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Westwood M, Ramaekers B, Grimm S, Armstrong N, Wijnen B, Ahmadu C, de Kock S, Noake C, Joore M. Software with artificial intelligence-derived algorithms for analysing CT brain scans in people with a suspected acute stroke: a systematic review and cost-effectiveness analysis. Health Technol Assess 2024; 28:1-204. [PMID: 38512017 PMCID: PMC11017149 DOI: 10.3310/rdpa1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background Artificial intelligence-derived software technologies have been developed that are intended to facilitate the review of computed tomography brain scans in patients with suspected stroke. Objectives To evaluate the clinical and cost-effectiveness of using artificial intelligence-derived software to support review of computed tomography brain scans in acute stroke in the National Health Service setting. Methods Twenty-five databases were searched to July 2021. The review process included measures to minimise error and bias. Results were summarised by research question, artificial intelligence-derived software technology and study type. The health economic analysis focused on the addition of artificial intelligence-derived software-assisted review of computed tomography angiography brain scans for guiding mechanical thrombectomy treatment decisions for people with an ischaemic stroke. The de novo model (developed in R Shiny, R Foundation for Statistical Computing, Vienna, Austria) consisted of a decision tree (short-term) and a state transition model (long-term) to calculate the mean expected costs and quality-adjusted life-years for people with ischaemic stroke and suspected large-vessel occlusion comparing artificial intelligence-derived software-assisted review to usual care. Results A total of 22 studies (30 publications) were included in the review; 18/22 studies concerned artificial intelligence-derived software for the interpretation of computed tomography angiography to detect large-vessel occlusion. No study evaluated an artificial intelligence-derived software technology used as specified in the inclusion criteria for this assessment. For artificial intelligence-derived software technology alone, sensitivity and specificity estimates for proximal anterior circulation large-vessel occlusion were 95.4% (95% confidence interval 92.7% to 97.1%) and 79.4% (95% confidence interval 75.8% to 82.6%) for Rapid (iSchemaView, Menlo Park, CA, USA) computed tomography angiography, 91.2% (95% confidence interval 77.0% to 97.0%) and 85.0 (95% confidence interval 64.0% to 94.8%) for Viz LVO (Viz.ai, Inc., San Fransisco, VA, USA) large-vessel occlusion, 83.8% (95% confidence interval 77.3% to 88.7%) and 95.7% (95% confidence interval 91.0% to 98.0%) for Brainomix (Brainomix Ltd, Oxford, UK) e-computed tomography angiography and 98.1% (95% confidence interval 94.5% to 99.3%) and 98.2% (95% confidence interval 95.5% to 99.3%) for Avicenna CINA (Avicenna AI, La Ciotat, France) large-vessel occlusion, based on one study each. These studies were not considered appropriate to inform cost-effectiveness modelling but formed the basis by which the accuracy of artificial intelligence plus human reader could be elicited by expert opinion. Probabilistic analyses based on the expert elicitation to inform the sensitivity of the diagnostic pathway indicated that the addition of artificial intelligence to detect large-vessel occlusion is potentially more effective (quality-adjusted life-year gain of 0.003), more costly (increased costs of £8.61) and cost-effective for willingness-to-pay thresholds of £3380 per quality-adjusted life-year and higher. Limitations and conclusions The available evidence is not suitable to determine the clinical effectiveness of using artificial intelligence-derived software to support the review of computed tomography brain scans in acute stroke. The economic analyses did not provide evidence to prefer the artificial intelligence-derived software strategy over current clinical practice. However, results indicated that if the addition of artificial intelligence-derived software-assisted review for guiding mechanical thrombectomy treatment decisions increased the sensitivity of the diagnostic pathway (i.e. reduced the proportion of undetected large-vessel occlusions), this may be considered cost-effective. Future work Large, preferably multicentre, studies are needed (for all artificial intelligence-derived software technologies) that evaluate these technologies as they would be implemented in clinical practice. Study registration This study is registered as PROSPERO CRD42021269609. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR133836) and is published in full in Health Technology Assessment; Vol. 28, No. 11. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | | | | | - Ben Wijnen
- Kleijnen Systematic Reviews (KSR) Ltd, York, UK
| | | | | | - Caro Noake
- Kleijnen Systematic Reviews (KSR) Ltd, York, UK
| | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
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Wan S, Lu W, Fu Y, Wang M, Liu K, Chen S, Chen W, Wang Y, Wu J, Leng X, Fiehler J, Siddiqui AH, Guan S, Xiang J. Automated ASPECTS calculation may equal the performance of experienced clinicians: a machine learning study based on a large cohort. Eur Radiol 2024; 34:1624-1634. [PMID: 37658137 DOI: 10.1007/s00330-023-10053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/15/2023] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES The Alberta Stroke Program Early CT Score (ASPECTS) is a semi-quantitative method to evaluate the severity of early ischemic change on non-contrast computed tomography (NCCT) in patients with acute ischemic stroke (AIS). In this work, we propose an automated ASPECTS method based on large cohort of data and machine learning. METHODS For this study, we collected 3626 NCCT cases from multiple centers and annotated directly on this dataset by neurologists. Based on image analysis and machine learning methods, we constructed a two-stage machine learning model. The validity and reliability of this automated ASPECTS method were tested on an independent external validation set of 300 cases. Statistical analyses on the total ASPECTS, dichotomized ASPECTS, and region-level ASPECTS were presented. RESULTS On an independent external validation set of 300 cases, for the total ASPECTS results, the intraclass correlation coefficient between automated ASPECTS and expert-rated was 0.842. The agreement between ASPECTS threshold of ≥ 6 versus < 6 using a dichotomized method was moderate (κ = 0.438, 0.391-0.477), and the detection rate (sensitivity) was 86.5% for patients with ASPECTS threshold of ≥ 6. Compared with the results of previous studies, our method achieved a slight lead in sensitivity (67.8%) and AUC (0.845), with comparable accuracy (78.9%) and specificity (81.2%). CONCLUSION The proposed automated ASPECTS method driven by a large cohort of NCCT images performed equally well compared with expert-rated ASPECTS. This work further demonstrates the validity and reliability of automated ASPECTS evaluation method. CLINICAL RELEVANCE STATEMENT The automated ASPECTS method proposed by this study may help AIS patients to receive rapid intervention, but should not be used as a stand-alone diagnostic basis. KEY POINTS NCCT-based manual ASPECTS scores were poorly consistent. Machine learning can automate the ASPECTS scoring process. Machine learning model design based on large cohort data can effectively improve the consistency of ASPECTS scores.
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Affiliation(s)
- Shu Wan
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Lu
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Yu Fu
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming Wang
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kaizheng Liu
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Sijing Chen
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wubiao Chen
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jun Wu
- Department of Neurology, Qingtian County People's Hospital, Lishui, China
| | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology, University at Buffalo, Buffalo, NY, USA
| | - Sheng Guan
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Nagaratnam K, Neuhaus A, Briggs JH, Ford GA, Woodhead ZVJ, Maharjan D, Harston G. Artificial intelligence-based decision support software to improve the efficacy of acute stroke pathway in the NHS: an observational study. Front Neurol 2024; 14:1329643. [PMID: 38304325 PMCID: PMC10830745 DOI: 10.3389/fneur.2023.1329643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/28/2023] [Indexed: 02/03/2024] Open
Abstract
Introduction In a drip-and-ship model for endovascular thrombectomy (EVT), early identification of large vessel occlusion (LVO) and timely referral to a comprehensive center (CSC) are crucial when patients are admitted to an acute stroke center (ASC). Several artificial intelligence (AI) decision-aid tools are increasingly being used to facilitate the rapid identification of LVO. This retrospective cohort study aimed to evaluate the impact of deploying e-Stroke AI decision support software in the hyperacute stroke pathway on process metrics and patient outcomes at an ASC in the United Kingdom. Methods Except for the deployment of e-Stroke on 01 March 2020, there were no significant changes made to the stroke pathway at the ASC. The data were obtained from a prospective stroke registry between 01 January 2019 and 31 March 2021. The outcomes were compared between the 14 months before and 12 months after the deployment of AI (pre-e-Stroke cohort vs. post-e-Stroke cohort) on 01 March 2020. Time window analyses were performed using Welch's t-test. Cochran-Mantel-Haenszel test was used to compare changes in disability at 3 months assessed by modified Rankin Score (mRS) ordinal shift analysis, and Fisher's exact test was used for dichotomised mRS analysis. Results In the pre-e-Stroke cohort, 19 of 22 patients referred received EVT. In the post-e-Stroke cohort, 21 of the 25 patients referred were treated. The mean door-in-door-out (DIDO) and door-to-referral times in pre-e-Stroke vs. post-e-Stroke cohorts were 141 vs. 79 min (difference 62 min, 95% CI 96.9-26.8 min, p < 0.001) and 71 vs. 44 min (difference 27 min, 95% CI 47.4-5.4 min, p = 0.01), respectively. The adjusted odds ratio (age and NIHSS) for mRS ordinal shift analysis at 3 months was 3.14 (95% CI 0.99-10.51, p = 0.06) and the dichotomized mRS 0-2 at 3 months was 16% vs. 48% (p = 0.04) in the pre- vs. post-e-Stroke cohorts, respectively. Conclusion In this single-center study in the United Kingdom, the DIDO time significantly decreased since the introduction of e-Stroke decision support software into an ASC hyperacute stroke pathway. The reduction in door-in to referral time indicates faster image interpretation and referral for EVT. There was an indication of an increased proportion of patients regaining independent function after EVT. However, this should be interpreted with caution given the small sample size. Larger, prospective studies and further systematic real-world evaluation are needed to demonstrate the widespread generalisability of these findings.
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Affiliation(s)
- Kiruba Nagaratnam
- Stroke Medicine, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ain Neuhaus
- Stroke Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - James H. Briggs
- Stroke Medicine, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
- Brainomix Limited, Oxford, United Kingdom
| | - Gary A. Ford
- Stroke Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Dibyaa Maharjan
- Stroke Medicine, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - George Harston
- Stroke Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- Brainomix Limited, Oxford, United Kingdom
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Mallon D, Fallon M, Blana E, McNamara C, Menon A, Ip CL, Garnham J, Yousry T, Cowley P, Simister R, Doig D. Real-world evaluation of Brainomix e-Stroke software. Stroke Vasc Neurol 2023:svn-2023-002859. [PMID: 38164621 DOI: 10.1136/svn-2023-002859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND PURPOSE Brainomix e-Stroke is an artificial intelligence-based decision support tool that aids the interpretation of CT imaging in the context of acute stroke. While e-Stroke has the potential to improve the speed and accuracy of diagnosis, real-world validation is essential. The aim of this study was to prospectively evaluate the performance of Brainomix e-Stroke in an unselected cohort of patients with suspected acute ischaemic stroke. METHODS The study cohort included all patients admitted to the University College London Hospital Hyperacute Stroke Unit between October 2021 and April 2022. For e-ASPECTS and e-CTA, the ground truth was determined by a neuroradiologist with access to all clinical and imaging data. For e-CTP, the values of the core infarct and ischaemic penumbra were compared with those derived from syngo.via, an alternate software used at our institution. RESULTS 1163 studies were performed in 551 patients admitted during the study period. Of these, 1130 (97.2%) were successfully processed by e-Stroke in an average of 4 min. For identifying acute middle cerebral artery territory ischaemia, e-ASPECTS had an accuracy of 77.0% and was more specific (83.5%) than sensitive (58.6%). The accuracy for identifying hyperdense thrombus was lower (69.1%), which was mainly due to many false positives (positive predictive value of 22.9%). Identification of acute haemorrhage was highly accurate (97.8%) with a sensitivity of 100% and a specificity of 97.6%; false positives were typically caused by areas of calcification. The accuracy of e-CTA for large vessel occlusions was 91.5%. The core infarct and ischaemic penumbra volumes provided by e-CTP strongly correlated with those provided by syngo.via (ρ=0.804-0.979). CONCLUSION Brainomix e-Stroke software provides rapid and reliable analysis of CT imaging in the acute stroke setting although, in line with the manufacturer's guidance, it should be used as an adjunct to expert interpretation rather than a standalone decision-making tool.
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Affiliation(s)
- Dermot Mallon
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Matthew Fallon
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eirini Blana
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cillian McNamara
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arathi Menon
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chak Lam Ip
- Comprehensive Stroke Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jack Garnham
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Peter Cowley
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert Simister
- UCL Queen Square Institute of Neurology, London, UK
- Comprehensive Stroke Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Doig
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Queen Square Institute of Neurology, London, UK
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Brugnara G, Mihalicz P, Herweh C, Schönenberger S, Purrucker J, Nagel S, Ringleb PA, Bendszus M, Möhlenbruch MA, Neuberger U. Clinical value of automated volumetric quantification of early ischemic tissue changes on non-contrast CT. J Neurointerv Surg 2023; 15:e178-e183. [PMID: 36175015 DOI: 10.1136/jnis-2022-019400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Quantitative and automated volumetric evaluation of early ischemic changes on non-contrast CT (NCCT) has recently been proposed as a new tool to improve prognostic performance in patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS). We aimed to test its clinical value compared with the Alberta Stroke Program Early CT Score (ASPECTS) in a large single-institutional patient cohort. METHODS A total of 1103 patients with AIS due to large vessel occlusion in the M1 or proximal M2 segments who underwent NCCT and EVT between January 2013 and November 2019 were retrospectively enrolled. Acute ischemic volumes (AIV) and ASPECTS were generated from the baseline NCCT through e-ASPECTS (Brainomix). Correlations were tested using Spearman's coefficient. The predictive capabilities of AIV for a favorable outcome (modified Rankin Scale score at 90 days ≤2) were tested using multivariable logistic regression as well as machine-learning models. Performance of the models was assessed using receiver operating characteristic (ROC) curves and differences were tested using DeLong's test. RESULTS Patients with a favorable outcome had a significantly lower AIV (median 12.0 mL (IQR 5.7-21.7) vs 18.8 mL (IQR 9.4-33.9), p<0.001). AIV was highly correlated with ASPECTS (rho=0.78, p<0.001) and weakly correlated with the National Institutes of Health Stroke Scale score at baseline (rho=0.22, p<0.001), and was an independent predictor of an unfavorable clinical outcome (adjusted OR 0.97, 95% CI 0.96 to 0.98). No significant difference was found between machine-learning models using either AIV or ASPECTS or both metrics for predicting a good clinical outcome (p>0.05). CONCLUSION AIV is an independent predictor of clinical outcome and presented a non-inferior performance compared with ASPECTS, without clear advantages for prognostic modelling.
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Affiliation(s)
- Gianluca Brugnara
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Section of Computational Neuroimaging, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Mihalicz
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Herweh
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jan Purrucker
- Neurology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Simon Nagel
- Neurology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Department of Neurology, Städtisches Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Peter Arthur Ringleb
- Neurology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Neuberger
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Section of Computational Neuroimaging, Heidelberg University Hospital, Heidelberg, Germany
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Adamou A, Beltsios ET, Bania A, Gkana A, Kastrup A, Chatziioannou A, Politi M, Papanagiotou P. Artificial intelligence-driven ASPECTS for the detection of early stroke changes in non-contrast CT: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:e298-e304. [PMID: 36522179 DOI: 10.1136/jnis-2022-019447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent advances in machine learning have enabled development of the automated Alberta Stroke Program Early CT Score (ASPECTS) prediction algorithms using non-contrast enhanced computed tomography (NCCT) scans. The applicability of automated ASPECTS in daily clinical practice is yet to be established. The objective of this meta-analysis was to directly compare the performance of automated and manual ASPECTS predictions in recognizing early stroke changes on NCCT. METHODS The MEDLINE, Scopus, and Cochrane databases were searched. The last database search was performed on March 10, 2022. Studies reporting the diagnostic performance and validity of automated ASPECTS software compared with expert readers were included. The outcomes were the interobserver reliability of outputs between ASPECTS versus expert readings, experts versus reference standard, and ASPECTS versus reference standard by means of pooled Fisher's Z transformation of the interclass correlation coefficients (ICCs). RESULTS Eleven studies were included in the meta-analysis, involving 1976 patients. The meta-analyses showed good interobserver reliability between experts (ICC 0.72 (95% CI 0.63 to 0.79); p<0.001), moderate reliability in the correlation between automated and expert readings (ICC 0.54 (95% CI 0.40 to 0.67); p<0.001), good reliability between the total expert readings and the reference standard (ICC 0.62 (95% CI 0.52 to 0.71); p<0.001), and good reliability between the automated predictions and the reference standard (ICC 0.72 (95% CI 0.61 to 0.80); p<0.001). CONCLUSIONS Artificial intelligence-driven ASPECTS software has comparable or better performance than physicians in terms of recognizing early stroke changes on NCCT.
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Affiliation(s)
- Antonis Adamou
- Department of Radiology, University of Thessaly, School of Health Sciences, Larissa, Greece
| | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Angelina Bania
- Faculty of Medicine, University of Patras, School of Health Sciences, Patras, Greece
| | - Androniki Gkana
- Deparment of Radiology, Ippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte GmbH, Bremen, Germany
| | - Achilles Chatziioannou
- Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Politi
- Interventional Radiology Unit, Evangelismos General Hospital, Athens, Greece
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte GmbH, Bremen, Germany
| | - Panagiotis Papanagiotou
- Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte GmbH, Bremen, Germany
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Cobb R, Cook GJR, Reader AJ. Deep Learned Segmentations of Inflammation for Novel ⁹⁹ mTc-maraciclatide Imaging of Rheumatoid Arthritis. Diagnostics (Basel) 2023; 13:3298. [PMID: 37958194 PMCID: PMC10647206 DOI: 10.3390/diagnostics13213298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease that causes joint pain, stiffness, and erosion. Power Doppler ultrasound and MRI are imaging modalities used in detecting and monitoring the disease, but they have limitations. ⁹⁹mTc-maraciclatide gamma camera imaging is a novel technique that can detect joint inflammation at all sites in a single examination and has been shown to correlate with power Doppler ultrasound. In this work, we investigate if machine learning models can be used to automatically segment regions of normal, low, and highly inflamed tissue from 192 ⁹⁹mTc-maraciclatide scans of the hands and wrists from 48 patients. Two models were trained: a thresholding model that learns lower and upper threshold values and a neural-network-based nnU-Net model that uses a convolutional neural network (CNN). The nnU-Net model showed 0.94 ± 0.01, 0.51 ± 0.14, and 0.76 ± 0.16 modified Dice scores for segmenting the normal, low, and highly inflamed tissue, respectively, when compared to clinical segmented labels. This outperforms the thresholding model, which achieved modified Dice scores of 0.92 ± 0.01, 0.14 ± 0.07, and 0.35 ± 0.21, respectively. This is an important first step in developing artificial intelligence (AI) tools to assist clinicians' workflow in the use of this new radiopharmaceutical.
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Affiliation(s)
- Robert Cobb
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK;
| | - Gary J. R. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK;
- King’s College London and Guy’s and St Thomas’ PET Centre, King’s College London, London WC2R 2LS, UK
| | - Andrew J. Reader
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK;
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Krawchuk LJ, Sharrock MF. Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury. Semin Neurol 2023; 43:699-711. [PMID: 37802120 DOI: 10.1055/s-0043-1775790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Prognostic imaging biomarkers after acute brain injury inform treatment decisions, track the progression of intracranial injury, and can be used in shared decision-making processes with families. Herein, key established biomarkers and prognostic scoring systems are surveyed in the literature, and their applications in clinical practice and clinical trials are discussed. Biomarkers in acute ischemic stroke include computed tomography (CT) hypodensity scoring, diffusion-weighted lesion volume, and core infarct size on perfusion imaging. Intracerebral hemorrhage biomarkers include hemorrhage volume, expansion, and location. Aneurysmal subarachnoid biomarkers include hemorrhage grading, presence of diffusion-restricting lesions, and acute hydrocephalus. Traumatic brain injury CT scoring systems, contusion expansion, and diffuse axonal injury grading are reviewed. Emerging biomarkers including white matter disease scoring, diffusion tensor imaging, and the automated calculation of scoring systems and volumetrics are discussed.
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Affiliation(s)
- Lindsey J Krawchuk
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew F Sharrock
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kobeissi H, Kallmes DF, Benson J, Nagelschneider A, Madhavan A, Messina SA, Schwartz K, Campeau N, Carr CM, Nasr DM, Braksick S, Scharf EL, Klaas J, Woodhead ZVJ, Harston G, Briggs J, Joly O, Gerry S, Kuhn AL, Kostas AA, Nael K, AbdalKader M, Kadirvel R, Brinjikji W. Impact of e-ASPECTS software on the performance of physicians compared to a consensus ground truth: a multi-reader, multi-case study. Front Neurol 2023; 14:1221255. [PMID: 37745671 PMCID: PMC10513025 DOI: 10.3389/fneur.2023.1221255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background The Alberta Stroke Program Early CT Score (ASPECTS) is used to quantify the extent of injury to the brain following acute ischemic stroke (AIS) and to inform treatment decisions. The e-ASPECTS software uses artificial intelligence methods to automatically process non-contrast CT (NCCT) brain scans from patients with AIS affecting the middle cerebral artery (MCA) territory and generate an ASPECTS. This study aimed to evaluate the impact of e-ASPECTS (Brainomix, Oxford, UK) on the performance of US physicians compared to a consensus ground truth. Methods The study used a multi-reader, multi-case design. A total of 10 US board-certified physicians (neurologists and neuroradiologists) scored 54 NCCT brain scans of patients with AIS affecting the MCA territory. Each reader scored each scan on two occasions: once with and once without reference to the e-ASPECTS software, in random order. Agreement with a reference standard (expert consensus read with reference to follow-up imaging) was evaluated with and without software support. Results A comparison of the area under the curve (AUC) for each reader showed a significant improvement from 0.81 to 0.83 (p = 0.028) with the support of the e-ASPECTS tool. The agreement of reader ASPECTS scoring with the reference standard was improved with e-ASPECTS compared to unassisted reading of scans: Cohen's kappa improved from 0.60 to 0.65, and the case-based weighted Kappa improved from 0.70 to 0.81. Conclusion Decision support with the e-ASPECTS software significantly improves the accuracy of ASPECTS scoring, even by expert US neurologists and neuroradiologists.
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Affiliation(s)
- Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - John Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Ajay Madhavan
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Kara Schwartz
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Norbert Campeau
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Carrie M. Carr
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Deena M. Nasr
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Sherri Braksick
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Eugene L. Scharf
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - James Klaas
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - George Harston
- Brainomix Limited, Oxford, United Kingdom
- Acute Stroke Service, Oxford University Hospitals NHSFT, Oxford, United Kingdom
| | - James Briggs
- Brainomix Limited, Oxford, United Kingdom
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Anna L. Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, UMass Medical Center, Worcester, MA, United States
| | - Angelos A. Kostas
- Huntington Hospital and Hill Medical Imaging, Pasadena, CA, United States
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Mohamad AbdalKader
- Department of Radiology, Boston Medical Center, Boston, MA, United States
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
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10
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Deep Learning Applied to Intracranial Hemorrhage Detection. J Imaging 2023; 9:jimaging9020037. [PMID: 36826956 PMCID: PMC9963867 DOI: 10.3390/jimaging9020037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Intracranial hemorrhage is a serious medical problem that requires rapid and often intensive medical care. Identifying the location and type of any hemorrhage present is a critical step in the treatment of the patient. Detection of, and diagnosis of, a hemorrhage that requires an urgent procedure is a difficult and time-consuming process for human experts. In this paper, we propose methods based on EfficientDet's deep-learning technology that can be applied to the diagnosis of hemorrhages at a patient level and which could, thus, become a decision-support system. Our proposal is two-fold. On the one hand, the proposed technique classifies slices of computed tomography scans for the presence of hemorrhage or its lack of, and evaluates whether the patient is positive in terms of hemorrhage, and achieving, in this regard, 92.7% accuracy and 0.978 ROC AUC. On the other hand, our methodology provides visual explanations of the chosen classification using the Grad-CAM methodology.
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11
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Mair G, White P, Bath PM, Muir KW, Al‐Shahi Salman R, Martin C, Dye D, Chappell FM, Vacek A, von Kummer R, Macleod M, Sprigg N, Wardlaw JM. External Validation of e-ASPECTS Software for Interpreting Brain CT in Stroke. Ann Neurol 2022; 92:943-957. [PMID: 36053916 PMCID: PMC9826303 DOI: 10.1002/ana.26495] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/08/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to test e-ASPECTS software in patients with stroke. Marketed as a decision-support tool, e-ASPECTS may detect features of ischemia or hemorrhage on computed tomography (CT) imaging and quantify ischemic extent using Alberta Stroke Program Early CT Score (ASPECTS). METHODS Using CT from 9 stroke studies, we compared software with masked experts. As per indications for software use, we assessed e-ASPECTS results for patients with/without middle cerebral artery (MCA) ischemia but no other cause of stroke. In an analysis outside the intended use of the software, we enriched our dataset with non-MCA ischemia, hemorrhage, and mimics to simulate a representative "front door" hospital population. With final diagnosis as the reference standard, we tested the diagnostic accuracy of e-ASPECTS for identifying stroke features (ischemia, hyperattenuated arteries, and hemorrhage) in the representative population. RESULTS We included 4,100 patients (51% women, median age = 78 years, National Institutes of Health Stroke Scale [NIHSS] = 10, onset to scan = 2.5 hours). Final diagnosis was ischemia (78%), hemorrhage (14%), or mimic (8%). From 3,035 CTs with expert-rated ASPECTS, most (2084/3035, 69%) e-ASPECTS results were within one point of experts. In the representative population, the diagnostic accuracy of e-ASPECTS was 71% (95% confidence interval [CI] = 70-72%) for detecting ischemic features, 85% (83-86%) for hemorrhage. Software identified more false positive ischemia (12% vs 2%) and hemorrhage (14% vs <1%) than experts. INTERPRETATION On independent testing, e-ASPECTS provided moderate agreement with experts and overcalled stroke features. Therefore, future prospective trials testing impacts of artificial intelligence (AI) software on patient care and outcome are required before widespread implementation of stroke decision-support software. ANN NEUROL 2022;92:943-957.
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Affiliation(s)
- Grant Mair
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Philip White
- Translational and Clinical Research InstituteNewcastle University and Newcastle upon Tyne Hospitals NHS TrustNewcastle upon TyneUK
| | - Philip M. Bath
- Stroke Trials Unit, Mental Health & Clinical NeuroscienceUniversity of NottinghamNottinghamUK
| | - Keith W. Muir
- School of Psychology & NeuroscienceUniversity of GlasgowGlasgowUK
| | | | - Chloe Martin
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - David Dye
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | | | - Adam Vacek
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Rüdiger von Kummer
- Department of NeuroradiologyUniversity Hospital, Technische Universität DresdenDresdenGermany
| | - Malcolm Macleod
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Nikola Sprigg
- Translational and Clinical Research InstituteNewcastle University and Newcastle upon Tyne Hospitals NHS TrustNewcastle upon TyneUK
| | - Joanna M. Wardlaw
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- UK Dementia Research Institute Centre at the University of EdinburghEdinburghUK
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Guisado-Alonso D, Camps-Renom P, Delgado-Mederos R, Granell E, Prats-Sánchez L, Martínez-Domeño A, Guasch-Jiménez M, Acosta MV, Ramos-Pachón A, Martí-Fàbregas J. Automated scoring of collaterals, blood pressure, and clinical outcome after endovascular treatment in patients with acute ischemic stroke and large-vessel occlusion. Front Neurol 2022; 13:944779. [PMID: 36016546 PMCID: PMC9397141 DOI: 10.3389/fneur.2022.944779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction We aimed to determine whether the degree of collateral circulation is associated with blood pressure at admission in acute ischemic stroke patients treated with endovascular treatment and to determine its prognostic value. Methods We evaluated patients with anterior large vessel occlusion treated with endovascular treatment in a single-center prospective registry. We collected clinical and radiological data. Automated and validated software (Brainomix Ltd., Oxford, UK) was used to generate the collateral score (CS) from the baseline single-phase CT angiography: 0, filling of ≤10% of the occluded MCA territory; 1, 11–50%; 2, 51–90%; 3, >90%. When dichotomized, we considered that CS was good (CS = 2–3), or poor (CS = 0–1). We performed bivariate and multivariable ordinal logistic regression analysis to predict CS categories in our population. The secondary outcome was to determine the influence of automated CS on functional outcome at 3 months. We defined favorable functional outcomes as mRS 0–2 at 3 months. Results We included 101 patients with a mean age of 72.1 ± 13.1 years and 57 (56.4%) of them were women. We classified patients into 4 groups according to the CS: 7 patients (6.9%) as CS = 0, 15 (14.9%) as CS = 1, 43 (42.6%) as CS = 2 and 36 (35.6%) as CS = 3. Admission systolic blood pressure [aOR per 10 mmHg increase 0.79 (95% CI 0.68–0.92)] and higher baseline NIHSS [aOR 0.90 (95% CI, 0.84–0.96)] were associated with a worse CS. The OR of improving 1 point on the 3-month mRS was 1.63 (95% CI, 1.10–2.44) favoring a better CS (p = 0.016). Conclusion In acute ischemic stroke patients with anterior large vessel occlusion treated with endovascular treatment, admission systolic blood pressure was inversely associated with the automated scoring of CS on baseline CT angiography. Moreover, a good CS was associated with a favorable outcome.
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Affiliation(s)
- Daniel Guisado-Alonso
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
- *Correspondence: Pol Camps-Renom
| | - Raquel Delgado-Mederos
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Esther Granell
- Department of Radiology, UDIAT Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Marina Guasch-Jiménez
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - M. Victoria Acosta
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Anna Ramos-Pachón
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
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13
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Al-Dasuqi K, Johnson MH, Cavallo JJ. Use of artificial intelligence in emergency radiology: An overview of current applications, challenges, and opportunities. Clin Imaging 2022; 89:61-67. [PMID: 35716432 DOI: 10.1016/j.clinimag.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/04/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022]
Abstract
The value of artificial intelligence (AI) in healthcare has become evident, especially in the field of medical imaging. The accelerated pace and acuity of care in the Emergency Department (ED) has made it a popular target for artificial intelligence-driven solutions. Software that helps better detect, report, and appropriately guide management can ensure high quality patient care while enabling emergency radiologists to better meet the demands of quick turnaround times. Beyond diagnostic applications, AI-based algorithms also have the potential to optimize other important steps within the ED imaging workflow. This review will highlight the different types of AI-based applications currently available for use in the ED, as well as the challenges and opportunities associated with their implementation.
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Affiliation(s)
- Khalid Al-Dasuqi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042, United States of America.
| | - Michele H Johnson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042, United States of America.
| | - Joseph J Cavallo
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042, United States of America.
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14
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Jabal MS, Joly O, Kallmes D, Harston G, Rabinstein A, Huynh T, Brinjikji W. Interpretable Machine Learning Modeling for Ischemic Stroke Outcome Prediction. Front Neurol 2022; 13:884693. [PMID: 35665041 PMCID: PMC9160988 DOI: 10.3389/fneur.2022.884693] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeMechanical thrombectomy greatly improves stroke outcomes. Nonetheless, some patients fall short of full recovery despite good reperfusion. The purpose of this study was to develop machine learning (ML) models for the pre-interventional prediction of functional outcome at 3 months of thrombectomy in acute ischemic stroke (AIS), using clinical and auto-extractable radiological information consistently available upon first emergency evaluation.Materials and MethodsA two-center retrospective cohort of 293 patients with AIS who underwent thrombectomy was analyzed. ML models were developed to predict dichotomized modified Rankin score at 90 days (mRS-90) using clinical and imaging features, both separately and combined. Conventional and experimental imaging biomarkers were quantified using automated image-processing software from non-contract computed tomography (CT) and computed tomography angiography (CTA). Shapley Additive Explanation (SHAP) was applied for model interpretability and predictor importance analysis of the optimal model.ResultsMerging clinical and imaging features returned the best results for mRS-90 prediction. The best performing classifier was Extreme Gradient Boosting (XGB) with an area under the receiver operating characteristic curve (AUC) = 84% using selected features. The most important classifying features were age, baseline National Institutes of Health Stroke Scale (NIHSS), occlusion side, degree of brain atrophy [primarily represented by cortical cerebrospinal fluid (CSF) volume and lateral ventricle volume], early ischemic core [primarily represented by e-Alberta Stroke Program Early CT Score (ASPECTS)], and collateral circulation deficit volume on CTA.ConclusionMachine learning that is applied to quantifiable image features from CT and CTA alongside basic clinical characteristics constitutes a promising automated method in the pre-interventional prediction of stroke prognosis. Interpretable models allow for exploring which initial features contribute the most to post-thrombectomy outcome prediction overall and for each individual patient outcome.
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Affiliation(s)
- Mohamed Sobhi Jabal
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Mohamed Sobhi Jabal
| | | | - David Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - George Harston
- Brainomix Limited, Oxford, United Kingdom
- Oxford University Hospitals National Health Service Trust, Oxford, United Kingdom
| | | | - Thien Huynh
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
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15
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Cao Z, Xu J, Song B, Chen L, Sun T, He Y, Wei Y, Niu G, Zhang Y, Feng Q, Ding Z, Shi F, Shen D. Deep learning derived automated ASPECTS on non-contrast CT scans of acute ischemic stroke patients. Hum Brain Mapp 2022; 43:3023-3036. [PMID: 35357053 PMCID: PMC9189036 DOI: 10.1002/hbm.25845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 02/05/2023] Open
Abstract
Ischemic stroke is the most common type of stroke, ranked as the second leading cause of death worldwide. The Alberta Stroke Program Early CT Score (ASPECTS) is considered as a systematic method of assessing ischemic change on non-contrast CT scans (NCCT) of acute ischemic stroke (AIS) patients, while still suffering from the requirement of experts' experience and also the inconsistent results between readers. In this study, we proposed an automated ASPECTS method to utilize the powerful learning ability of neural networks for objectively scoring CT scans of AIS patients. First, we proposed to use the CT perfusion (CTP) from one-stop stroke imaging to provide the golden standard of ischemic regions for ASPECTS scoring. Second, we designed an asymmetry network to capture features when comparing the left and right sides for each ASPECTS region to estimate its ischemic status. Third, we performed experiments in a large main dataset of 870 patients, as well as an independent testing dataset consisting of 207 patients with radiologists' scorings. Experimental results show that our network achieved remarkable performance, as sensitivity and accuracy of 93.7 and 92.4% in the main dataset, and 95.5 and 91.3% in the independent testing dataset, respectively. In the latter dataset, our analysis revealed a high positive correlation between the ASPECTS score and the prognosis of patients in 90DmRs. Also, we found ASPECTS score is a good indicator of the size of CTP core volume of an infraction. The proposed method shows its potential for automated ASPECTS scoring on NCCT images.
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Affiliation(s)
- Zehong Cao
- School of Biomedical Engineering Southern Medical UniversityGuangzhouChina,Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Jiaona Xu
- The Fourth School of Clinical MedicineZhejiang Chinese Medicine UniversityHangzhouChina,Department of Neurology, Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Bin Song
- Department of Radiology, West China HospitalSichuan UniversityChengduChina
| | - Lizhou Chen
- Department of Radiology, West China HospitalSichuan UniversityChengduChina
| | - Tianyang Sun
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Yichu He
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Ying Wei
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Guozhong Niu
- Department of Neurology, Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Yu Zhang
- School of Biomedical Engineering Southern Medical UniversityGuangzhouChina
| | - Qianjin Feng
- School of Biomedical Engineering Southern Medical UniversityGuangzhouChina
| | - Zhongxiang Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Feng Shi
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Dinggang Shen
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina,School of Biomedical EngineeringShanghaiTech UniversityShanghaiChina
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16
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Brinjikji W. The re-invention of the vascular neuroradiologist in the age of direct-to-consumer radiology applications. Interv Neuroradiol 2022; 28:7-8. [PMID: 35098754 PMCID: PMC8905074 DOI: 10.1177/15910199221077754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Waleed Brinjikji
- Department of Neurosurgery and Neuroradiology, Mayo Clinic, Rochester, MN
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