was unable to detect any specific feature for classifying lymphomas, and almost all the lymphomas were classified as adenocarcinomas. The combination between CEUS and B-mode US is very accurate in the classification of some FPLs, especially nodular hyperplasia and adenocarcinomas. Cytopathology and or histopathology is still a fundamental step FPL diagnostic workflow.

Contrast-enhanced ultrasound features of focal pancreatic lesions in dogs.

BACKGROUND: Contrast-enhanced ultrasound (CEUS) features of pancreatic lesions are poorly reported in veterinary literature. METHODS: Qualitative and quantitative features of pancreatic benign (nodular hyperplasia [NH], cyst and abscess) and malignant (adenocarcinoma and insulinoma) lesions during B-mode and CEUS examinations are described in 75 dogs. RESULTS: Adenocarcinomas (n = 23) had mixed echogenicity at B-mode, and they were hypoenhancing or non-enhancing at CEUS, with a non-homogeneous and cystic enhancement pattern. Insulinomas (n = 23) appeared as hypoechoic lesions at B-mode, and as hyperenhancing, homogeneous and solid lesions at CEUS. NH (n = 17) had an constant appearance, being hypoechoic at ultrasound (US) and isoenhancing at CEUS. Cysts (n = 7) were all anechoic, with acoustic enhancement clearly detectable at US, but were non-enhancing at CEUS. Lastly, abscesses (n = 5) had mixed echogenicity, and they showed both hyperenhancement and non-enhancement at CEUS. Hypoenhancement and non-homogeneous appearance had a moderate diagnostic accuracy in the detection of adenocarcinomas. In particular, hyperenhancement was evident only in malignant lesions (adenocarcinomas and insulinomas). CONCLUSION: CEUS, in combination with B-mode US features, is a valuable tool for distinction of benign and malignant abnormalities of the pancreas and can potentially differentiate insulinomas from adenocarcinomas.

A Machine Learning-Based Approach for Classification of Focal Splenic Lesions Based on Their CT Features.

The aim of the study was to describe the CT features of focal splenic lesions (FSLs) in dogs in order to predict lesion histotype. Dogs that underwent a CT scan and had a FSL diagnosis by cytology or histopathology were retrospectively included in the study. For the statistical analysis the cases were divided into four groups, based on the results of cytopatholoy or hystopathology, namely: nodular hyperplasia (NH), other benign lesions (OBLs), sarcoma (SA), round cell tumour (RCT). Several qualitative and quantitative CT features were described for each case. The relationship occurring between each individual CT feature and the histopathological groups was explred by means of c chi-square test for the count data and by means of Kruskal-Wallis or ANOVA for the continuous data. Furthermore, the main features of each group were described using factorial discriminant analysis, and a decision tree for lesion classification was then developed. Sarcomas were characterised by large dimensions, a cystic appearance and an overall low post contrast-enhancement. NH and OBLs were characterised by small dimensions, a solid appearance and a high post-contrast enhancement. OBLs showed higher post-contrast values than NH. Lastly, RCTs did not exhibit any distinctive CT features. The proposed decision tree had a high accuracy for the classification of SA (0.89) and a moderate accuracy for the classification of OBLs and NH (0.79), whereas it was unable to classify RCTs. The results of the factorial analysis and the proposed decision tree could help the clinician in classifying FSLs based on their CT features. A definitive FSL diagnosis can only be obtained by microscopic examination of the spleen.

Corrigendum: Diagnostic Accuracy of Delayed Phase Post Contrast Computed Tomographic Images in the Diagnosis of Focal Liver Lesions in Dogs: 69 Cases.

[This corrects the article DOI: 10.3389/fvets.2021.611556.].

Diagnostic Accuracy of Delayed Phase Post Contrast Computed Tomographic Images in the Diagnosis of Focal Liver Lesions in Dogs: 69 Cases.

To describe the computed tomographic (CT) features of focal liver lesions (FLLs) in dogs, that could enable predicting lesion histotype. Dogs diagnosed with FLLs through both CT and cytopathology and/or histopathology were retrospectively collected. Ten qualitative and 6 quantitative CT features have been described for each case. Lastly, a machine learning-based decision tree was developed to predict the lesion histotype. Four categories of FLLs - hepatocellular carcinoma (HCC, n = 13), nodular hyperplasia (NH, n = 19), other benign lesions (OBL, n = 18), and other malignant lesions (OML, n = 19) - were evaluated in 69 dogs. Five of the observed qualitative CT features resulted to be statistically significant in the distinction between the 4 categories: surface, appearance, lymph-node appearance, capsule formation, and homogeneity of contrast medium distribution. Three of the observed quantitative CT features were significantly different between the 4 categories: the Hounsfield Units (HU) of the radiologically normal liver parenchyma during the pre-contrast scan, the maximum dimension, and the ellipsoid volume of the lesion. Using the machine learning-based decision tree, it was possible to correctly classify NHs, OBLs, HCCs, and OMLs with an accuracy of 0.74, 0.88, 0.87, and 0.75, respectively. The developed decision tree could be an easy-to-use tool to predict the histotype of different FLLs in dogs. Cytology and histology are necessary to obtain the final diagnosis of the lesions.

Automatic classification of canine thoracic radiographs using deep learning.

The interpretation of thoracic radiographs is a challenging and error-prone task for veterinarians. Despite recent advancements in machine learning and computer vision, the development of computer-aided diagnostic systems for radiographs remains a challenging and unsolved problem, particularly in the context of veterinary medicine. In this study, a novel method, based on multi-label deep convolutional neural network (CNN), for the classification of thoracic radiographs in dogs was developed. All the thoracic radiographs of dogs performed between 2010 and 2020 in the institution were retrospectively collected. Radiographs were taken with two different radiograph acquisition systems and were divided into two data sets accordingly. One data set (Data Set 1) was used for training and testing and another data set (Data Set 2) was used to test the generalization ability of the CNNs. Radiographic findings used as non mutually exclusive labels to train the CNNs were: unremarkable, cardiomegaly, alveolar pattern, bronchial pattern, interstitial pattern, mass, pleural effusion, pneumothorax, and megaesophagus. Two different CNNs, based on ResNet-50 and DenseNet-121 architectures respectively, were developed and tested. The CNN based on ResNet-50 had an Area Under the Receive-Operator Curve (AUC) above 0.8 for all the included radiographic findings except for bronchial and interstitial patterns both on Data Set 1 and Data Set 2. The CNN based on DenseNet-121 had a lower overall performance. Statistically significant differences in the generalization ability between the two CNNs were evident, with the CNN based on ResNet-50 showing better performance for alveolar pattern, interstitial pattern, megaesophagus, and pneumothorax.

Contrast-enhanced ultrasound features of malignant focal liver masses in dogs.

A total of 185 cases (150 retrospectively and 35 prospectively) of malignant liver masses were collected. In the retrospectively collected cases hyperenhancement during wash-in was the most common feature in HCCs but there was a high percentage of cases showing no enhancement or hypo/isoenhancement. ICCs displayed a large variety of contrast enhancement patterns and, although statically significant differences between ICCs and HCCs were evident, no clear distinction between these two pathologies was possible based only on their CEUS appearance. Sarcomas displayed all the possible degrees of wash-in enhancement with non-enhancing being the most common appearance. Metastases displayed all the possible contrast-enhancement patterns, with the most common being hyperenhancement in the wash-in phase followed by hypoenhancement in the wash-out phase. A decision tree was developed based on the features of the retrospectively selected cases. Based on the developed decision tree 27/35 prospectively collected cases were correctly classified. Even if some significant differences among groups were evident, all the histotypes displayed all the possible patterns of contrast enhancement, and, therefore, the differentiation of liver masses in dogs based only on their CEUS features is not feasible and, therefore, cytology or histopathology is required.

Correlation between renal histopathology and renal ultrasound in dogs.

Fifty-three privately owned dogs were included in the study. Ultrasonography of the kidneys was performed ante mortem. All the dogs died or were euthanized for reasons unrelated to this study. Histopathology of both kidneys was performed, and a degeneration and an inflammation score ranging from zero to two was assigned by consensus between two pathologists. A numerical score based on a three level semi-quantitative scale (0, 0.5, 1) was assigned by consensus between two of the authors to the following ultrasonographic abnormalities: cortico-medullary definition, echogenicity of the renal cortex, echogenicity of the medulla, renal shape, cysts, scars, mineralizations, subcapsular perirenal fluid accumulation, pyelectasia. The scores deriving from the consensus were summed to create a summary index called renal ultrasound score (RUS). Statistically significant differences in cortico-medullary definition, echogenicity of the renal cortex, echogenicity of the medulla, renal shape, scars and pyelectasia were evident between the degeneration score groups. There were significantly different distributions of cortico-medullary definition, renal shape and scars between the inflammatory score groups. There were statistically significant differences in the RUS between the degenerative score groups (F = 24.154, p-value<.001). Post-hoc tests revealed significant differences between all groups. There were no significant differences in the RUS between the inflammatory score groups (F = 1.312, p-value = .264). Post-hoc tests revealed no significant differences between groups. The results of the present study suggest that the number and severity of the ultrasonographic abnormalities are correlated with the severity of the kidney degeneration. On the other hand, inflammation showed poor influence on the ultrasonographic appearance of the kidneys.

Contrast-enhanced ultrasonography features of hepatobiliary neoplasms in cats.

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) features of primary hepatobiliary neoplasms have been reported in dogs but no information is available in cats. METHODS: Qualitative and quantitative features of bile duct adenomas (BDAs, n=20), bile duct carcinomas (BDCs, n=16), and hepatocellular carcinomas (HCCs, n=8) are described in 44 cats. RESULTS: There was an overlap in CEUS qualitative features between different histotypes, both in wash-in and wash-out phases. Distinction between different neoplasms based only on the CEUS qualitative features was not possible. At peak of enhancement, the BDAs, BDCs and HCCs showed a large range of echogenicities, from hypoenhancement to hyperenhancement, in comparison to the liver parenchyma. Eight of 20 BDAs showed inhomogeneous hyperenhancement during wash-in, which is a feature reported as typical of malignant lesions in dogs. BDC had a significantly faster wash-in compared with both BDA and HCC but the diagnostic accuracy of all the included quantitative variables was only moderate. No significant differences in the wash-out quantitative features of BDA and BDC were evident. CONCLUSION: There is poor evidence that CEUS may be used to distinguish between different primary hepatobiliary neoplasms in cats.

A Frailty Index based on clinical data to quantify mortality risk in dogs.

Frailty is defined as a decline in an organism's physiological reserves resulting in increased vulnerability to stressors. In humans, a single continuous variable, the so-called Frailty Index (FI), can be obtained by multidimensionally assessing the biological complexity of an ageing organism. Here, we evaluate this variability in dogs and compare it to the data available for humans. In dogs, there was a moderate correlation between age and the FI, and the distribution of the FI increased with age. Deficit accumulation was strongly related to mortality. The effect of age, when combined with the FI, was negligible. No sex-related differences were evident. The FI could be considered in epidemiological studies and/or experimental trials to account for the potential confounding effects of the health status of individual dogs. The age-related deficit accumulation reported in dogs is similar to that demonstrated in humans. Therefore, dogs might represent an excellent model for human aging studies.

Survivin and laryngeal carcinoma prognosis: nuclear localization and expression of splice variants.

AIMS: Aberrant survivin expression in cancer cells has been associated with tumour progression, radiation/drug resistance and shorter patient survival. The aim of the present study was to investigate survivin expression in laryngeal carcinoma (LSCC) tissue and - for the first time at this site - the expression of survivin splice variants. P53 was also studied. METHODS AND RESULTS: Survivin and p53 expression was determined immunohistochemically in 86 consecutive patients operated for LSCC. Survivin mRNA expression was assessed by quantitative real-time polymerase chain reaction (PCR). Hot-spot mutations in exons 5, 6, 7 and 8 of the TP53 gene were studied by sequencing analysis. A nuclear localization for survivin predominated. There was a significant association between a higher nuclear survivin expression and LSCC recurrence (P = 0.046). Disease-free survival (DFS) for LSCC patients with a nuclear survivin expression >7.0% was shorter than in cases whose expression was ≤7.0% (P = 0.05). Wild-type survivin correlated significantly with nuclear survivin expression (P = 0.02). p53 expression was associated with the co-expression of wild-type survivin and survivin-2B (P = 0.01). CONCLUSIONS: Nuclear expression of survivin appears to influence LSCC aggressiveness, a higher nuclear survivin expression correlating with a higher recurrence rate and a shorter DFS. Wild-type survivin was the most frequently detected splice variant in LSCC tissues.