Explainable deep-learning-based ischemia detection using hybrid O-15 H2O perfusion positron emission tomography and computed tomography imaging with clinical data
Open accessAbstract
BACKGROUND: O perfusion positron emission tomography computed tomography (PET/CT) and coronary CT angiography (CTA) imaging. The classifier uses polar map images with numerical data and visualizes data findings. METHODS: A DLmodel was implemented and evaluated on 138 individuals, consisting of a combined image-and data-based classifier considering 35 clinical, CTA, and PET variables. Data from invasive coronary angiography were used as reference. Performance was evaluated with clinical classification using accuracy (ACC), area under the receiver operating characteristic curve (AUC), F1 score (F1S), sensitivity (SEN), specificity (SPE), precision (PRE), net benefit, and Cohen's Kappa. Statistical testing was conducted using McNemar's test. RESULTS: The DL model had a median ACC = 0.8478, AUC = 0.8481, F1S = 0.8293, SEN = 0.8500, SPE = 0.8846, and PRE = 0.8500. Improved detection of true-positive and false-negative cases, increased net benefit in thresholds up to 34%, and comparable Cohen's kappa was seen, reaching similar performance to clinical reading. Statistical testing revealed no significant differences between DL model and clinical reading. CONCLUSIONS: The combined DL model is a feasible and an effective method in detection of CAD, allowing to highlight important data findings individually in interpretable manner.
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Some papers studied in this review attempt to incorporate unimodal explainable AI methods, like Shapley values and Grad-CAM.
“Some papers studied in this review indeed attempt to incorporate (unimodal) explainable AI methods, like Shapley values (Kolk et al., 2024; Sangnark et al., 2024; Teuho et al., 2024; Xu et al., 2022a; Parvin et al., 2024) and Grad-CAM (Sangnark et al., 2024; Teuho et al., 2024).”
From Navigating the landscape of multimodal AI in medicine: A scoping review on technical challenges and clinical applications (2025) · cites this paper as Teuho et al., 2024
Cites
A Unified Approach to Interpreting Model Predictions
Lundberg, S., & Lee, S.-I. (2017) · arXiv · doi:10.48550/arxiv.1705.07874 · Cited by 23,707 · see citing works
Advances in Neural Information Processing Systems 29
Teymur, O., Zygalakis, K., & Calderhead, B. (2016) · Cited by 13,881 · see citing works
Grad-CAM: Visual Explanations from Deep Networks via Gradient-Based Localization
Selvaraju, R. R., Cogswell, M., Das, A., Vedantam, R., Parikh, D., & Batra, D. (2020) · International Journal of Computer Vision · doi:10.1007/s11263-019-01228-7 · Cited by 6,909 · see citing works
Note on the Sampling Error of the Difference Between Correlated Proportions or Percentages
McNemar, Q. (1947) · Psychometrika · doi:10.1007/bf02295996 · Cited by 4,754 · see citing works
Approximate Statistical Tests for Comparing Supervised Classification Learning Algorithms
Dietterich, T. G. (1998) · Neural Computation · doi:10.1162/089976698300017197 · Cited by 3,840 · see citing works
Vickers, A. J., Van Calster, B., & Steyerberg, E. W. (2016) · BMJ · doi:10.1136/bmj.i6 · Cited by 1,163 · see citing works
Huang, S.-C., Pareek, A., Seyyedi, S., Banerjee, I., & Lungren, M. P. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-00341-z · Cited by 934 · see citing works
On Comparing Classifiers: Pitfalls to Avoid and a Recommended Approach
Salzberg, S. L. (1997) · Data Mining and Knowledge Discovery · doi:10.1023/a:1009752403260 · Cited by 822 · see citing works
Cury, R. C., Abbara, S., Achenbach, S. S., Agatston, A. A., Berman, D. S., Budoff, M. J., Dill, K. E., Jacobs, J. E., Maroules, C. D., Rubin, G. D., et al. (2016) · Journal of cardiovascular computed tomography · doi:10.1016/j.jcct.2016.04.005 · Cited by 658 · see citing works
On Interpretability of Artificial Neural Networks: A Survey
Fan, F., Xiong, J., Li, M., & Wang, G. (2021) · IEEE Transactions on Radiation and Plasma Medical Sciences · doi:10.1109/trpms.2021.3066428 · Cited by 573 · see citing works
Danad, I., Raijmakers, P. G. H. M., Driessen, R. S., Leipsic, J. A., Raju, R., Naoum, C., Knuuti, J. M., Mäki, M. T., Underwood, R., Min, J. K., et al. (2017) · JAMA Cardiology · doi:10.1001/jamacardio.2017.2471 · Cited by 480 · see citing works
Self-citationKajander, S. A., Joutsiniemi, E., Saraste, M., Pietilä, M., Ukkonen, H., Saraste, A., Sipilä, H. T., Teräs, M., Mäki, M. T., Airaksinen, J. K. E., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.915009 · Cited by 401 · see citing works
Self-citationDanad, I., Uusitalo, V., Kero, T., Saraste, A., Raijmakers, P. G. H. M., Lammertsma, A. A., Heymans, M. W., Kajander, S. A., Pietilä, M., James, S. K., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.05.069 · Cited by 329 · see citing works
Self-citationMachine learning in clinical decision making
Adlung, L., Cohen, Y., Mor, U., & Elinav, E. (2021) · Med · doi:10.1016/j.medj.2021.04.006 · Cited by 304 · see citing works
Edwards, A. L. (1948) · Psychometrika · doi:10.1007/bf02289261 · Cited by 198 · see citing works
EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging
Sciagrà, R., Lubberink, M., Hyafil, F., Saraste, A., Slart, R. H. J. A., Agostini, D., Nappi, C., Georgoulias, P., Bucerius, J. A., Rischpler, C., et al. (2020) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-020-05046-9 · Cited by 166 · see citing works
Self-citationNesterov, S. V., Han, C., Mäki, M. T., Kajander, S. A., Naum, A. S., Helenius, H. Y. M., Lisinen, I., Ukkonen, H., Pietilä, M., Joutsiniemi, E., et al. (2009) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-009-1143-8 · Cited by 157 · see citing works
Self-citationMoore, A., & Bell, M. (2022) · Clinical Medicine Insights Cardiology · doi:10.1177/11795468221133611 · Cited by 148 · see citing works
Otaki, Y., Singh, A., Kavanagh, P., Miller, R. J. H., Parekh, T., Tamarappoo, B. K., Sharir, T., Einstein, A. J., Fish, M. B., Ruddy, T. D., et al. (2021) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2021.04.030 · Cited by 132 · see citing works
Evaluation of machine learning algorithms for health and wellness applications: A tutorial
Tohka, J., & van Gils, M. (2021) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2021.104324 · Cited by 131 · see citing works
Menke, J., & Kowalski, J. (2015) · European Radiology · doi:10.1007/s00330-015-3831-z · Cited by 73 · see citing works
Tamarappoo, B. K., Lin, A., Commandeur, F., McElhinney, P. A., Cadet, S. J., Goeller, M., Razipour, A., Chen, X., Gransar, H., Cantú, S. M., et al. (2020) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2020.11.008 · Cited by 64 · see citing works
Juárez‐Orozco, L. E., Knol, R. J. J., Sánchez-Catasús, C. A., Martinez‐Manzanera, O., van der Zant, F. M., & Knuuti, J. M. (2018) · Journal of Nuclear Cardiology · doi:10.1007/s12350-018-1304-x · Cited by 62 · see citing works
Self-citationApostolopoulos, I. D., Apostolopoulos, D. I., Spyridonidis, T., Papathanasiou, N. D., & Panayiotakis, G. (2021) · Physica Medica · doi:10.1016/j.ejmp.2021.04.011 · Cited by 59 · see citing works
Deep Learning in Quantitative PET Myocardial Perfusion Imaging
Juárez‐Orozco, L. E., Martinez‐Manzanera, O., van der Zant, F. M., Knol, R. J. J., & Knuuti, J. M. (2019) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2019.08.009 · Cited by 50 · see citing works
Self-citationPapandrianos, N. I., & Papageorgiou, E. I. (2021) · Applied Sciences · doi:10.3390/app11146362 · Cited by 49 · see citing works
Stenström, I., Maaniitty, T., Uusitalo, V., Pietilä, M., Ukkonen, H., Kajander, S. A., Mäki, M. T., Bax, J. J., Knuuti, J. M., & Saraste, A. (2017) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jex193 · Cited by 35 · see citing works
Self-citationPieszko, K., Shanbhag, A. D., Singh, A., Hauser, M. T., Miller, R. J. H., Liang, J. X., Motwani, M., Kwieciński, J., Sharir, T., Einstein, A. J., et al. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00806-x · Cited by 32 · see citing works
Machine Learning in the Evaluation of Myocardial Ischemia Through Nuclear Cardiology
Juárez‐Orozco, L. E., Martinez‐Manzanera, O., Storti, A. E., & Knuuti, J. M. (2019) · Current Cardiovascular Imaging Reports · doi:10.1007/s12410-019-9480-x · Cited by 24 · see citing works
Self-citationArtificial Intelligence to Improve Risk Prediction with Nuclear Cardiac Studies
Juárez‐Orozco, L. E., Klén, R., Niemi, M., Ruijsink, B., Daquarti, G. J., van Es, R., Benjamins, J. W., Yeung, M. W., van der Harst, P., & Knuuti, J. M. (2022) · Current Cardiology Reports · doi:10.1007/s11886-022-01649-w · Cited by 20 · see citing works
Self-citationBenjamins, J. W., Yeung, M. W., Maaniitty, T., Saraste, A., Klén, R., van der Harst, P., Knuuti, J. M., & Juárez‐Orozco, L. E. (2021) · International Journal of Cardiology · doi:10.1016/j.ijcard.2021.04.009 · Cited by 13 · see citing works
Self-citationYeung, M. W., Benjamins, J. W., Knol, R. J. J., van der Zant, F. M., Asselbergs, F. W., van der Harst, P., & Juárez‐Orozco, L. E. (2022) · Journal of Nuclear Cardiology · doi:10.1007/s12350-022-02920-x · Cited by 13 · see citing works
Future of nuclear cardiology is bright: Promise of cardiac PET/CT and artificial intelligence
Slomka, P. J. (2022) · Journal of Nuclear Cardiology · doi:10.1007/s12350-022-02942-5 · Cited by 12 · see citing works
Teuho, J., Schultz, J., Klén, R., Knuuti, J. M., Saraste, A., Ono, N., & Kanaya, S. (2022) · Scientific Reports · doi:10.1038/s41598-022-06604-x · Cited by 11 · see citing works
Self-citationNuclear Cardiology Data Analyzed Using Machine Learning
Nakajima, K., & Maruyama, K. (2022) · Annals of Nuclear Cardiology · doi:10.17996/anc.22-00164 · Cited by 3 · see citing works
Machine learning models for positron emission tomography myocardial perfusion imaging
Williams, M. C. (2024) · Journal of Nuclear Cardiology · doi:10.1016/j.nuclcard.2024.101805 · Cited by 2 · see citing works
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Schouten, D., Nicoletti, G., Dille, B., Chia, C., Vendittelli, P., Schuurmans, M., Litjens, G., & Khalili, N. (2025) · Medical Image Analysis · doi:10.1016/j.media.2025.103621 · Cited by 108 · see citing works
Yaman, S., Aslan, Ö., Güler, H., Şengür, A., Hafeez‐Baig, A., Tan, R., Deo, R. C., Barua, P. D., & Acharya, U. R. (2025) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2025.108858 · Cited by 13 · see citing works
Hu, X., Zhang, H., Caobelli, F., Huang, Y., Li, Y., Zhang, J., Shi, K., & Yu, F. (2024) · iScience · doi:10.1016/j.isci.2024.111374 · Cited by 9 · see citing works
Artificial intelligence in nuclear cardiology: Enhancing diagnostic accuracy and efficiency
Miller, R. J. H., Chareonthaitawee, P., & Slomka, P. J. (2025) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2025.09.010 · Cited by 6 · see citing works
Targeted molecular imaging of myocardial infarction: One more step in the right direction
Carli, M. F. D. (2024) · Journal of Nuclear Cardiology · doi:10.1016/j.nuclcard.2024.102021
Artificial intelligence for nuclear cardiology: Perspectives and challenges
Gilbert, C., Chunta, A., & Miller, R. J. H. (2025) · International Journal of Cardiovascular Sciences · doi:10.36660/ijcs.20240225
Mostafavi, S., Shanbhag, A. D., Ramirez, G., Lemley, M. H., Miller, R. J. H., Chareonthaitawee, P., Liang, J. X., Dey, D., Kavanagh, P., Slipczuk, L. N., et al. (2026) · medRxiv · doi:10.64898/2026.08.20.26360938
- Authors
- Teuho, J., Schultz, J., Klén, R., Juarez-Orozco, L. E., Knuuti, J., Saraste, A., Ono, N., & Kanaya, S.
- Affiliations
- University of Turku (FI)
- Nara Institute of Science and Technology (JP)
- Corresponding author
- Teuho, Jarmo
- ORCID
- Venue
- Journal of Nuclear Cardiology
- Publisher
- Elsevier BV
- Published
- 2024-08
- Volume
- 38
- Pages
- 101889
- ISSN
- 1071-3581 (ISSN-L)
- OpenAlex
- W4399510790
- Cited by
- 7
- References
- 37
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Nuclear Cardiology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UTUPub (University of Turku) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
- Funders
- Turun Yliopistosäätiö
- Japan Society for the Promotion of Science (21K12111, 21KK0183, P19748)
- Finnish Cultural Foundation
- Turun Yliopisto
- Academy of Finland (351482, 322019)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Keywords
- coronary artery disease, myocardial ischemia detection, hybrid PET/CT, explainable deep learning, coronary CT angiography, clinical data integration, invasive coronary angiography, computer-aided diagnosis, model interpretability
- MeSH terms
- Positron Emission Tomography Computed Tomography, Computed Tomography Angiography, Deep Learning, Aged, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Oxygen Radioisotopes, Sensitivity and Specificity, Coronary Angiography, Myocardial Ischemia, Myocardial Perfusion Imaging
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