AI-Based Automated Quantification of Arterial Stenosis in Head and Neck CT Angiography: A Comparison with Manual Measurements from Digital Subtraction Angiography and CT Angiography

To evaluate the performance of an artificial intelligence (AI) algorithm for automated quantification of arterial stenosis in head and neck CT angiography (CTA).

Patients who received head and neck CTA and DSA between January 2019 and December 2021 in two centers were included. The quantitative performance of CerebralDoc per-lesion was evaluated through intraclass correlation coefficients (ICCs) and Bland-Altman analysis, comparing automated stenosis measurements and manual measurements across 0–100%, < 50%, ≥ 50% and ≥ 70% thresholds. Sensitivity analysis included linear and logistic regression, and subgroups analysis was performed to identify influencing factors.

287 patients with 1765 lesions were analyzed. ICCs between CerebralDoc and DSA for ≥ 50% and ≥ 70% stenosis were excellent (0.955, 0.922, respectively), for 0–100% stenosis was good (0.735), and for < 50% stenosis was poor (0.056). For ≥ 50% and ≥ 70% stenosis of CerebralDoc and CTA manual measurements versus DSA, ICCs were close (0.955 vs 0.994; 0.922 vs 0.986), and differences were small (0.258% vs -0.362%; 0.369% vs -0.199%). The sensitivity analysis revealed that specific locations (V1, V2, V3, V4) and slender vessels have large or remarkable differences ranging from 15.551% to 44.238%.

CerebralDoc exhibited excellent performance in automatically quantifying arterial stenosis of ≥ 50% and ≥ 70% in head and neck CTA. However, further research was needed to improve its performance for < 50% stenosis and to address differences in specific locations and slender vessels.