Perfusion imaging is the current gold standard for acute ischemic stroke analysis. It allows quantification of the salvageable and non-salvageable tissue regions (penumbra and core areas respectively). In clinical settings, the singular value decomposition (SVD) deconvolution is one of the most accepted and used approaches for generating interpretable and physically meaningful maps. Though this method has been widely validated in experimental and clinical settings, it might produce suboptimal results because the chosen inputs to the model cannot guarantee optimal performance. For the most critical input, the arterial input function (AIF), it is still controversial how and where it should be chosen even though the method is very sensitive to this input. In this work we propose an AIF selection approach that is optimized for maximal core lesion segmentation performance. The AIF is regressed by a neural network optimized through a differentiable SVD deconvolution, aiming to maximize core lesion segmentation agreement with ground truth data. To our knowledge, this is the first work exploiting a differentiable deconvolution model with neural networks. We show that our approach is able to generate AIFs without any manual annotation, and hence avoiding manual rater's influences. The method achieves manual expert performance in the ISLES18 dataset. We conclude that the methodology opens new possibilities for improving perfusion imaging quantification with deep neural networks.
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…
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…
icometrix（icometrix公司）；Technical University of Munich（慕尼黑工业大学）；KU Leuven（荷语鲁汶大学）
Perfusion imaging is crucial in acute ischemic stroke for quantifying the salvageable penumbra and irreversibly damaged core lesions. As such, it helps clinicians to decide on the optimal reperfusion treatment. In perfusion CT imaging, deconvolution methods are used to obtain clinically interpretable perfusion parameters that allow identifying brain tissue abnormalities. Deconvolution methods require the selection of two reference vascular functions as inputs to the model: the arterial input function (AIF) and the venous output function, with the AIF as the most critical model input. When manu…
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…
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 …
DSA-NRP: No-Reflow Prediction from Angiographic Perfusion Dynamics in Stroke EVT
Department of Electrical and Computer Engineering, UCLA（电气与计算机工程系，加州大学洛杉矶分校）；Medical Informatics, UCLA（医学信息学，加州大学洛杉矶分校）；Department of Radiological Sciences, UCLA（放射科学系，加州大学洛杉矶分校）；Department of Radiology, UC San Francisco（放射科，旧金山大学医学院）；Department of Bioengineering, UCLA（生物工程系，加州大学洛杉矶分校）；Department of Pathology and Laboratory Medicine, UCLA（病理学与实验室医学系，加州大学洛杉矶分校）
University of North Carolina at Chapel Hill（北卡罗来纳大学教堂山分校）；Kitware, Inc.（Kitware公司）
Perfusion imaging (PI) is clinically used to assess strokes and brain tumors. Commonly used PI approaches based on magnetic resonance imaging (MRI) or computed tomography (CT) measure the effect of a contrast agent moving through blood vessels and into tissue. Contrast-agent free approaches, for example, based on intravoxel incoherent motion, also exist, but are so far not routinely used clinically. These methods rely on estimating on the arterial input function (AIF) to approximately model tissue perfusion, neglecting spatial dependencies, and reliably estimating the AIF is also non-trivial, …
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…
CT perfusion imaging (CTP) is used in the diagnostic workup of acute ischemic stroke (AIS). CTP may be performed within the angio suite using flat detector CT (FDCT) to help reduce patient management time. In order to significantly improve FDCT perfusion (FDCTP) imaging, data-processing algorithms need to be able to compensate for the higher levels of noise, slow rotation speed, and a lower frame rate of current FDCT devices. We performed a realistic simulation of FDCTP acquisition based on CTP data from seven subjects. We used the time separation technique (TST) as a model-based approach for …
Quantitative perfusion maps using a novelty spatiotemporal convolutional neural network
School of Applied Technology, Shenzhen University（深圳大学应用技术学院）；College of Health Science and Environmental Engineering, Shenzhen Technology University（深圳技术大学健康科学与环境工程学院）；Department of Biomedical Engineering, Columbia University（哥伦比亚大学生物医学工程系）；Zuckerman Institute, Columbia University（哥伦比亚大学扎克曼研究所）；College of Medicine and Biological Information Engineering, Northeastern University（东北大学医学与生物信息工程学院）；School of Biomedical Engineering, Medical School, Shenzhen University（深圳大学医学院生物医学工程学院）；Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine（同济大学医学院附属上海市第四人民医院）
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…
National Technical University of Ukraine “Igor Sikorsky Kyiv Polytechnic Institute”（乌克兰国立技术大学“伊戈尔·西科斯基基辅理工学院”）
Accurate detection of arterial input function is a crucial step in obtaining perfusion hemodynamic parameters using dynamic susceptibility contrast-enhanced magnetic resonance imaging. It is required as input for perfusion quantification and has a great impact on the result of the deconvolution operation. To improve the reproducibility and reliability of arterial input function detection, several semi- or fully automatic methods have been proposed. This study provides an overview of the current state of the field of arterial input function detection. Methods most commonly used for semi- and fu…
Center for Advanced Medical Computing and Analysis（高级医学计算与分析中心）；Gordon Center for Medical Imaging（戈登医学成像中心）；Massachusetts General Hospital（麻省总医院）；Harvard Medical School（哈佛医学院）
Dynamic computed tomography perfusion (CTP) imaging is a promising approach for acute ischemic stroke diagnosis and evaluation. Hemodynamic parametric maps of cerebral parenchyma are calculated from repeated CT scans of the first pass of iodinated contrast through the brain. It is necessary to reduce the dose of CTP for routine applications due to the high radiation exposure from the repeated scans, where image denoising is necessary to achieve a reliable diagnosis. In this paper, we proposed a self-supervised deep learning method for CTP denoising, which did not require any high-dose referenc…
Indian Institute of Technology Kharagpur（印度理工学院卡拉格布尔分校）
Ischaemic stroke is a medical condition caused by occlusion of blood supply to the brain tissue thus forming a lesion. A lesion is zoned into a core associated with irreversible necrosis typically located at the center of the lesion, while reversible hypoxic changes in the outer regions of the lesion are termed as the penumbra. Early estimation of core and penumbra in ischaemic stroke is crucial for timely intervention with thrombolytic therapy to reverse the damage and restore normalcy. Multisequence magnetic resonance imaging (MRI) is commonly employed for clinical diagnosis. However, a sequ…
