Differential Diagnostic Reasoning Method for Benign Paroxysmal Positional Vertigo Based on Dynamic Uncertain Causality Graph

The accurate differentiation of the subtypes of benign paroxysmal positional vertigo (BPPV) can significantly improve the efficacy of repositioning maneuver in its treatment and thus reduce unnecessary clinical tests and inappropriate medications. In this study, attempts have been made towards developing approaches of causality modeling and diagnostic reasoning about the uncertainties that can arise from medical information. A dynamic uncertain causality graph-based differential diagnosis model for BPPV including 354 variables and 885 causality arcs is constructed. New algorithms are also proposed for differential diagnosis through logical and probabilistic inference, with an emphasis on solving the problems of intricate and confounding disease factors, incomplete clinical observations, and insufficient sample data. This study further uses vertigo cases to test the performance of the proposed method in clinical practice. The results point to high accuracy, a satisfactory discriminatory ability for BPPV, and favorable robustness regarding incomplete medical information. The underlying pathological mechanisms and causality semantics are verified using compact graphical representation and reasoning process, which enhance the interpretability of the diagnosis conclusions.

[1]  Ju-Hong Lee,et al.  Automatic differential diagnosis of pancreatic serous and mucinous cystadenomas based on morphological features , 2013, Comput. Biol. Medicine.

[2]  Weiyi Liu,et al.  A Parallel and Incremental Approach for Data-Intensive Learning of Bayesian Networks , 2015, IEEE Transactions on Cybernetics.

[3]  Yanjun Wang,et al.  The methodology of Dynamic Uncertain Causality Graph for intelligent diagnosis of vertigo , 2014, Comput. Methods Programs Biomed..

[4]  S. W. Denholm,et al.  Benign paroxysmal positional vertigo. , 1993, BMJ.

[5]  H. Jenkins,et al.  Unrecognized Benign Paroxysmal Positional Vertigo in Elderly Patients , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[6]  Sumit K Agrawal,et al.  Diagnosis and management of benign paroxysmal positional vertigo (BPPV). , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[7]  J. Gavilán,et al.  'Carrusel': an expert system for vestibular diagnosis. , 1990, Acta oto-laryngologica.

[8]  José Antonio Lozano,et al.  Using Multidimensional Bayesian Network Classifiers to Assist the Treatment of Multiple Sclerosis , 2012, IEEE Transactions on Systems, Man, and Cybernetics, Part C (Applications and Reviews).

[9]  T. Brandt,et al.  Benign paroxysmal positional vertigo: Diagnostic criteria. , 2015, Journal of vestibular research : equilibrium & orientation.

[10]  Y. Choung,et al.  Clinical Features of Recurrent or Persistent Benign Paroxysmal Positional Vertigo , 2012, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[11]  Amiya Kumar Tripathy,et al.  Knowledge Discovery in Medical Systems Using Differential Diagnosis, LAMSTAR, and $k$-NN , 2012, IEEE Transactions on Information Technology in Biomedicine.

[12]  MengChu Zhou,et al.  Common Bayesian Network for Classification of EEG-Based Multiclass Motor Imagery BCI , 2016, IEEE Transactions on Systems, Man, and Cybernetics: Systems.

[13]  Jean Lieber,et al.  RespiDiag: A Case-Based Reasoning System for the Diagnosis of Chronic Obstructive Pulmonary Disease , 2014, Expert Syst. Appl..

[14]  R. Prashanth,et al.  Automatic classification and prediction models for early Parkinson's disease diagnosis from SPECT imaging , 2014, Expert Syst. Appl..

[15]  Fevrier Valdez,et al.  A new neural network model based on the LVQ algorithm for multi-class classification of arrhythmias , 2014, Inf. Sci..

[16]  Qin Zhang,et al.  Cubic Dynamic Uncertain Causality Graph: A New Methodology for Modeling and Reasoning About Complex Faults With Negative Feedbacks , 2018, IEEE Transactions on Reliability.

[17]  E. Pérez-Fernández,et al.  [Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo]. , 2010, Neurologia.

[18]  Eduardo Massad,et al.  Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: A nursing approach , 2013, Int. J. Medical Informatics.

[19]  Yi-Ping Phoebe Chen,et al.  Computational intelligence for heart disease diagnosis: A medical knowledge driven approach , 2013, Expert Syst. Appl..

[20]  G Magenes,et al.  Expert systems as a diagnostic aid in otoneurology. , 1990, ORL; journal for oto-rhino-laryngology and its related specialties.

[21]  Qin Zhang,et al.  Dynamic Uncertain Causality Graph for Knowledge Representation and Probabilistic Reasoning: Directed Cyclic Graph and Joint Probability Distribution , 2015, IEEE Transactions on Neural Networks and Learning Systems.

[22]  Remco J. Renken,et al.  Classification of Parkinsonian Syndromes from FDG-PET Brain Data Using Decision Trees with SSM/PCA Features , 2015, Comput. Math. Methods Medicine.

[23]  A. Cerasa,et al.  Machine learning on brain MRI data for differential diagnosis of Parkinson's disease and Progressive Supranuclear Palsy , 2014, Journal of Neuroscience Methods.

[24]  D. Balatsouras,et al.  Benign paroxysmal positional vertigo and its management. , 2007, Medical science monitor : international medical journal of experimental and clinical research.

[25]  M Juhola,et al.  Otoneurological expert system for vertigo. , 1999, Acta oto-laryngologica.

[26]  Susan L. Whitney,et al.  Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo , 2008, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[27]  A. Barabasi,et al.  Network medicine : a network-based approach to human disease , 2010 .

[28]  Andrés Cano,et al.  A Method for Integrating Expert Knowledge When Learning Bayesian Networks From Data , 2011, IEEE Transactions on Systems, Man, and Cybernetics, Part B (Cybernetics).

[29]  David P. Crabb,et al.  Exploring Early Glaucoma and the Visual Field Test: Classification and Clustering Using Bayesian Networks , 2014, IEEE Journal of Biomedical and Health Informatics.

[30]  John C. Li,et al.  The 360-Degree Maneuver for Treatment of Benign Positional Vertigo , 2006, Otology and Neurotology.

[31]  Yasuhiro Nakata,et al.  Differential Diagnosis Tool for Parkinsonian Syndrome Using Multiple Structural Brain Measures , 2013, Comput. Math. Methods Medicine.

[32]  E. Pérez-Fernández,et al.  Estudio metaanalítico de la eficacia de la maniobra de Epley en el vértigo posicional paroxístico benigno , 2010 .

[33]  Martti Juhola,et al.  Production of Diagnostic Rules from a Neurotologic Database with Decision Trees , 2000, The Annals of otology, rhinology, and laryngology.

[34]  M. Dolores del Castillo,et al.  methodology for the characterization and diagnosis of cognitive mpairments — Application to specific language impairment , 2014 .

[35]  A. C. Fishera,et al.  Web-StrabNet : a web-based expert system for the differential diagnosis of vertical strabismus ( squint ) , 2010 .