Multivessel Coronary Artery Segmentation and Stenosis Localisation using Ensemble Learning

Abstract

Coronary angiography analysis is a common clinical task performed by cardiologists to diagnose coronary artery disease (CAD) through an assessment of atherosclerotic plaque's accumulation. This study introduces an end-to-end machine learning solution developed as part of our solution for the MICCAI 2023 Automatic Region-based Coronary Artery Disease diagnostics using x-ray angiography imagEs (ARCADE) challenge, which aims to benchmark solutions for multivessel coronary artery segmentation and potential stenotic lesion localisation from X-ray coronary angiograms. We adopted a robust baseline model training strategy to progressively improve performance, comprising five successive stages of binary class pretraining, multivessel segmentation, fine-tuning using class frequency weighted dataloaders, fine-tuning using F1-based curriculum learning strategy (F1-CLS), and finally multi-target angiogram view classifier-based collective adaptation. Unlike many other medical imaging procedures, this task exhibits a notable degree of interobserver variability. %, making it particularly amenable to automated analysis. Our ensemble model combines the outputs from six baseline models using the weighted ensembling approach, which our analysis shows is found to double the predictive accuracy of the proposed solution. The final prediction was further refined, targeting the correction of misclassified blobs. Our solution achieved a mean F1 score of $37.69\%$ for coronary artery segmentation, and $39.41\%$ for stenosis localisation, positioning our team in the 5th position on both leaderboards. This work demonstrates the potential of automated tools to aid CAD diagnosis, guide interventions, and improve the accuracy of stent injections in clinical settings.