Feasibility of a deep learning artificial intelligence model for the diagnosis of pediatric ileocolic intussusception with grayscale ultrasonography

Purpose: This study explored the feasibility of utilizing a deep learning artificial intelligence (AI) model to detect ileocolic intussusception on grayscale ultrasound images. Methods: This retrospective observational study incorporated ultrasound images of children who underwent emergency ultrasonography for suspected ileocolic intussusception. After excluding video clips, Doppler images, and annotated images, 40,765 images from two tertiary hospitals were included (positive-to-negative ratio: Seoul National University Hospital, 2,775:35,373; Pusan National University Yangsan Hospital, 140:2,477). Images from Seoul National University Hospital were split into a training set, a tuning set, and an internal test set (ITS) at a ratio of 7:1.5:1.5. Images from Pusan National University Yangsan Hospital comprised an external test set (ETS). For each image indicating intussusception, two radiologists provided a bounding box as the ground-truth label. If intussusception was suspected in the input image, the model generated a bounding box with a confidence score (0-1) at the estimated lesion location. Average precision (AP) was used to evaluate overall model performance. The performance of practical thresholds for the model-generated confidence score, as determined from the ITS, was verified using the ETS. Results: The AP values for the ITS and ETS were 0.952 and 0.936, respectively. Two confidence thresholds, CT_opt and CT_precision, were set at 0.557 and 0.790, respectively. For the ETS, the per-image precision and recall were 95.7% and 80.0% with CT_opt, and 98.4% and 44.3% with CT_precision. For per-patient diagnosis, the sensitivity and specificity were 100.0% and 97.1% with CT_opt, and 100.0% and 99.0% with CT_precision. The average number of false positives per patient was 0.04 with CT_opt and 0.01 for CT_precision. Conclusion: The feasibility of using an AI model to diagnose ileocolic intussusception on ultrasonography was demonstrated. However, further study involving bias-free data is warranted for robust clinical validation.