Machine learning for diagnosis of coronary artery disease in computed tomography angiography: A survey

Abstract

Coronary artery disease (CAD) has become a major illness endangering human health. It mainly manifests as atherosclerotic plaques, especially vulnerable plaques without obvious symptoms in the early stage. Once a rupture occurs, it will lead to severe coronary stenosis, which in turn may trigger a major adverse cardiovascular event. Computed tomography angiography (CTA) has become a standard diagnostic tool for early screening of coronary plaque and stenosis due to its advantages in high resolution, noninvasiveness, and three-dimensional imaging. However, manual examination of CTA images by radiologists has been proven to be tedious and time-consuming, which might also lead to intra- and interobserver errors. Nowadays, many machine learning algorithms have enabled the (semi-)automatic diagnosis of CAD by extracting quantitative features from CTA images. This paper provides a survey of these machine learning algorithms for the diagnosis of CAD in CTA images, including coronary artery extraction, coronary plaque detection, vulnerable plaque identification, and coronary stenosis assessment. Most included articles were published within this decade and are found in the Web of Science. We wish to give readers a glimpse of the current status, challenges, and perspectives of these machine learning-based analysis methods for automatic CAD diagnosis.

Keywords: Machine learning; Deep learning; Coronary artery disease; Atherosclerotic plaque; Vulnerability; Stenosis; Segmentation; Computed tomography angiography

Core tip: There are reviews that contributed to the segmentation of the coronary artery, detection of calcified plaques, and calculation of fractional flow reserve. To the best of our knowledge, this is the first paper to survey the machine learning algorithms for the diagnosis of coronary artery disease in computed tomography angiography images, including extraction of coronary arteries, detection of calcified, soft and mixed plaques, identification of plaque vulnerability features including low density plaque, positive remodeling, spot calcification, and napkin ring sign, assessment of both anatomically and hemodynamically significant stenosis, and the challenges and perspectives of these machine learning-based analysis methods.