Deep Learning Multi-label Tongue Image Analysis and Its Application in a Population Undergoing Routine Medical Checkup

BACKGROUND: Research on intelligent tongue diagnosis is a main direction in the modernization of tongue diagnosis technology. Identification of tongue shape and texture features is a difficult task for tongue diagnosis in traditional Chinese medicine (TCM). This study aimed to explore the application of deep learning techniques in tongue image analyses. METHODS: A total of 8676 tongue images were annotated by clinical experts, into seven categories, including the fissured tongue, tooth-marked tongue, stasis tongue, spotted tongue, greasy coating, peeled coating, and rotten coating. Based on the labeled tongue images, the deep learning model faster region-based convolutional neural networks (Faster R-CNN) was utilized to classify tongue images. Four performance indices, i.e., accuracy, recall, precision, and F1-score, were selected to evaluate the model. Also, we applied it to analyze tongue image features of 3601 medical checkup participants in order to explore gender and age factors and the correlations among tongue features in diseases through complex networks. RESULTS: The average accuracy, recall, precision, and F1-score of our model achieved 90.67%, 91.25%, 99.28%, and 95.00%, respectively. Over the tongue images from the medical checkup population, the model Faster R-CNN detected 41.49% fissured tongue images, 37.16% tooth-marked tongue images, 29.66% greasy coating images, 18.66% spotted tongue images, 9.97% stasis tongue images, 3.97% peeled coating images, and 1.22% rotten coating images. There were significant differences in the incidence of the fissured tongue, tooth-marked tongue, spotted tongue, and greasy coating among age and gender. Complex networks revealed that fissured tongue and tooth-marked were closely related to hypertension, dyslipidemia, overweight and nonalcoholic fatty liver disease (NAFLD), and a greasy coating tongue was associated with hypertension and overweight. CONCLUSION: The model Faster R-CNN shows good performance in the tongue image classification. And we have preliminarily revealed the relationship between tongue features and gender, age, and metabolic diseases in a medical checkup population.