Cancer patients have a higher risk of cardiovascular disease (CVD) mortality than the general population. Low dose computed tomography (LDCT) for lung cancer screening offers an opportunity for simultaneous CVD risk estimation in at-risk patients. Our deep learning CVD risk prediction model, trained with 30,286 LDCTs from the National Lung Cancer Screening Trial, achieves an area under the curve (AUC) of 0.871 on a separate test set of 2,085 subjects and identifies patients with high CVD mortality risks (AUC of 0.768). We validate our model against ECG-gated cardiac CT based markers, including coronary artery calcification (CAC) score, CAD-RADS score, and MESA 10-year risk score from an independent dataset of 335 subjects. Our work shows that, in high-risk patients, deep learning can convert LDCT for lung cancer screening into a dual-screening quantitative tool for CVD risk estimation.

Low-Dose CT (LDCT) can significantly improve the accuracy of lung cancer diagnosis and thus reduce cancer deaths compared to chest X-ray. The lung cancer risk population is also at high risk of other deadly diseases, for instance, cardiovascular diseases. Therefore, predicting the all-cause mortality risks of this population is of great importance. This paper introduces a knowledge-based analytical method using deep convolutional neural network (CNN) for all-cause mortality prediction. The underlying approach combines structural image features extracted from CNNs, based on LDCT volume at different scales, and clinical knowledge obtained from quantitative measurements, to predict the mortality risk of lung cancer screening subjects. The proposed method is referred as Knowledge-based Analysis of Mortality Prediction Network (KAMP-Net). It constitutes a collaborative framework that utilizes both imaging features and anatomical information, instead of completely relying on automatic feature extraction. Our work demonstrates the feasibility of incorporating quantitative clinical measurements to assist CNNs in all-cause mortality prediction from chest LDCT images. The results of this study confirm that radiologist defined features can complement CNNs in performance improvement. The experiments demonstrate that KAMP-Net can achieve a superior performance when compared to other methods. Our code is available at https://github.com/DIAL-RPI/KAMP-Net.

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