Automatic detection of acute ischemic stroke using non-contrast computed tomography and two-stage deep learning model
Kobe University Hospital(神户大学医院);Research Center for Advanced Science and Technology, The University of Tokyo(东京大学先进科学技术研究中心);Ichinomiyanishi Nishi Hospital(一宮西医院);Osaka Red Cross Hospital(大阪红十字医院)
Background and Purpose: We aimed to develop and evaluate an automatic acute ischemic stroke-related (AIS) detection system involving a two-stage deep learning model.
Methods: We included 238 cases from two different institutions. AIS-related findings were annotated on each of the 238 sets of head CT images by referring to head magnetic resonance imaging (MRI) images in which an MRI examination was performed within 24 h following the CT scan. These 238 annotated cases were divided into a training set including 189 cases and test set including 49 cases. Subsequently, a two-stage deep learning detection model was constructed from the training set using the You Only Look Once v3 model and Visual Geometry Group 16 classification model. Then, the two-stage model performed the AIS detection process in the test set. To assess the detection model's results, a board-certified radiologist also evaluated the test set head CT images with and without the aid of the detection model. The sensitivity of AIS detection and number of false positives were calculated for the evaluation of the test set detection results. The sensitivity of the radiologist with and without the software detection results was compared using the McNemar test. A p-value of less than 0.05 was considered statistically significant.
Results: For the two-stage model and radiologist without and with the use of the software results, the sensitivity was 37.3%, 33.3%, and 41.3%, respectively, and the number of false positives per one case was 1.265, 0.327, and 0.388, respectively. On using the two-stage detection model's results, the board-certified radiologist's detection sensitivity significantly improved (p-value = 0.0313).
Conclusions: Our detection system involving the two-stage deep learning model significantly improved the radiologist's sensitivity in AIS detection.
This article focuses on the control center of each human body: the brain. We will point out the pivotal role of the cerebral vasculature and how its complex mechanisms may vary between subjects. We then emphasize a specific acute pathological state, i.e., acute ischemic stroke, and show how medical imaging and its analysis can be used to define the treatment. We show how the core-penumbra concept is used in practice using mismatch criteria and how machine learning can be used to make predictions of the final infarct, either via deconvolution or convolutional neural networks.
Automated Segmentation of Ischemic Stroke Lesions in Non-Contrast Computed Tomography Images for Enhanced Treatment and Prognosis
Kwame Nkrumah University of Science and Technology(库马西科技大学);Department of Computer Engineering(计算机工程系);Kumasi Centre for Collaborative Research in Tropical Medicine(库马西热带医学协作研究中心);Komfo Anokye Teaching Hospital(科莫福·阿诺耶教学医院)
University of California, Los Angeles(加州大学洛杉矶分校);VA Phoenix Healthcare System(凤凰城退伍军人医疗系统)
Treatment of acute ischemic strokes (AIS) is largely contingent upon the time since stroke onset (TSS). However, TSS may not be readily available in up to 25% of patients with unwitnessed AIS. Current clinical guidelines for patients with unknown TSS recommend the use of MRI to determine eligibility for thrombolysis, but radiology assessments have high inter-reader variability. In this work, we present deep learning models that leverage MRI diffusion series to classify TSS based on clinically validated thresholds. We propose an intra-domain task-adaptive transfer learning method, which involve…
Local Gamma Augmentation for Ischemic Stroke Lesion Segmentation on MRI
University of Copenhagen(哥本哈根大学);Cerebriu A/S(Cerebriu公司);Rigshospitalet, Copenhagen, Denmark(哥本哈根大学医院);Pioneer Centre for Artificial Intelligence, University of Copenhagen(哥本哈根大学人工智能先锋中心)
Dual-Encoder Transformer-Based Multimodal Learning for Ischemic Stroke Lesion Segmentation Using Diffusion MRI
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University(麻醉学、围术期与疼痛医学系,斯坦福大学);Department of Biomedical Sciences, Seoul National University(生物医学科学系,首尔国立大学);Department of Computer Engineering, National University of Sciences and Technology (NUST)(计算机工程系,国立科学与技术大学(NUST));Department of Computer Science, The University of Alabama(计算机科学系,阿拉巴马大学);Department of Computer Science, Hanyang University(计算机科学系,翰阳大学)
Molinette Hospital(莫利内特医院);University of Turin(都灵大学);University Medical Center Utrecht(乌得勒支大学医学中心)
Purpose: In this study we investigate whether a Convolutional Neural Network (CNN) can generate clinically relevant parametric maps from CT perfusion data in a clinical setting of patients with acute ischemic stroke. Methods: Training of the CNN was done on a subset of 100 perfusion data, while 15 samples were used as validation. All the data used for the training/validation of the network and to generate ground truth (GT) maps, using a state-of-the-art deconvolution-algorithm, were previously pre-processed using a standard pipeline. Validation was carried out through manual segmentation of in…
Acute ischemic stroke lesion segmentation in non-contrast CT images using 3D convolutional neural networks
Novosibirsk State University(新西伯利亚国立大学);International Tomography Center SB RAS(西伯利亚分院国际断层扫描中心);Sobolev Institute of Mathematics SB RAS(西伯利亚分院索博列夫数学研究所)
The Pennsylvania State University(宾夕法尼亚州立大学);Johns Hopkins University(约翰斯·霍普金斯大学);Houston Methodist Hospital(休斯顿卫理公会医院)
Accurate infarct segmentation in non-contrast CT (NCCT) images is a crucial step toward computer-aided acute ischemic stroke (AIS) assessment. In clinical practice, bilateral symmetric comparison of brain hemispheres is usually used to locate pathological abnormalities. Recent research has explored asymmetries to assist with AIS segmentation. However, most previous symmetry-based work mixed different types of asymmetries when evaluating their contribution to AIS. In this paper, we propose a novel Asymmetry Disentanglement Network (ADN) to automatically separate pathological asymmetries and int…
Fusion of Diffusion Weighted MRI and Clinical Data for Predicting Functional Outcome after Acute Ischemic Stroke with Deep Contrastive Learning
Queens College of the City University of NY(纽约市立大学皇后学院);National Chung Cheng University(台湾中正大学);Ditmanson Medical Foundation Chia-Yi Christian Hospital(戴德森医疗财团法人嘉义基督教医院)
Acute stroke lesion segmentation tasks are of great clinical interest as they can help doctors make better informed treatment decisions. Magnetic resonance imaging (MRI) is time demanding but can provide images that are considered gold standard for diagnosis. Automated stroke lesion segmentation can provide with an estimate of the location and volume of the lesioned tissue, which can help in the clinical practice to better assess and evaluate the risks of each treatment. We propose a deep learning methodology for acute and sub-acute stroke lesion segmentation using multimodal MR imaging. The p…
University of Stavanger(斯塔万格大学);Stavanger University Hospital(斯塔万格大学医院)
More than 13 million people suffer from ischemic cerebral stroke worldwide each year. Thrombolytic treatment can reduce brain damage but has a narrow treatment window. Computed Tomography Perfusion imaging is a commonly used primary assessment tool for stroke patients, and typically the radiologists will evaluate resulting parametric maps to estimate the affected areas, dead tissue (core), and the surrounding tissue at risk (penumbra), to decide further treatments. Different work has been reported, suggesting thresholds, and semi-automated methods, and in later years deep neural networks, for …
Sberbank AI Lab(俄罗斯联邦储蓄银行人工智能实验室);New York University(纽约大学)
Segmentation of ischemic stroke and intracranial hemorrhage on computed tomography is essential for investigation and treatment of stroke. In this paper, we modified the U-Net CNN architecture for the stroke identification problem using non-contrast CT. We applied the proposed DL model to historical patient data and also conducted clinical experiments involving ten experienced radiologists. Our model achieved strong results on historical data, and significantly outperformed seven radiologist out of ten, while being on par with the remaining three.
Nankai University(南开大学);Tianjin Huanhu Hospital(天津市环湖医院);the University of Aizu(会津大学);Tianjin Medical University(天津医科大学);College of Electronic Information and Optical Engineering, Nankai University(南开大学电子信息与光学工程学院);School of Computer Science and Engineering, the University of Aizu(会津大学计算机科学与工程学院);School of Basic Medical Sciences, Tianjin Medical University(天津医科大学基础医学院);Department of Medical Imaging, Tianjin Huanhu Hospital(天津市环湖医院医学影像科);Key Laboratory for Cerebral Artery and Neural Degeneration of Tianjin(天津市脑血管及神经变性重点实验室);Tianjin Key Laboratory of Optoelectronic Sensor and Sensing Network Technology(天津市光电传感器与传感网络技术重点实验室)
The patient with ischemic stroke can benefit most from the earliest possible definitive diagnosis. While the high quality medical resources are quite scarce across the globe, an automated diagnostic tool is expected in analyzing the magnetic resonance (MR) images to provide reference in clinical diagnosis. In this paper, we propose a deep learning method to automatically segment ischemic stroke lesions from multi-modal MR images. By using atrous convolution and global convolution network, our proposed residual-structured fully convolutional network (Res-FCN) is able to capture features from la…
ISLES 2022: A multi-center magnetic resonance imaging stroke lesion segmentation dataset
Technical University of Munich(慕尼黑工业大学);Klinikum rechts der Isar(右岸医院);School of Medicine, Technical University of Munich(慕尼黑工业大学医学院);icometrix(icometrix公司);University Medical Center Hamburg-Eppendorf(汉堡埃彭多夫大学医学中心);University of Bern(伯尔尼大学);ARTORG Center for Biomedical Engineering Research, Univ. of Bern(伯尔尼大学生物医学工程研究ARTORG中心);University of Southern California(南加州大学);Chan Division of Occupational Science and Occupational Therapy, University of Southern California(南加州大学陈职业科学与职业治疗系);TranslaTUM – Central Institute for Translational Cancer Research, Technical University of Munich(慕尼黑工业大学TranslaTUM转化癌症研究中心)
CT perfusion (CTP) has been used to triage ischemic stroke patients in the early stage, because of its speed, availability, and lack of contraindications. Perfusion parameters including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time of peak (Tmax) could also be computed from CTP data. However, CTP data or the perfusion parameters, are ambiguous to locate the infarct core or tissue at risk (penumbra), which is normally confirmed by the follow-up Diffusion Weighted Imaging (DWI) or perfusion diffusion mismatch. In this paper, we propose a novel generativ…
National University of Singapore(新加坡国立大学);NIT, Tiruchirappalli(蒂鲁吉拉伯利国家技术学院)
Ischemic stroke occurs through a blockage of clogged blood vessels supplying blood to the brain. Segmentation of the stroke lesion is vital to improve diagnosis, outcome assessment and treatment planning. In this work, we propose a segmentation model with adversarial learning for ischemic lesion segmentation. We adopt U-Net with skip connection and dropout as segmentation baseline network and a fully connected network (FCN) as discriminator network. Discriminator network consists of 5 convolution layers followed by leaky-ReLU and an upsampling layer to rescale the output to the size of the inp…
Philips Research North America(飞利浦北美研究院);MIT(麻省理工学院)
Infarcted brain tissue resulting from acute stroke readily shows up as hyperintense regions within diffusion-weighted magnetic resonance imaging (DWI). It has also been proposed that computed tomography perfusion (CTP) could alternatively be used to triage stroke patients, given improvements in speed and availability, as well as reduced cost. However, CTP has a lower signal to noise ratio compared to MR. In this work, we investigate whether a conditional mapping can be learned by a generative adversarial network to map CTP inputs to generated MR DWI that more clearly delineates hyperintense re…
Ischemic Stroke Lesion Segmentation challenge (ISLES 2022) offers a platform for researchers to compare their solutions to 3D segmentation of ischemic stroke regions from 3D MRIs. In this work, we describe our solution to ISLES 2022 segmentation task. We re-sample all images to a common resolution, use two input MRI modalities (DWI and ADC) and train SegResNet semantic segmentation network from MONAI. The final submission is an ensemble of 15 models (from 3 runs of 5-fold cross validation). Our solution (team name NVAUTO) achieves the top place in terms of Dice metric (0.824), and overall rank…
CREATIS(CREATIS实验室);Université Lyon 1(里昂第一大学);INSA-Lyon(里昂国立应用科学学院);Hospices Civils de Lyon(里昂民用医院);CarMeN(CarMeN实验室);LARIS(LARIS实验室);Universite d’Angers(昂热大学)
Patient outcome prediction is critical in management of ischemic stroke. In this paper, a novel machine learning model is proposed for stroke outcome prediction using multimodal Magnetic Resonance Imaging (MRI). The proposed model consists of two serial levels of Autoencoders (AEs), where different AEs at level 1 are used for learning unimodal features from different MRI modalities and a AE at level 2 is used to combine the unimodal features into compressed multimodal features. The sequences of multimodal features of a given patient are then used by an LSTM network for predicting outcome score…
The University of Hong Kong(香港大学);Hospital Authority(医院管理局)
The hyperdense middle cerebral artery (MCA) dot sign has been reported as an important factor in the diagnosis of acute ischemic stroke due to large vessel occlusion. Interpreting the initial CT brain scan in these patients requires high level of expertise, and has high inter-observer variability. An automated computerized interpretation of the urgent CT brain image, with an emphasis to pick up early signs of ischemic stroke will facilitate early patient diagnosis, triage, and shorten the door-to-revascularization time for these group of patients. In this paper, we present an automated detecti…
Christian Medical College Ludhiana(卢迪亚纳基督教医学院);Pacific Neuroscience Institute(太平洋神经科学研究所)
A stroke occurs when an artery in the brain ruptures and bleeds or when the blood supply to the brain is cut off. Blood and oxygen cannot reach the brain's tissues due to the rupture or obstruction resulting in tissue death. The Middle cerebral artery (MCA) is the largest cerebral artery and the most commonly damaged vessel in stroke. The quick onset of a focused neurological deficit caused by interruption of blood flow in the territory supplied by the MCA is known as an MCA stroke. Alberta stroke programme early CT score (ASPECTS) is used to estimate the extent of early ischemic changes in pa…
Deep learning based disease detection and segmentation algorithms promise to improve many clinical processes. However, such algorithms require vast amounts of annotated training data, which are typically not available in the medical context due to data privacy, legal obstructions, and non-uniform data acquisition protocols. Synthetic databases with annotated pathologies could provide the required amounts of training data. We demonstrate with the example of ischemic stroke that an improvement in lesion segmentation is feasible using deep learning based augmentation. To this end, we train differ…
Diffusion-Weighted Magnetic Resonance Imaging (DWI) is widely used for early cerebral infarct detection caused by ischemic stroke. Manual segmentation is done by a radiologist as a common clinical process, nonetheless, challenges of cerebral infarct segmentation come from low resolution and uncertain boundaries. Many segmentation techniques have been proposed and proved by manual segmentation as gold standard. In order to reduce human error in research operation and clinical process, we adopt a semi-automatic segmentation as gold standard using Fluid-Attenuated Inversion-Recovery (FLAIR) Magne…
Nankai University(南开大学);Guilin University of Electronic Technology(桂林电子科技大学);Tianjin Huanhu Hospital(天津市环湖医院)
Ischemic stroke is a common disease in the elderly population, which can cause long-term disability and even death. However, the time window for treatment of ischemic stroke in its acute stage is very short. To fast localize and quantitively evaluate the acute ischemic stroke (AIS) lesions, many deep-learning-based lesion segmentation methods have been proposed in the literature, where a deep convolutional neural network (CNN) was trained on hundreds of fully labeled subjects with accurate annotations of AIS lesions. Despite that high segmentation accuracy can be achieved, the accurate labels …
Comparing Baseline and Day-1 Diffusion MRI Using Multimodal Deep Embeddings for Stroke Outcome Prediction
1 Department of Computer Science, University of Geneva, Switzerland 2 Department of Electrical \& Computer Engineering, University of Florida, FL, USA 3 Service of Medical Informatics, University Hospital of Geneva, Switzerland 4 Department of Imaging;Medical Informatics, University of Geneva, Switzerland
Stroke Locus Net: Occluded Vessel Localization from MRI Modalities
Department of Electrical Engineering, College of Engineering, Qatar University, Doha, Qatar(电气工程系,工程学院,卡塔尔大学,多哈,卡塔尔);Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar(数学与统计学系,艺术与科学学院,卡塔尔大学,多哈,卡塔尔)
本研究提出端到端深度学习流水线 Stroke Locus Net,结合 nnUNet 分割、动脉图谱与 pGAN 生成,仅用 MRI 扫描实现闭塞血管定位,为更快速的中风诊断提供潜力。
Pattern Recognition and Intelligent System Laboratory, School of Artificial Intelligence, Beijing University of Posts and Telecommunications(北京邮电大学人工智能学院模式识别与智能系统实验室);Deepwise AI Lab(深度科技人工智能实验室);Jinling Hospital, Nanjing University School of Medicine(南京大学医学院附属金陵医院);Department of Computer Science and Technology, Peking University(北京大学计算机科学技术系);The University of Hong Kong(香港大学)
Quantitative estimation of the acute ischemic infarct is crucial to improve neurological outcomes of the patients with stroke symptoms. Since the density of lesions is subtle and can be confounded by normal physiologic changes, anatomical asymmetry provides useful information to differentiate the ischemic and healthy brain tissue. In this paper, we propose a symmetry enhanced attention network (SEAN) for acute ischemic infarct segmentation. Our proposed network automatically transforms an input CT image into the standard space where the brain tissue is bilaterally symmetric. The transformed im…
The University of Hong Kong(香港大学);Hospital Authority(医院管理局)
Large vessel occlusion (LVO) plays an important role in the diagnosis of acute ischemic stroke. Identifying LVO of patients in the early stage on admission would significantly lower the probabilities of suffering from severe effects due to stroke or even save their lives. In this paper, we utilized both structural and imaging data from all recorded acute ischemic stroke patients in Hong Kong. Total 300 patients (200 training and 100 testing) are used in this study. We established three hierarchical models based on demographic data, clinical data and features obtained from computerized tomograp…
University of Zurich (UZH)(苏黎世大学);Zurich University of Applied Sciences (ZHAW)(苏黎世应用科技大学);Konstanz University of Applied Sciences(康斯坦茨应用科技大学);University Hospital Zurich (UHZ)(苏黎世大学医院)
At present, the majority of the proposed Deep Learning (DL) methods provide point predictions without quantifying the models uncertainty. However, a quantification of the reliability of automated image analysis is essential, in particular in medicine when physicians rely on the results for making critical treatment decisions. In this work, we provide an entire framework to diagnose ischemic stroke patients incorporating Bayesian uncertainty into the analysis procedure. We present a Bayesian Convolutional Neural Network (CNN) yielding a probability for a stroke lesion on 2D Magnetic Resonance (…
Nanyang Technological University(南洋理工大学);Alibaba Group Holding Ltd(阿里巴巴集团控股有限公司)
We implement a visual interpretability method Layer-wise Relevance Propagation (LRP) on top of 3D U-Net trained to perform lesion segmentation on the small dataset of multi-modal images provided by ISLES 2017 competition. We demonstrate that LRP modifications could provide more sensible visual explanations to an otherwise highly noise-skewed saliency map. We also link amplitude of modified signals to useful information content. High amplitude localized signals appear to constitute the noise that undermines the interpretability capacity of LRP. Furthermore, mathematical framework for possible a…
Universidad Técnica Particular de Loja(洛哈技术大学);University of Waterloo(滑铁卢大学);Universitat Politècnica de València(瓦伦西亚理工大学);Consejo Superior de Investigaciones Científicas (CSIC)(西班牙国家研究委员会)
Medical brain image analysis is a necessary step in Computer Assisted /Aided Diagnosis (CAD) systems. Advancements in both hardware and software in the past few years have led to improved segmentation and classification of various diseases. In the present work, we review the published literature on systems and algorithms that allow for classification, identification, and detection of White Matter Hyperintensities (WMHs) of brain MRI images specifically in cases of ischemic stroke and demyelinating diseases. For the selection criteria, we used the bibliometric networks. Out of a total of 140 do…
USC Stevens Neuroimaging and Informatics Institute(南加州大学史蒂文斯神经影像与信息学研究所);Zilkha Neurogenetic Institute, Keck School of Medicine of USC(南加州大学凯克医学院齐尔卡神经遗传学研究所);Martinos Center for Biomedical Imaging, Massachusetts General Hospital(麻省总医院马蒂诺斯生物医学成像中心);Yale University(耶鲁大学);University of Iowa(爱荷华大学);Augusta University(奥古斯塔大学);University of Texas(德克萨斯大学);Kennedy Krieger Institute, Johns Hopkins University(约翰斯·霍普金斯大学肯尼迪·克里格研究所)
While ischemic stroke is a leading cause of death worldwide, there has been little success translating putative cerebroprotectants from rodent preclinical trials to human patients. We investigated computational image-based assessment tools for practical improvement of the quality, scalability, and outlook for large scale preclinical screening for potential therapeutic interventions in rodent models. We developed, evaluated, and deployed a pipeline for image-based stroke outcome quantification for the Stroke Preclinical Assessment Network (SPAN), a multi-site, multi-arm, multi-stage study evalu…
The rapid increment of morbidity of brain stroke in the last few years have been a driving force towards fast and accurate segmentation of stroke lesions from brain MRI images. With the recent development of deep-learning, computer-aided and segmentation methods of ischemic stroke lesions have been useful for clinicians in early diagnosis and treatment planning. However, most of these methods suffer from inaccurate and unreliable segmentation results because of their inability to capture sufficient contextual features from the MRI volumes. To meet these requirements, 3D convolutional neural ne…
University of Alberta(阿尔伯塔大学);Alberta Machine Intelligence Institute(阿尔伯塔机器智能研究所)
As one of the leading causes of mortality and disability worldwide, Acute Ischemic Stroke (AIS) occurs when the blood supply to the brain is suddenly interrupted because of a blocked artery. Within seconds of AIS onset, the brain cells surrounding the blocked artery die, which leads to the progression of the lesion. The automated and precise prediction of the existing lesion plays a vital role in the AIS treatment planning and prevention of further injuries. The current standard AIS assessment method, which thresholds the 3D measurement maps extracted from Computed Tomography Perfusion (CTP) i…
Multimodal Deep Learning for Stroke Prediction and Detection using Retinal Imaging and Clinical Data
Division of Engineering, New York University Abu Dhabi(纽约大学阿布扎赫尔分校工程系);Institute for Healthier Living Abu Dhabi(阿布扎赫尔健康生活研究所);Eye Institute at Cleveland Clinic Abu Dhabi(阿布扎赫尔克利夫兰医学中心眼科研究所);Canberra Hospital(堪培拉医院)
Erasmus MC, University Medical Center Rotterdam(鹿特丹伊拉斯谟大学医学中心);Leiden UMC(莱顿大学医学中心);Maastricht UMC(马斯特里赫特大学医学中心);Haaglanden Medical Center(海牙哈格兰登医学中心)
The Thrombolysis in Cerebral Infarction (TICI) score is an important metric for reperfusion therapy assessment in acute ischemic stroke. It is commonly used as a technical outcome measure after endovascular treatment (EVT). Existing TICI scores are defined in coarse ordinal grades based on visual inspection, leading to inter- and intra-observer variation. In this work, we present autoTICI, an automatic and quantitative TICI scoring method. First, each digital subtraction angiography (DSA) acquisition is separated into four phases (non-contrast, arterial, parenchymal and venous phase) using a m…
University of Electronic Science and Technology of China(电子科技大学);SenseTime Research(商汤科技研究院);Huashan Hospital, Fudan University(复旦大学附属华山医院);Fudan University(复旦大学);Jing’an District Centre Hospital of Shanghai(上海市静安区中心医院)
Ischemic stroke lesion segmentation from Computed Tomography Perfusion (CTP) images is important for accurate diagnosis of stroke in acute care units. However, it is challenged by low image contrast and resolution of the perfusion parameter maps, in addition to the complex appearance of the lesion. To deal with this problem, we propose a novel framework based on synthesized pseudo Diffusion-Weighted Imaging (DWI) from perfusion parameter maps to obtain better image quality for more accurate segmentation. Our framework consists of three components based on Convolutional Neural Networks (CNNs) a…
University of Minho(米尼奥大学);University Hospital Inselspital and University of Bern(Inselspital大学医院与伯尔尼大学);University of Bern(伯尔尼大学)
Stroke is the second most common cause of death in developed countries, where rapid clinical intervention can have a major impact on a patient's life. To perform the revascularization procedure, the decision making of physicians considers its risks and benefits based on multi-modal MRI and clinical experience. Therefore, automatic prediction of the ischemic stroke lesion outcome has the potential to assist the physician towards a better stroke assessment and information about tissue outcome. Typically, automatic methods consider the information of the standard kinetic models of diffusion and p…
During the diagnosis of ischemic strokes, the Circle of Willis and its surrounding vessels are the arteries of interest. Their visualization in case of an acute stroke is often enabled by Computed Tomography Angiography (CTA). Still, the identification and analysis of the cerebral arteries remain time consuming in such scans due to a large number of peripheral vessels which may disturb the visual impression. In previous work we proposed VirtualDSA++, an algorithm designed to segment and label the cerebrovascular tree on CTA scans. Especially with stroke patients, labeling is a delicate procedu…