Predicting treatment-specific lesion outcomes in acute ischemic stroke from 4D CT perfusion imaging using spatio-temporal convolutional neural networks

TY - JOUR

T1 - Predicting treatment-specific lesion outcomes in acute ischemic stroke from 4D CT perfusion imaging using spatio-temporal convolutional neural networks

AU - Amador, Kimberly

AU - Wilms, Matthias

AU - Winder, Anthony

AU - Fiehler, Jens

AU - Forkert, Nils D

N1 - Copyright © 2022 Elsevier B.V. All rights reserved.

PY - 2022/11

Y1 - 2022/11

N2 - For the diagnosis and precise treatment of acute ischemic stroke, predicting the final location and volume of lesions is of great clinical interest. Current deep learning-based prediction methods mainly use perfusion parameter maps, which can be calculated from spatio-temporal (4D) CT perfusion (CTP) imaging data, to estimate the tissue outcome of an acute ischemic stroke. However, this calculation relies on a deconvolution operation, an ill-posed problem requiring strong regularization and definition of an arterial input function. Thus, improved predictions might be achievable if the deep learning models were applied directly to acute 4D CTP data rather than perfusion maps. In this work, a novel deep spatio-temporal convolutional neural network is proposed for predicting treatment-dependent stroke lesion outcomes by making full use of raw 4D CTP data. By merging a U-Net-like architecture with temporal convolutional networks, we efficiently process the spatio-temporal information available in CTP datasets to make a tissue outcome prediction. The proposed method was evaluated on 147 patients using a 10-fold cross validation, which demonstrated that the proposed 3D+time model (mean Dice=0.45) significantly outperforms both a 2D+time variant of our approach (mean Dice=0.43) and a state-of-the-art method that uses perfusion maps (mean Dice=0.38). These results show that 4D CTP datasets include more predictive information than perfusion parameter maps, and that the proposed method is an efficient approach to make use of this complex data.

AB - For the diagnosis and precise treatment of acute ischemic stroke, predicting the final location and volume of lesions is of great clinical interest. Current deep learning-based prediction methods mainly use perfusion parameter maps, which can be calculated from spatio-temporal (4D) CT perfusion (CTP) imaging data, to estimate the tissue outcome of an acute ischemic stroke. However, this calculation relies on a deconvolution operation, an ill-posed problem requiring strong regularization and definition of an arterial input function. Thus, improved predictions might be achievable if the deep learning models were applied directly to acute 4D CTP data rather than perfusion maps. In this work, a novel deep spatio-temporal convolutional neural network is proposed for predicting treatment-dependent stroke lesion outcomes by making full use of raw 4D CTP data. By merging a U-Net-like architecture with temporal convolutional networks, we efficiently process the spatio-temporal information available in CTP datasets to make a tissue outcome prediction. The proposed method was evaluated on 147 patients using a 10-fold cross validation, which demonstrated that the proposed 3D+time model (mean Dice=0.45) significantly outperforms both a 2D+time variant of our approach (mean Dice=0.43) and a state-of-the-art method that uses perfusion maps (mean Dice=0.38). These results show that 4D CTP datasets include more predictive information than perfusion parameter maps, and that the proposed method is an efficient approach to make use of this complex data.

KW - Humans

KW - Brain Ischemia/diagnostic imaging

KW - Four-Dimensional Computed Tomography

KW - Ischemic Stroke

KW - Neural Networks, Computer

KW - Perfusion Imaging/methods

KW - Stroke/diagnostic imaging

U2 - 10.1016/j.media.2022.102610

DO - 10.1016/j.media.2022.102610

M3 - SCORING: Journal article

C2 - 36103772

VL - 82

JO - MED IMAGE ANAL

JF - MED IMAGE ANAL

SN - 1361-8415

M1 - 102610

ER -