Artificial intelligence (AI) is likely to revolutionize the way medical images are analysed and has the potential to improve the identification and analysis of vulnerable or high-risk atherosclerotic plaques in coronary arteries, leading to advances in the treatment of coronary artery disease. However, coronary plaque analysis is challenging owing to cardiac and respiratory motion, as well as the small size of cardiovascular structures. Moreover, the analysis of coronary imaging data is time-consuming, can be performed only by clinicians with dedicated cardiovascular imaging training, and is subject to considerable interreader and intrareader variability. AI has the potential to improve the assessment of images of vulnerable plaque in coronary arteries, but requires robust development, testing and validation. Combining human expertise with AI might facilitate the reliable and valid interpretation of images obtained using CT, MRI, PET, intravascular ultrasonography and optical coherence tomography. In this Roadmap, we review existing evidence on the application of AI to the imaging of vulnerable plaque in coronary arteries and provide consensus recommendations developed by an interdisciplinary group of experts on AI and non-invasive and invasive coronary imaging. We also outline future requirements of AI technology to address bias, uncertainty, explainability and generalizability, which are all essential for the acceptance of AI and its clinical utility in handling the anticipated growing volume of coronary imaging procedures.
In this Roadmap, Föllmer et al. summarize the evidence for the application of artificial intelligence (AI) technology to the imaging of vulnerable plaques in coronary arteries and discuss the current and future approaches to addressing the limitations of AI-guided coronary plaque imaging, such as bias, uncertainty and generalizability.
Key points: Artificial intelligence (AI) might have the potential to transform the assessment of vulnerable or high-risk plaque in coronary arteries by improving the detection, quantification and prognostication of vulnerable plaque and integration with other imaging and clinical parameters.The advantages of AI for the assessment of vulnerable plaque images include reducing observer variability, improving accuracy, enabling standardization, improving speed and facilitating the synthesis of diverse information.The challenges for the development and implementation of AI include the presence of anatomical variations and imaging artefacts; the lack of reproducibility, generalizability and robustness across diverse imaging platforms; and the potential for the technology to introduce or worsen biases.Clinical research has already been performed on AI tools for plaque assessment, but validated commercial solutions for clinical use are not yet available.For AI to achieve its true potential for vulnerable plaque assessment in clinical practice, large and diverse studies are required, and AI tools must be trustworthy, explainable and interpretable.