title: Integration of clinical and imaging data to predict the presence of coronary artery disease with the use of neural networks.
abstract: OBJECTIVE
  To establish proof of the principle that a computer-based neural network method can be employed that will enhance diagnostic accuracy vis-a-vis image analysis alone in the interpretation of treadmill exercise tests performed in conjunction with myocardial perfusion imaging.
  
  
  METHODS
  One-hundred-and-two patients underwent myocardial perfusion imaging in association with the standard Bruce protocol. Twenty objective parameters describing each patient's exercise physiology, general clinical status and image appearance were used to train an artificial neural network. Classification accuracy of the neural network and clinical interpretation was determined by coronary angiography. We evaluated the ability of the neural network to integrate clinical, exercise and imaging data to determine the likelihood of coronary artery disease and compared these results with an optimized method of clinical image interpretation, which made use of all available clinical, angiographic and stress test data.
  
  
  RESULTS
  The artificial neural network had a sensitivity of 88% and a specificity of 65% for detection of ischemic heart disease and was comparable to that of the optimized clinical method (sensitivity 80%, specificity 69%). Incorporation of clinical and exercise data significantly improved the predictive accuracy of the network compared to a network based on image data alone (P<0.05).
  
  
  CONCLUSIONS
  The results show a computer-based neural network can perform as well as expert readers working under optimal conditions including full knowledge of the patient's clinical, prior angiographic and stress test data. Thus, the method is promising as a diagnostic aid to the recognition of ischemic heart disease in the clinical setting of treadmill exercise testing in conjunction with myocardial perfusion imaging.
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Scott
authors.forename: Kusai
authors.initials: K
authors.lastname: Aziz
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Yasuda
authors.forename: Henry
authors.initials: H
authors.lastname: Gewirtz
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D016571:Neural Networks, Computer; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity