Quantification of pulmonary involvement in COVID-19 pneumonia by means of a cascade oftwo U-nets: training and assessment on multipledatasets using different annotation criteria

The automatic assignment of a severity score to the CT scans of patients affected by COVID-19 pneumonia could reduce the workload in radiology departments. This study aims at exploiting Artificial intelligence (AI) for the identification, segmentation and quantification of COVID-19 pulmonary lesions. We investigated the effects of using multiple datasets, heterogeneously populated and annotated according to different criteria. We developed an automated analysis pipeline, the LungQuant system, based on a cascade of two U-nets. The first one (U-net_1) is devoted to the identification of the lung parenchyma, the second one (U-net_2) acts on a bounding box enclosing the segmented lungs to identify the areas affected by COVID-19 lesions. Different public datasets were used to train the U-nets and to evaluate their segmentation performances, which have been quantified in terms of the Dice index. The accuracy in predicting the CT-Severity Score (CT-SS) of the LungQuant system has been also evaluated. Both Dice and accuracy showed a dependency on the quality of annotations of the available data samples. On an independent and publicly available benchmark dataset, the Dice values measured between the masks predicted by LungQuant system and the reference ones were 0.95$\pm$0.01 and 0.66$\pm$0.13 for the segmentation of lungs and COVID-19 lesions, respectively. The accuracy of 90% in the identification of the CT-SS on this benchmark dataset was achieved. We analysed the impact of using data samples with different annotation criteria in training an AI-based quantification system for pulmonary involvement in COVID-19 pneumonia. In terms of the Dice index, the U-net segmentation quality strongly depends on the quality of the lesion annotations. Nevertheless, the CT-SS can be accurately predicted on independent validation sets, demonstrating the satisfactory generalization ability of the LungQuant.