Expert-level differentiation of incomplete Kawasaki disease and pneumonia from echocardiography via multiple large receptive attention mechanisms

Abstract

Background: Incomplete Kawasaki disease (KD) is challenging to diagnose due to its lack of classic clinical features, yet it has a higher incidence of coronary artery lesions, making early detection crucial. Echocardiography plays a vital role in identifying these lesions, but differentiating incomplete KD from other febrile illnesses, such as COVID-19, is difficult. Algorithms capable of achieving expert-level performance are needed to aid diagnosis, particularly in the absence of pediatric cardiologists. Methods: To address this need, we developed two novel deep learning models: the Multiple Receptive Attention Network (MRANet) and the Multiple Large Receptive Attention Network (MLRANet). These models incorporate multiple receptive attention layers and multiple large receptive attention layers to enhance their ability to identify KD-related coronary artery abnormalities on echocardiography. The models were trained and tested on 203 echocardiographic datasets and compared with advanced deep learning models to assess diagnostic performance. Results: Both MRANet and MLRANet outperformed existing deep learning models, achieving diagnostic accuracy comparable to experienced pediatric cardiologists. Notably, MLRANet demonstrated the highest sensitivity (93.48%) and specificity (66.15%), exceeding expert-level performance in detecting coronary artery abnormalities. Furthermore, MLRANet was able to distinguish incomplete KD from pneumonia effectively, showing diagnostic results aligned with the KD specialists. Conclusions: MLRANet has proven to be a valuable tool for computer-aided diagnosis of incomplete KD, offering accurate and reliable detection of coronary artery abnormalities without requiring specialist input. These findings suggest that MLRANet can facilitate timely and precise incomplete KD diagnosis, improving patient outcomes and addressing the shortage of pediatric cardiologists worldwide. © 2025 Elsevier Ltd