A Pilot Study on Automatic Three-Dimensional Quantification of Barrett's Esophagus for Risk Stratification and Therapy Monitoring
A Pilot Study on Automatic Three-Dimensional Quantification of Barrett's Esophagus for Risk Stratification and Therapy Monitoring
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DOI：
10.1053/j.gastro.2021.05.059
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发表时间：
2021-08-18
期刊：
影响因子：
29.4
通讯作者：
Braden, Barbara
中科院分区：
文献类型：
--
作者：
Ali, Sharib;Bailey, Adam;Braden, Barbara
背景与目的：使用广泛接受的布拉格C&M分类进行巴雷特上皮测量高度依赖于操作者。我们提出了一种新的方法来自动测量这种风险评分。该方法还能够量化Barrett上皮（EMT）和岛的面积，这在以前是不可能的。此外，它允许食管表面的三维（3D）重建，实现交互式3D可视化。我们的目的是评估所提出的人工智能系统对体模和内窥镜患者数据的准确性。方法：使用高级深度学习，深度估计器网络用于预测内窥镜摄像机与胃皱襞的距离。通过分割食管和胃食管交界处，并将它们投影到估计的mm距离，我们测量了包括食管的C&M评分。衍生的内窥镜人工智能系统在具有不同BEA的专用3D打印食管体模上进行了测试，并在来自131名患者的194个高清视频上进行了测试，这些患者的C&M值由专家内窥镜医师进行评分。研究结果：内窥镜体模视频数据显示，C&M和岛测量的准确度为97.2%，平均偏差为± 0.9 mm，而对于ESTA，我们实现了98.4%的准确度，与地面实况相比，平均偏差仅为± 0.4 cm（2）。在患者数据上，我们的系统提供的C&M测量值与专家评分一致，C和M评分的边际总体相对误差（平均差）分别为8%（3.6 mm）和7%（2.8 mm）。结论：所提出的方法自动提取布拉格C&M分数具有很高的准确性。整个Barrett区的量化和3D重建为风险分层和治疗反应评估提供了新的机会。
BACKGROUND & AIMS: Barrett's epithelium measurement using widely accepted Prague C&M classification is highly operator dependent. We propose a novel methodology for measuring this risk score automatically. The method also enables quantification of the area of Barrett's epithelium (BEA) and islands, which was not possible before. Furthermore, it allows 3-dimensional (3D) reconstruction of the esophageal surface, enabling interactive 3D visualization. We aimed to assess the accuracy of the proposed artificial intelligence system on both phantom and endoscopic patient data. METHODS: Using advanced deep learning, a depth estimator network is used to predict endoscope camera distance from the gastric folds. By segmenting BEA and gastroesophageal junction and projecting them to the estimated mm distances, we measure C&M scores including the BEA. The derived endoscopy artificial intelligence system was tested on a purpose-built 3D printed esophagus phantom with varying BEAs and on 194 high-definition videos from 131 patients with C&M values scored by expert endoscopists. RESULTS: Endoscopic phantom video data demonstrated a 97.2% accuracy with a marginal +/- 0.9 mm average deviation for C&M and island measurements, while for BEA we achieved 98.4% accuracy with only +/- 0.4 cm(2) average deviation compared with ground-truth. On patient data, the C&M measurements provided by our system concurred with expert scores with marginal overall relative error (mean difference) of 8% (3.6 mm) and 7% (2.8 mm) for C and M scores, respectively. CONCLUSIONS: The proposed methodology automatically extracts Prague C&M scores with high accuracy. Quantification and 3D reconstruction of the entire Barrett's area provides new opportunities for risk stratification and assessment of therapy response.