Dynamic Multi-Image Weighting for Automated Detection and Diagnosis of Abnormal Urinary Tract on Voiding Cystourethrography with a Deep Learning System: A Retrospective, Large-Scale, Multicenter Study

We aimed to develop a voiding cystourethrography (VCUG) diagnostic artificial intelligence model (VCUG-DAM), which relies on a novel architecture to automatically segment and diagnose the bladder, urethra, and ureters using a single VCUG image, while dynamically assessing the relative importance of each image. A total of 7,899 VCUG images from 1,660 patients across 15 Chinese hospitals were collected between 2021 and 2023. In stage 1, we assessed the performances of the VCUG-DAM model. The patient-level area under the curve (AUC) of VCUG-DAM was 0.8772, 0.7752, 0.9443, and 0.9342 for bladder, urethral, left, and right vesicoureteral reflux (VUR), respectively. In stage 2, we explored whether the VCUG-DAM model could improve the diagnostic ability of clinicians. VCUG-DAM improved the clinician's diagnostic performance, with mean AUCs increasing from 0.8185 to 0.9456 for the bladder, 0.6507 to 0.7943 for the urethra, 0.6288 to 0.9641 for the left VUR, and 0.7305 to 0.9506 for the right VUR (all <i>P</i> < 0.0001). In stage 3, the consistency of the VCUG-DAM for VUR grading was validated. VCUG-DAM improved inter-clinician agreement for VUR grading. The fully automated VCUG-DAM demonstrated high accuracy, reliability, and robustness in multitask diagnoses of urinary tract abnormalities across multiple VCUG images, while improving the diagnostic ability of clinicians as an auxiliary tool.