Detection and Localisation of Abnormal Parathyroid Glands: An Explainable Deep Learning Approach

Abstract

Parathyroid scintigraphy with 99mTc-sestamibi (MIBI) is an established technique for localising abnormal parathyroid glands (PGs). However, the identification and localisation of PGs require much attention from medical experts and are time-consuming. Artificial intelligence methods can offer an assisting solution. This retrospective study enrolled 632 patients who underwent parathyroid scintigraphy with double-phase and thyroid subtraction techniques. The study proposes a three-path approach, employing the state-of-the-art convolutional neural network called VGG19. Images input to the model involved a set of three scintigraphic images in each case: MIBI early phase, MIBI late phase, and 99mTcO4 thyroid scan. A medical expert’s diagnosis provided the ground truth for positive/negative results. Moreover, the visualised suggested areas of interest produced by the Grad-CAM algorithm are examined to evaluate the PG-level agreement between the model and the experts. Medical experts identified 545 abnormal glands in 452 patients. On a patient basis, the deep learning (DL) model attained an accuracy of 94.8% (sensitivity 93.8%; specificity 97.2%) in distinguishing normal from abnormal scintigraphic images. On a PG basis and in achieving identical positioning of the findings with the experts, the model correctly identified and localised 453/545 glands (83.1%) and yielded 101 false focal results (false positive rate 18.23%). Concerning surgical findings, the expert’s sensitivity was 89.68% on patients and 77.6% on a PG basis, while that of the model reached 84.5% and 67.6%, respectively. Deep learning in parathyroid scintigraphy can potentially assist medical experts in identifying abnormal findings.