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  1. Faust O, Razaghi H, Barika R, Ciaccio EJ, Acharya UR
    Comput Methods Programs Biomed, 2019 Jul;176:81-91.
    PMID: 31200914 DOI: 10.1016/j.cmpb.2019.04.032
    BACKGROUND AND OBJECTIVE: Sleep is an important part of our life. That importance is highlighted by the multitude of health problems which result from sleep disorders. Detecting these sleep disorders requires an accurate interpretation of physiological signals. Prerequisite for this interpretation is an understanding of the way in which sleep stage changes manifest themselves in the signal waveform. With that understanding it is possible to build automated sleep stage scoring systems. Apart from their practical relevance for automating sleep disorder diagnosis, these systems provide a good indication of the amount of sleep stage related information communicated by a specific physiological signal.

    METHODS: This article provides a comprehensive review of automated sleep stage scoring systems, which were created since the year 2000. The systems were developed for Electrocardiogram (ECG), Electroencephalogram (EEG), Electrooculogram (EOG), and a combination of signals.

    RESULTS: Our review shows that all of these signals contain information for sleep stage scoring.

    CONCLUSIONS: The result is important, because it allows us to shift our research focus away from information extraction methods to systemic improvements, such as patient comfort, redundancy, safety and cost.

  2. Abbasian Ardakani A, Bureau NJ, Ciaccio EJ, Acharya UR
    Comput Methods Programs Biomed, 2022 Mar;215:106609.
    PMID: 34990929 DOI: 10.1016/j.cmpb.2021.106609
    Radiomics is a newcomer field that has opened new windows for precision medicine. It is related to extraction of a large number of quantitative features from medical images, which may be difficult to detect visually. Underlying tumor biology can change physical properties of tissues, which affect patterns of image pixels and radiomics features. The main advantage of radiomics is that it can characterize the whole tumor non-invasively, even after a single sampling from an image. Therefore, it can be linked to a "digital biopsy". Physicians need to know about radiomics features to determine how their values correlate with the appearance of lesions and diseases. Indeed, physicians need practical references to conceive of basics and concepts of each radiomics feature without knowing their sophisticated mathematical formulas. In this review, commonly used radiomics features are illustrated with practical examples to help physicians in their routine diagnostic procedures.
  3. Raghavendra U, Gudigar A, Bhandary SV, Rao TN, Ciaccio EJ, Acharya UR
    J Med Syst, 2019 Jul 30;43(9):299.
    PMID: 31359230 DOI: 10.1007/s10916-019-1427-x
    Glaucoma is a type of eye condition which may result in partial or consummate vision loss. Higher intraocular pressure is the leading cause for this condition. Screening for glaucoma and early detection can avert vision loss. Computer aided diagnosis (CAD) is an automated process with the potential to identify glaucoma early through quantitative analysis of digital fundus images. Preparing an effective model for CAD requires a large database. This study presents a CAD tool for the precise detection of glaucoma using a machine learning approach. An autoencoder is trained to determine effective and important features from fundus images. These features are used to develop classes of glaucoma for testing. The method achieved an F - measure value of 0.95 utilizing 1426 digital fundus images (589 control and 837 glaucoma). The efficacy of the system is evident, and is suggestive of its possible utility as an additional tool for verification of clinical decisions.
  4. Jahmunah V, Lih Oh S, Rajinikanth V, Ciaccio EJ, Hao Cheong K, Arunkumar N, et al.
    Artif Intell Med, 2019 09;100:101698.
    PMID: 31607349 DOI: 10.1016/j.artmed.2019.07.006
    Examination of the brain's condition with the Electroencephalogram (EEG) can be helpful to predict abnormality and cerebral activities. The purpose of this study was to develop an Automated Diagnostic Tool (ADT) to investigate and classify the EEG signal patterns into normal and schizophrenia classes. The ADT implements a sequence of events, such as EEG series splitting, non-linear features mining, t-test assisted feature selection, classification and validation. The proposed ADT is employed to evaluate a 19-channel EEG signal collected from normal and schizophrenia class volunteers. A dataset was created by splitting the raw 19-channel EEG into a sequence of 6250 sample points, which was helpful to produce 1142 features of normal and schizophrenia class patterns. Non-linear feature extraction was then implemented to mine 157 features from each EEG pattern, from which 14 of the principal features were identified based on significance. Finally, a signal classification practice with Decision-Tree (DT), Linear-Discriminant analysis (LD), k-Nearest-Neighbour (KNN), Probabilistic-Neural-Network (PNN), and Support-Vector-Machine (SVM) with various kernels was implemented. The experimental outcome showed that the SVM with Radial-Basis-Function (SVM-RBF) offered a superior average performance value of 92.91% on the considered EEG dataset, as compared to other classifiers implemented in this work.
  5. Acharya UR, Faust O, Ciaccio EJ, Koh JEW, Oh SL, Tan RS, et al.
    Comput Methods Programs Biomed, 2019 Jul;175:163-178.
    PMID: 31104705 DOI: 10.1016/j.cmpb.2019.04.018
    BACKGROUND AND OBJECTIVE: Complex fractionated atrial electrograms (CFAE) may contain information concerning the electrophysiological substrate of atrial fibrillation (AF); therefore they are of interest to guide catheter ablation treatment of AF. Electrogram signals are shaped by activation events, which are dynamical in nature. This makes it difficult to establish those signal properties that can provide insight into the ablation site location. Nonlinear measures may improve information. To test this hypothesis, we used nonlinear measures to analyze CFAE.

    METHODS: CFAE from several atrial sites, recorded for a duration of 16 s, were acquired from 10 patients with persistent and 9 patients with paroxysmal AF. These signals were appraised using non-overlapping windows of 1-, 2- and 4-s durations. The resulting data sets were analyzed with Recurrence Plots (RP) and Recurrence Quantification Analysis (RQA). The data was also quantified via entropy measures.

    RESULTS: RQA exhibited unique plots for persistent versus paroxysmal AF. Similar patterns were observed to be repeated throughout the RPs. Trends were consistent for signal segments of 1 and 2 s as well as 4 s in duration. This was suggestive that the underlying signal generation process is also repetitive, and that repetitiveness can be detected even in 1-s sequences. The results also showed that most entropy metrics exhibited higher measurement values (closer to equilibrium) for persistent AF data. It was also found that Determinism (DET), Trapping Time (TT), and Modified Multiscale Entropy (MMSE), extracted from signals that were acquired from locations at the posterior atrial free wall, are highly discriminative of persistent versus paroxysmal AF data.

    CONCLUSIONS: Short data sequences are sufficient to provide information to discern persistent versus paroxysmal AF data with a significant difference, and can be useful to detect repeating patterns of atrial activation.

  6. Jahmunah V, Oh SL, Wei JKE, Ciaccio EJ, Chua K, San TR, et al.
    Phys Med, 2019 Jun;62:95-104.
    PMID: 31153403 DOI: 10.1016/j.ejmp.2019.05.004
    The heart muscle pumps blood to vital organs, which is indispensable for human life. Congestive heart failure (CHF) is characterized by the inability of the heart to pump blood adequately throughout the body without an increase in intracardiac pressure. The symptoms include lung and peripheral congestion, leading to breathing difficulty and swollen limbs, dizziness from reduced delivery of blood to the brain, as well as arrhythmia. Coronary artery disease, myocardial infarction, and medical co-morbidities such as kidney disease, diabetes, and high blood pressure all take a toll on the heart and can impair myocardial function. CHF prevalence is growing worldwide. It afflicts millions of people globally, and is a leading cause of death. Hence, proper diagnosis, monitoring and management are imperative. The importance of an objective CHF diagnostic tool cannot be overemphasized. Standard diagnostic tests for CHF include chest X-ray, magnetic resonance imaging (MRI), nuclear imaging, echocardiography, and invasive angiography. However, these methods are costly, time-consuming, and they can be operator-dependent. Electrocardiography (ECG) is inexpensive and widely accessible, but ECG changes are typically not specific for CHF diagnosis. A properly designed computer-aided detection (CAD) system for CHF, based on the ECG, would potentially reduce subjectivity and provide quantitative assessment for informed decision-making. Herein, we review existing CAD for automatic CHF diagnosis, and highlight the development of an ECG-based CAD diagnostic system that employs deep learning algorithms to automatically detect CHF.
  7. Yildirim O, Baloglu UB, Tan RS, Ciaccio EJ, Acharya UR
    Comput Methods Programs Biomed, 2019 Jul;176:121-133.
    PMID: 31200900 DOI: 10.1016/j.cmpb.2019.05.004
    BACKGROUND AND OBJECTIVE: For diagnosis of arrhythmic heart problems, electrocardiogram (ECG) signals should be recorded and monitored. The long-term signal records obtained are analyzed by expert cardiologists. Devices such as the Holter monitor have limited hardware capabilities. For improved diagnostic capacity, it would be helpful to detect arrhythmic signals automatically. In this study, a novel approach is presented as a candidate solution for these issues.

    METHODS: A convolutional auto-encoder (CAE) based nonlinear compression structure is implemented to reduce the signal size of arrhythmic beats. Long-short term memory (LSTM) classifiers are employed to automatically recognize arrhythmias using ECG features, which are deeply coded with the CAE network.

    RESULTS: Based upon the coded ECG signals, both storage requirement and classification time were considerably reduced. In experimental studies conducted with the MIT-BIH arrhythmia database, ECG signals were compressed by an average 0.70% percentage root mean square difference (PRD) rate, and an accuracy of over 99.0% was observed.

    CONCLUSIONS: One of the significant contributions of this study is that the proposed approach can significantly reduce time duration when using LSTM networks for data analysis. Thus, a novel and effective approach was proposed for both ECG signal compression, and their high-performance automatic recognition, with very low computational cost.

  8. Acharya UR, Fernandes SL, WeiKoh JE, Ciaccio EJ, Fabell MKM, Tanik UJ, et al.
    J Med Syst, 2019 Aug 09;43(9):302.
    PMID: 31396722 DOI: 10.1007/s10916-019-1428-9
    The aim of this work is to develop a Computer-Aided-Brain-Diagnosis (CABD) system that can determine if a brain scan shows signs of Alzheimer's disease. The method utilizes Magnetic Resonance Imaging (MRI) for classification with several feature extraction techniques. MRI is a non-invasive procedure, widely adopted in hospitals to examine cognitive abnormalities. Images are acquired using the T2 imaging sequence. The paradigm consists of a series of quantitative techniques: filtering, feature extraction, Student's t-test based feature selection, and k-Nearest Neighbor (KNN) based classification. Additionally, a comparative analysis is done by implementing other feature extraction procedures that are described in the literature. Our findings suggest that the Shearlet Transform (ST) feature extraction technique offers improved results for Alzheimer's diagnosis as compared to alternative methods. The proposed CABD tool with the ST + KNN technique provided accuracy of 94.54%, precision of 88.33%, sensitivity of 96.30% and specificity of 93.64%. Furthermore, this tool also offered an accuracy, precision, sensitivity and specificity of 98.48%, 100%, 96.97% and 100%, respectively, with the benchmark MRI database.
  9. Vicnesh J, Wei JKE, Ciaccio EJ, Oh SL, Bhagat G, Lewis SK, et al.
    J Med Syst, 2019 Apr 26;43(6):157.
    PMID: 31028562 DOI: 10.1007/s10916-019-1285-6
    Celiac disease is a genetically determined disorder of the small intestine, occurring due to an immune response to ingested gluten-containing food. The resulting damage to the small intestinal mucosa hampers nutrient absorption, and is characterized by diarrhea, abdominal pain, and a variety of extra-intestinal manifestations. Invasive and costly methods such as endoscopic biopsy are currently used to diagnose celiac disease. Detection of the disease by histopathologic analysis of biopsies can be challenging due to suboptimal sampling. Video capsule images were obtained from celiac patients and controls for comparison and classification. This study exploits the use of DAISY descriptors to project two-dimensional images onto one-dimensional vectors. Shannon entropy is then used to extract features, after which a particle swarm optimization algorithm coupled with normalization is employed to select the 30 best features for classification. Statistical measures of this paradigm were tabulated. The accuracy, positive predictive value, sensitivity and specificity obtained in distinguishing celiac versus control video capsule images were 89.82%, 89.17%, 94.35% and 83.20% respectively, using the 10-fold cross-validation technique. When employing manual methods rather than the automated means described in this study, technical limitations and inconclusive results may hamper diagnosis. Our findings suggest that the computer-aided detection system presented herein can render diagnostic information, and thus may provide clinicians with an important tool to validate a diagnosis of celiac disease.
  10. Hagiwara Y, Koh JEW, Tan JH, Bhandary SV, Laude A, Ciaccio EJ, et al.
    Comput Methods Programs Biomed, 2018 Oct;165:1-12.
    PMID: 30337064 DOI: 10.1016/j.cmpb.2018.07.012
    BACKGROUND AND OBJECTIVES: Glaucoma is an eye condition which leads to permanent blindness when the disease progresses to an advanced stage. It occurs due to inappropriate intraocular pressure within the eye, resulting in damage to the optic nerve. Glaucoma does not exhibit any symptoms in its nascent stage and thus, it is important to diagnose early to prevent blindness. Fundus photography is widely used by ophthalmologists to assist in diagnosis of glaucoma and is cost-effective.

    METHODS: The morphological features of the disc that is characteristic of glaucoma are clearly seen in the fundus images. However, manual inspection of the acquired fundus images may be prone to inter-observer variation. Therefore, a computer-aided detection (CAD) system is proposed to make an accurate, reliable and fast diagnosis of glaucoma based on the optic nerve features of fundus imaging. In this paper, we reviewed existing techniques to automatically diagnose glaucoma.

    RESULTS: The use of CAD is very effective in the diagnosis of glaucoma and can assist the clinicians to alleviate their workload significantly. We have also discussed the advantages of employing state-of-art techniques, including deep learning (DL), when developing the automated system. The DL methods are effective in glaucoma diagnosis.

    CONCLUSIONS: Novel DL algorithms with big data availability are required to develop a reliable CAD system. Such techniques can be employed to diagnose other eye diseases accurately.

  11. Jahmunah V, Sudarshan VK, Oh SL, Gururajan R, Gururajan R, Zhou X, et al.
    Int J Imaging Syst Technol, 2021 Jun;31(2):455-471.
    PMID: 33821093 DOI: 10.1002/ima.22552
    In 2020 the world is facing unprecedented challenges due to COVID-19. To address these challenges, many digital tools are being explored and developed to contain the spread of the disease. With the lack of availability of vaccines, there is an urgent need to avert resurgence of infections by putting some measures, such as contact tracing, in place. While digital tools, such as phone applications are advantageous, they also pose challenges and have limitations (eg, wireless coverage could be an issue in some cases). On the other hand, wearable devices, when coupled with the Internet of Things (IoT), are expected to influence lifestyle and healthcare directly, and they may be useful for health monitoring during the global pandemic and beyond. In this work, we conduct a literature review of contact tracing methods and applications. Based on the literature review, we found limitations in gathering health data, such as insufficient network coverage. To address these shortcomings, we propose a novel intelligent tool that will be useful for contact tracing and prediction of COVID-19 clusters. The solution comprises a phone application combined with a wearable device, infused with unique intelligent IoT features (complex data analysis and intelligent data visualization) embedded within the system to aid in COVID-19 analysis. Contact tracing applications must establish data collection and data interpretation. Intelligent data interpretation can assist epidemiological scientists in anticipating clusters, and can enable them to take necessary action in improving public health management. Our proposed tool could also be used to curb disease incidence in future global health crises.
  12. Barua PD, Chan WY, Dogan S, Baygin M, Tuncer T, Ciaccio EJ, et al.
    Entropy (Basel), 2021 Dec 08;23(12).
    PMID: 34945957 DOI: 10.3390/e23121651
    Optical coherence tomography (OCT) images coupled with many learning techniques have been developed to diagnose retinal disorders. This work aims to develop a novel framework for extracting deep features from 18 pre-trained convolutional neural networks (CNN) and to attain high performance using OCT images. In this work, we have developed a new framework for automated detection of retinal disorders using transfer learning. This model consists of three phases: deep fused and multilevel feature extraction, using 18 pre-trained networks and tent maximal pooling, feature selection with ReliefF, and classification using the optimized classifier. The novelty of this proposed framework is the feature generation using widely used CNNs and to select the most suitable features for classification. The extracted features using our proposed intelligent feature extractor are fed to iterative ReliefF (IRF) to automatically select the best feature vector. The quadratic support vector machine (QSVM) is utilized as a classifier in this work. We have developed our model using two public OCT image datasets, and they are named database 1 (DB1) and database 2 (DB2). The proposed framework can attain 97.40% and 100% classification accuracies using the two OCT datasets, DB1 and DB2, respectively. These results illustrate the success of our model.
  13. Dogan S, Barua PD, Baygin M, Tuncer T, Tan RS, Ciaccio EJ, et al.
    Cogn Neurodyn, 2024 Oct;18(5):2503-2519.
    PMID: 39555305 DOI: 10.1007/s11571-024-10104-1
    This paper presents an innovative feature engineering framework based on lattice structures for the automated identification of Alzheimer's disease (AD) using electroencephalogram (EEG) signals. Inspired by the Shannon information entropy theorem, we apply a probabilistic function to create the novel Lattice123 pattern, generating two directed graphs with minimum and maximum distance-based kernels. Using these graphs and three kernel functions (signum, upper ternary, and lower ternary), we generate six feature vectors for each input signal block to extract textural features. Multilevel discrete wavelet transform (MDWT) was used to generate low-level wavelet subbands. Our proposed model mirrors deep learning approaches, facilitating feature extraction in frequency and spatial domains at various levels. We used iterative neighborhood component analysis to select the most discriminative features from the extracted vectors. An iterative hard majority voting and a greedy algorithm were used to generate voted vectors to select the optimal channel-wise and overall results. Our proposed model yielded a classification accuracy of more than 98% and a geometric mean of more than 96%. Our proposed Lattice123 pattern, dynamic graph generation, and MDWT-based multilevel feature extraction can detect AD accurately as the proposed pattern can extract subtle changes from the EEG signal accurately. Our prototype is ready to be validated using a large and diverse database.
  14. Acharya UR, Raghavendra U, Koh JEW, Meiburger KM, Ciaccio EJ, Hagiwara Y, et al.
    Comput Methods Programs Biomed, 2018 Nov;166:91-98.
    PMID: 30415722 DOI: 10.1016/j.cmpb.2018.10.006
    BACKGROUND AND OBJECTIVE: Liver fibrosis is a type of chronic liver injury that is characterized by an excessive deposition of extracellular matrix protein. Early detection of liver fibrosis may prevent further growth toward liver cirrhosis and hepatocellular carcinoma. In the past, the only method to assess liver fibrosis was through biopsy, but this examination is invasive, expensive, prone to sampling errors, and may cause complications such as bleeding. Ultrasound-based elastography is a promising tool to measure tissue elasticity in real time; however, this technology requires an upgrade of the ultrasound system and software. In this study, a novel computer-aided diagnosis tool is proposed to automatically detect and classify the various stages of liver fibrosis based upon conventional B-mode ultrasound images.

    METHODS: The proposed method uses a 2D contourlet transform and a set of texture features that are efficiently extracted from the transformed image. Then, the combination of a kernel discriminant analysis (KDA)-based feature reduction technique and analysis of variance (ANOVA)-based feature ranking technique was used, and the images were then classified into various stages of liver fibrosis.

    RESULTS: Our 2D contourlet transform and texture feature analysis approach achieved a 91.46% accuracy using only four features input to the probabilistic neural network classifier, to classify the five stages of liver fibrosis. It also achieved a 92.16% sensitivity and 88.92% specificity for the same model. The evaluation was done on a database of 762 ultrasound images belonging to five different stages of liver fibrosis.

    CONCLUSIONS: The findings suggest that the proposed method can be useful to automatically detect and classify liver fibrosis, which would greatly assist clinicians in making an accurate diagnosis.

  15. Rajendra Acharya U, Meiburger KM, Wei Koh JE, Vicnesh J, Ciaccio EJ, Shu Lih O, et al.
    Artif Intell Med, 2019 09;100:101724.
    PMID: 31607348 DOI: 10.1016/j.artmed.2019.101724
    Cardiovascular diseases are the primary cause of death globally. These are often associated with atherosclerosis. This inflammation process triggers important variations in the coronary arteries (CA) and can lead to coronary artery disease (CAD). The presence of CA calcification (CAC) has recently been shown to be a strong predictor of CAD. In this clinical setting, computed tomography angiography (CTA) has begun to play a crucial role as a non-intrusive imaging method to characterize and study CA plaques. Herein, we describe an automated algorithm to classify plaque as either normal, calcified, or non-calcified using 2646 CTA images acquired from 73 patients. The automated technique is based on various features that are extracted from the Gabor transform of the acquired CTA images. Specifically, seven features are extracted from the Gabor coefficients : energy, and Kapur, Max, Rényi, Shannon, Vajda, and Yager entropies. The features were then ordered based on the F-value and input to numerous classification methods to achieve the best classification accuracy with the least number of features. Moreover, two well-known feature reduction techniques were employed, and the features acquired were also ranked according to F-value and input to several classifiers. The best classification results were obtained using all computed features without the employment of feature reduction, using a probabilistic neural network. An accuracy, positive predictive value, sensitivity, and specificity of 89.09%, 91.70%, 91.83% and 83.70% was obtained, respectively. Based on these results, it is evident that the technique can be helpful in the automated classification of plaques present in CTA images, and may become an important tool to reduce procedural costs and patient radiation dose. This could also aid clinicians in plaque diagnostics.
  16. Gudigar A, Raghavendra U, Nayak S, Ooi CP, Chan WY, Gangavarapu MR, et al.
    Sensors (Basel), 2021 Dec 01;21(23).
    PMID: 34884045 DOI: 10.3390/s21238045
    The global pandemic of coronavirus disease (COVID-19) has caused millions of deaths and affected the livelihood of many more people. Early and rapid detection of COVID-19 is a challenging task for the medical community, but it is also crucial in stopping the spread of the SARS-CoV-2 virus. Prior substantiation of artificial intelligence (AI) in various fields of science has encouraged researchers to further address this problem. Various medical imaging modalities including X-ray, computed tomography (CT) and ultrasound (US) using AI techniques have greatly helped to curb the COVID-19 outbreak by assisting with early diagnosis. We carried out a systematic review on state-of-the-art AI techniques applied with X-ray, CT, and US images to detect COVID-19. In this paper, we discuss approaches used by various authors and the significance of these research efforts, the potential challenges, and future trends related to the implementation of an AI system for disease detection during the COVID-19 pandemic.
  17. Inamdar MA, Raghavendra U, Gudigar A, Chakole Y, Hegde A, Menon GR, et al.
    Sensors (Basel), 2021 Dec 20;21(24).
    PMID: 34960599 DOI: 10.3390/s21248507
    Amongst the most common causes of death globally, stroke is one of top three affecting over 100 million people worldwide annually. There are two classes of stroke, namely ischemic stroke (due to impairment of blood supply, accounting for ~70% of all strokes) and hemorrhagic stroke (due to bleeding), both of which can result, if untreated, in permanently damaged brain tissue. The discovery that the affected brain tissue (i.e., 'ischemic penumbra') can be salvaged from permanent damage and the bourgeoning growth in computer aided diagnosis has led to major advances in stroke management. Abiding to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we have surveyed a total of 177 research papers published between 2010 and 2021 to highlight the current status and challenges faced by computer aided diagnosis (CAD), machine learning (ML) and deep learning (DL) based techniques for CT and MRI as prime modalities for stroke detection and lesion region segmentation. This work concludes by showcasing the current requirement of this domain, the preferred modality, and prospective research areas.
  18. Hamyoon H, Yee Chan W, Mohammadi A, Yusuf Kuzan T, Mirza-Aghazadeh-Attari M, Leong WL, et al.
    Eur J Radiol, 2022 Dec;157:110591.
    PMID: 36356463 DOI: 10.1016/j.ejrad.2022.110591
    PURPOSE: To develop and validate a machine learning (ML) model for the classification of breast lesions on ultrasound images.

    METHOD: In the present study, three separate data cohorts containing 1288 breast lesions from three countries (Malaysia, Iran, and Turkey) were utilized for MLmodel development and external validation. The model was trained on ultrasound images of 725 breast lesions, and validation was done separately on the remaining data. An expert radiologist and a radiology resident classified the lesions based on the BI-RADS lexicon. Thirteen morphometric features were selected from a contour of the lesion and underwent a three-step feature selection process. Five features were chosen to be fed into the model separately and combined with the imaging signs mentioned in the BI-RADS reference guide. A support vector classifier was trained and optimized.

    RESULTS: The diagnostic profile of the model with various input data was compared to the expert radiologist and radiology resident. The agreement of each approach with histopathologic specimens was also determined. Based on BI-RADS and morphometric features, the model achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.885, which is higher than the expert radiologist and radiology resident performances with AUC of 0.814 and 0.632, respectively in all cohorts. DeLong's test also showed that the AUC of the ML protocol was significantly different from that of the expert radiologist (ΔAUCs = 0.071, 95%CI: (0.056, 0.086), P = 0.005).

    CONCLUSIONS: These results support the possible role of morphometric features in enhancing the already well-excepted classification schemes.

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