Machine Learning Automatically Detects COVID-19 using Chest CTs in a Large Multicenter Cohort.

Purpose: To investigate if AI-based classifiers can distinguish COVID-19 from other pulmonary diseases and normal groups, using chest CT images. To study the interpretability of discriminative features for COVID19 detection. Materials and Methods: Our database consists of 2096 CT exams that include CTs from 1150 COVID-19 patients. Training was performed on 1000 COVID-19, 131 ILD, 113 other pneumonias, 559 normal CTs, and testing on 100 COVID-19, 30 ILD, 30 other pneumonias, and 34 normal CTs. A metric-based approach for classification of COVID-19 used interpretable features, relying on logistic regression and random forests. A deep learning-based classifier differentiated COVID-19 based on 3D features extracted directly from CT intensities and from the probability distribution of airspace opacities. Results: Most discriminative features of COVID-19 are percentage of airspace opacity, ground glass opacities, consolidations, and peripheral and basal opacities, which coincide with the typical characterization of COVID-19 in the literature. Unsupervised hierarchical clustering compares the distribution of these features across COVID-19 and control cohorts. The metrics-based classifier achieved AUC, sensitivity, and specificity of respectively 0.85, 0.81, and 0.77. The DL-based classifier achieved AUC, sensitivity, and specificity of respectively 0.90, 0.86, and 0.81. Most of ambiguity comes from non-COVID-19 pneumonia with manifestations that overlap with COVID-19, as well as COVID-19 cases in early stages. Conclusion: A new method discriminates COVID-19 from other types of pneumonia, ILD, and normal, using quantitative patterns from chest CT. Our models balance interpretability of results and classification performance, and therefore may be useful to expedite and improve diagnosis of COVID-19.