Dynamic 3D radiomics analysis using artificial intelligence to assess the stage of COVID-19 on CT images.

Objective: To develop a dynamic 3D radiomics analysis method using artificial intelligence technique for automatically assessing four disease stages (i.e., early, progressive, peak, and absorption stages) of COVID-19 patients on CT images.

Methods: The dynamic 3D radiomics analysis method was composed of three AI algorithms (the lung segmentation, lesion segmentation, and stage-assessing AI algorithms) that were trained and tested on 313,767 CT images from 520 COVID-19 patients. This proposed method used 3D lung lesion that was segmented by the lung and lesion segmentation algorithms to extract radiomics features, and then combined with clinical metadata to assess the possible stage of COVID-19 patients using stage-assessing algorithm. Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used to evaluate diagnostic performance.

Results: Of 520 patients, 66 patients (mean age, 57 years ± 15 [standard deviation]; 35 women), including 203 CT scans, were tested. The dynamic 3D radiomics analysis method used 30 features, including 27 radiomics features and 3 clinical features to assess the possible disease stage of COVID-19 with an accuracy of 90%. For the prediction of each stage, the AUC of stage 1 was 0.965 (95% CI: 0.934, 0.997), AUC of stage 2 was 0.958 (95% CI: 0.931, 0.984), AUC of stage 3 was 0.998 (95% CI: 0.994, 1.000), and AUC of stage 4 was 0.975 (95% CI: 0.956, 0.994).

Conclusion: With high diagnostic performance, the dynamic 3D radiomics analysis using artificial intelligence could represent a potential tool for helping hospitals make appropriate resource allocations and follow-up of treatment response.

Key Points: • The AI segmentation algorithms were able to accurately segment the lung and lesion of COVID-19 patients of different stages. • The dynamic 3D radiomics analysis method successfully extracted the radiomics features from the 3D lung lesion. • The stage-assessing AI algorithm combining with clinical metadata was able to assess the four stages with an accuracy of 90%, a macro-average AUC of 0.975.