Abstract
PURPOSE: To explore the information in routine digital subtraction angiography (DSA) and evaluate deep learning algorithms for automated identification of anatomic location in DSA sequences. METHODS: DSA of the abdominal aorta, celiac, superior mesenteric, inferior mesenteric, and bilateral external iliac arteries was labeled with the anatomic location from retrospectively collected endovascular procedures performed between 2010 and 2020 at a tertiary care medical center. "Key" images within each sequence demonstrating the parent vessel and the first bifurcation were additionally labeled. Mode models aggregating single image predictions, trained with the full or "key" datasets, and a multiple instance learning (MIL) model were developed for location classification of the DSA sequences. Model performance was evaluated with a primary endpoint of multiclass classification accuracy and compared by McNemar's test. RESULTS: A total of 819 unique angiographic sequences from 205 patients and 276 procedures were included in the training, validation, and testing data and split into partitions at the patient level to preclude data leakage. The data demonstrate substantial information sparsity as a minority of the images were designated as "key" with sufficient information for localization by a domain expert. A Mode model, trained and tested with "key" images, demonstrated an overall multiclass classification accuracy of 0.975 (95% CI 0.941-1). A MIL model, trained and tested with all data, demonstrated an overall multiclass classification accuracy of 0.966 (95% CI 0.932-0.992). Both the Mode model with "key" images (p < 0.001) and MIL model (p < 0.001) significantly outperformed a Mode model trained and tested with the full dataset. The MIL model additionally automatically identified a set of top-5 images with an average overlap of 92.5% to manually labelled "key" images. CONCLUSION: Deep learning algorithms can identify anatomic locations in abdominopelvic DSA with high fidelity using manual or automatic methods to manage information sparsity.