WHEN ARTIFICIAL

INTELLIGENCE MEETS

RADIOLOGY: NOVEL BIOMARKERS FOR DEMENTIA

SIMON DUCHARME, MD MSC FRCP(C)

CANADIAN CONFERENCE ON DEMENTIA

OCTOBER 4TH, 2019

DISCLOSURE

• SITE PI FOR SPONSORED DEMENTIA CLINICAL TRIALS

• BIOGEN

• IONIS PHARMACEUTICALS

• NOVARTIS

• AZTHERAPIES INC.

• MEDITI PHARMA

• CO-FOUNDER ARCTIC FOX AI (AI BRAIN ANALYTICS FOR CLINICAL APPLICATIONS)

DISCLOSURE!

• I AM A CLINICIAN-SCIENTIST

INTERESTED IN AI FOR

DEMENTIA, NOT AN AI EXPERT!

• I AM NOT A RADIOLOGIST!

OUTLINE

• AI BACKGROUND

• AI IN RADIOLOGY

• AI APPLICATIONS IN DEMENTIA

• DISCUSSION

WHAT IS ARTIFICIAL INTELLIGENCE?

• COMPUTER SYSTEMS WITH THE ABILITY TO:

• INTERPRET EXTERNAL DATA

• LEARN FROM DATA

• ACHIEVE A TASK OR GOAL BASED ON THAT LEARNING

• INFORMAL DEFINITION: MACHINES THAT PERFORM TASKS RESEMBLING HUMAN COGNITIVE FUNCTIONS

Copied from

Deep Learning – A

visual introduction

(slideshare.net)

AI IN RADIOLOGY • POTENTIAL APPLICATIONS

• FRACTURE DETECTION

• LUNG NODULES

• MAMMOGRAMS – PREDICT FUTURE

CANCERS

• DETECTION OF INTRACRANIAL

HEMORRHAGE

• ACCELERATING IMAGE ACQUISITIONS

• TRIAGE OF SCAN PRIORITIES

• MAJOR POTENTIAL BENEFITS

• DETECTING PATTERNS NOT SEEN BY THE

HUMAN EYE

• INCREASING PRODUCTIVITY

• NOT INFLUENCED BY EXTERNAL

CONDITIONS

• REPLICATING PERFORMANCE OF

EXPERT RADIOLOGISTS IN SUBOPTIMAL CONDITIONS

• LOWERING COST?

• MAJOR CHALLENGES

• ACCESS TO HIGH QUALITY DATASETS

• CONFIDENTIALITY

• INTELLECTUAL PROPERTY

• DISTRIBUTION OF SOLUTIONS

• BUY IN FROM PHYSICIANS

• LOW MARKET PENETRANCE DESPITE THE

HYPE

• TRUST

• MEDICAL LIABILITY

AI FOR DEMENTIA

• SCREENING

• DIAGNOSIS

• PROGNOSIS

• TREATMENT?

AI FOR SCREENING LARGE AT-RISK POPULATIONS

AI FOR BRAIN MRI DIAGNOSIS

• CCCDTD5 NEUROIMAGING CONSENSUS

• INCLUDE 3D T1 VOLUMETRIC SEQUENCE

• SEMI-QUANTITATIVE SCALES: GLOBAL CORTICAL ATROPHY, MEDIAL TEMPORAL ATROPHY SCALE, FAZEKAS SCALE

• AUTOMATED VOLUMETRY REQUIRES LARGER STUDIES BUT:

• MOST REPORTS DO NOT INCLUDE STRUCTURED SEMI-QUANTITATIVE SCALES

• PERFORMANCE OF VOLUMETRY SIMILAR TO EXPERT RADIOLOGISTS

• HIPPOCAMPAL VOLUMETRY INCREASES DIAGNOSTIC CONFIDENCE

• AI COULD MAKE THIS TOOL MORE RELIABLE AND AVAILABLE

Boutet et al. 2012 Neuroradiology Bosco et al. 2017 Alzheimer Dement

• 2014 Open challenge

• Best performance accuracy 63%

(chance 33%) to distinguish AD, MCI

and controls

• Best performance combined volumes

with other features (cortical thickness,

shape, intensity)

AI FOR DEMENTIA

PROGNOSIS

AI FOR DEMENTIA PROGNOSIS – SNIPE SCORE

…

AlzMETRIX ™

…

Control

Alzheimer

Normal controls with automatic priors

Patients with AD with automatic priors

P. Coupé et al. Simultaneous Segmentation and Grading of Anatomical Structures for Patient's Classification, NeuroImage 2012 McGill Patent

• Shape analysis of hippocampal

structures

• MCI to dementia conversion -

87% prediction accuracy at

five years follow-up, with an

AUC > 0.85 from two to seven

years (peaking at 0.92 at five

years combined with ADAS-

Cog

• Predicts conversion to MCI from

SCI

Azar et al. Under review

INTEGRATING MULTIMODAL INFORMATION FOR

DIAGNOSIS AND PROGNOSIS

• ACCURACY REMAINS BELOW 80% IN

MOST STUDIES TO PREDICT MCI TO AD

CONVERSION

• BINARY PREDICTION FROM MCI TO AD

LESS INTERESTING THAN COURSE

PREDICTION

• MOST MODELS USE ML, LESS

PUBLICATIONS ON DL

Liu et al. 2018 Use of multimodality imaging and artificial

intelligence for diagnosis and prognosis of early stages of

Alzheimer's disease. Translational Research

AI FOR DEMENTIA

COURSE PREDICTION

• BEST COURSE PREDICTIONS FROM TWO

VISITS

• MARGINAL IMPACT OF ADDING CORTICAL

THICKNESS ON CLINICAL FEATURES

TREATMENT PREDICTIONS?

DISCUSSION QUESTIONS

• WOULD YOU WELCOME THE INPUT OF AI FOR MORE

PRECISE DIAGNOSES AND PROGNOSIS

• DO YOU TRUST AI ALGORITHMS FOR RADIOLOGICAL

INTERPRETATIONS?

• WHAT ARE YOUR CONCERS WITH AI IN MEDICINE?