利用3D生成AI从烟雾病患者的基线MRI合成乙酰唑胺给药后脑血流量图
Synthesizing Post-Acetazolamide Cerebral Blood Flow Maps from Baseline MRI in Moyamoya Using 3D Generative AI
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- Stanford School of Engineering（斯坦福工程学院）
- Stanford School of Medicine（斯坦福医学院）
- Medical University of Vienna（维也纳医科大学）
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中文总结 AI 辅助
本研究提出CAE3D模型，可从烟雾病患者基线MRI合成乙酰唑胺后脑血流量图，在多指标上优于对比方法，为ACZ禁忌患者的血流动力学评估提供可行方案。
中文摘要 AI 辅助
对于烟雾病患者，脑血管储备（CVR）受损是推荐行颅内外搭桥手术的重要血流动力学标准。该队列的标准CVR评估采用乙酰唑胺（ACZ）给药前后采集的成对动脉自旋标记（ASL）灌注MRI。当ACZ存在禁忌证或需避免使用时，血流动力学评估所需的ACZ后脑血流量（CBF）图无法获取。我们提出CAE3D，一种确定性3D条件自编码器，可直接从ACZ前ASL输入合成ACZ后CBF图。我们将CAE3D与10种对比方法进行评估，包括确定性和扩散式3D基线、2D上下文基线及冻结编码器基础模型适配器。CAE3D在保留测试集上实现最低平均绝对误差（MAE）为0.066，结构相似性（SSIM）为0.80，峰值信噪比（PSNR）为24.0 dB，全脑平均偏差接近零。其MAE优势在8个从头训练的基线中7个具有统计学显著性（不包括2D CAE_2D对比方法），SSIM和PSNR优势在全部8个基线中均显著。区域delta-CBF预测压缩了高反应区域的动态范围。这些结果证实，完成标准双扫描方案的患者可回顾性实现ACZ后CBF合成。将该方法扩展至ACZ禁忌证患者（本队列未包含此类患者）需外部及前瞻性验证。
英文摘要
For patients with Moyamoya disease, impaired cerebrovascular reserve (CVR) is an important hemodynamic criterion for recommending extracranial-to-intracranial bypass surgery. Standard CVR assessment in this cohort uses paired arterial spin labeling (ASL) perfusion MRI acquired before and after acetazolamide (ACZ). When ACZ is contraindicated or avoided, the post-ACZ cerebral blood flow (CBF) map needed for hemodynamic assessment is unavailable. We propose CAE3D, a deterministic 3D conditional autoencoder that synthesizes post-ACZ CBF maps directly from pre-ACZ ASL input. We evaluated CAE3D against ten comparators, including deterministic and diffusion-style 3D baselines, a 2D contextual baseline, and frozen-encoder foundation-model adapters. CAE3D achieved the lowest held-out MAE (0.066), with SSIM 0.80 and PSNR 24.0 dB, and near-zero full-brain mean bias. Its MAE advantage was statistically significant over seven of eight trained-from-scratch baselines, excluding the 2D CAE_2D comparator; its SSIM and PSNR advantages were significant over all eight. Regional delta-CBF predictions compressed the dynamic range in high-response territories. These results establish the retrospective feasibility of post-ACZ CBF synthesis in patients who completed the standard two-scan protocol. Extension to ACZ-contraindicated patients, who were not represented in this cohort, requires external and prospective validation.
