RT Journal Article
SR Electronic
T1 Automated Segmentation of Intracranial Thrombus on NCCT and CTA in Patients with Acute Ischemic Stroke Using a Coarse-to-Fine Deep Learning Model
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A7878
A1 K. Zhu
A1 F. Bala
A1 J. Zhang
A1 F. Benali
A1 P. Cimflova
A1 B.J. Kim
A1 R. McDonough
A1 N. Singh
A1 M.D. Hill
A1 M. Goyal
A1 A. Demchuk
A1 B.K. Menon
A1 W. Qiu
YR 2023
UL http://www.ajnr.org/content/early/2023/05/18/ajnr.A7878.abstract
AB BACKGROUND AND PURPOSE: Identifying the presence and extent of intracranial thrombi is crucial in selecting patients with acute ischemic stroke for treatment. This article aims to develop an automated approach to quantify thrombus on NCCT and CTA in patients with stroke.MATERIALS AND METHODS: A total of 499 patients with large-vessel occlusion from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial were included. All patients had thin-section NCCT and CTA images. Thrombi contoured manually were used as reference standard. A deep learning approach was developed to segment thrombi automatically. Of 499 patients, 263 and 66 patients were randomly selected to train and validate the deep learning model, respectively; the remaining 170 patients were independently used for testing. The deep learning model was quantitatively compared with the reference standard using the Dice coefficient and volumetric error. The proposed deep learning model was externally tested on 83 patients with and without large-vessel occlusion from another independent trial.RESULTS: The developed deep learning approach obtained a Dice coefficient of 70.7% (interquartile range, 58.0%–77.8%) in the internal cohort. The predicted thrombi length and volume were correlated with those of expert-contoured thrombi (r = 0.88 and 0.87, respectively; P < .001). When the derived deep learning model was applied to the external data set, the model obtained similar results in patients with large-vessel occlusion regarding the Dice coefficient (66.8%; interquartile range, 58.5%–74.6%), thrombus length (r = 0.73), and volume (r = 0.80). The model also obtained a sensitivity of 94.12% (32/34) and a specificity of 97.96% (48/49) in classifying large-vessel occlusion versus non-large-vessel occlusion.CONCLUSIONS: The proposed deep learning method can reliably detect and measure thrombi on NCCT and CTA in patients with acute ischemic stroke.AISacute ischemic strokeASSDaverage symmetric surface distanceDCDice coefficientDLdeep learningEVTendovascular therapyHD9595th percentile of the Hausdorff distanceIQRinterquartile rangeLVOlarge-vessel occlusionMeVOmedium-vessel occlusionSTAPLEsimultaneous truth and performance level estimation