Coronary artery disease stands as one of the primary contributors to global mortality rates. The automated identification of coronary artery stenosis from X-ray images plays a critical role in the diagnostic process for coronary heart disease. This task is challenging due to the complex structure of coronary arteries, intrinsic noise in X-ray images, and the fact that stenotic coronary arteries appear narrow and blurred in X-ray angiographies. This study employs five different variants of the Mamba-based model and one variant of the Swin Transformer-based model, primarily based on the U-Net architecture, for the localization of stenosis in Coronary artery disease. Our best results showed an F1 score of 68.79% for the U-Mamba BOT model, representing an 11.8% improvement over the semi-supervised approach.

Assessing the severity of stenoses in coronary angiography is critical to the patient's health, as coronary stenosis is an underlying factor in heart failure. Current practice for grading coronary lesions, i.e. fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), suffers from several drawbacks, including time, cost and invasiveness, alongside potential interobserver variability. In this context, some deep learning methods have emerged to assist cardiologists in automating the estimation of FFR/iFR values. Despite the effectiveness of these methods, their reliance on large datasets is challenging due to the distributed nature of sensitive medical data. Federated learning addresses this challenge by aggregating knowledge from multiple nodes to improve model generalization, while preserving data privacy. We propose the first federated detection transformer approach, FeDETR, to assess stenosis severity in angiography videos based on FFR/iFR values estimation. In our approach, each node trains a detection transformer (DETR) on its local dataset, with the central server federating the backbone part of the network. The proposed method is trained and evaluated on a dataset collected from five hospitals, consisting of 1001 angiographic examinations, and its performance is compared with state-of-the-art federated learning methods.

In the era of digital medicine, medical imaging serves as a widespread technique for early disease detection, with a substantial volume of images being generated and stored daily in electronic patient records. X-ray angiography imaging is a standard and one of the most common methods for rapidly diagnosing coronary artery diseases. The notable achievements of recent deep learning algorithms align with the increased use of electronic health records and diagnostic imaging. Deep neural networks, leveraging abundant data, advanced algorithms, and powerful computational capabilities, prove highly effective in the analysis and interpretation of images. In this context, Object detection methods have become a promising approach, particularly through convolutional neural networks (CNN), streamlining medical image analysis by eliminating manual feature extraction. This allows for direct feature extraction from images, ensuring high accuracy in results. Therefore, in our paper, we utilized the object detection method on X-ray angiography images to precisely identify the location of coronary artery stenosis. As a result, this model enables automatic and real-time detection of stenosis locations, assisting in the crucial and sensitive decision-making process for healthcare professionals.

This study explores the use of Federated Learning (FL) for stenosis detection in coronary angiography images (CA). Two heterogeneous datasets from two institutions were considered: Dataset 1 includes 1219 images from 200 patients, which we acquired at the Ospedale Riuniti of Ancona (Italy); Dataset 2 includes 7492 sequential images from 90 patients from a previous study available in the literature. Stenosis detection was performed by using a Faster R-CNN model. In our FL framework, only the weights of the model backbone were shared among the two client institutions, using Federated Averaging (FedAvg) for weight aggregation. We assessed the performance of stenosis detection using Precision (P rec), Recall (Rec), and F1 score (F1). Our results showed that the FL framework does not substantially affects clients 2 performance, which already achieved good performance with local training; for client 1, instead, FL framework increases the performance with respect to local model of +3.76%, +17.21% and +10.80%, respectively, reaching P rec = 73.56, Rec = 67.01 and F1 = 70.13. With such results, we showed that FL may enable multicentric studies relevant to automatic stenosis detection in CA by addressing data heterogeneity from various institutions, while preserving patient privacy.

Coronary angiography continues to serve as the primary method for diagnosing coronary artery disease (CAD), which is the leading global cause of mortality. The severity of CAD is quantified by the location, degree of narrowing (stenosis), and number of arteries involved. In current practice, this quantification is performed manually using visual inspection and thus suffers from poor inter-and intra-rater reliability. The MIC-CAI grand challenge: Automatic Region-based Coronary Artery Disease diagnostics using the X-ray angiography imagEs (ARCADE) curated a dataset with stenosis annotations, with the goal of creating an automated stenosis detection algorithm. Using a combination of machine learning and other computer vision techniques, we propose the architecture and algorithm StenUNet to accurately detect stenosis from X-ray Coronary Angiography. Our submission to the ARCADE challenge placed 3rd among all teams. We achieved an F1 score of 0.5348 on the test set, 0.0005 lower than the 2nd place.