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Johansen J, Offersen CM, Carlsen JF, Ingala S, Hansen AE, Nielsen MB, Darkner S, Pai A. An Automatic DWI/FLAIR Mismatch Assessment of Stroke Patients. Diagnostics (Basel) 2023; 14:69. [PMID: 38201378 PMCID: PMC10802848 DOI: 10.3390/diagnostics14010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
DWI/FLAIR mismatch assessment for ischemic stroke patients shows promising results in determining if patients are eligible for recombinant tissue-type plasminogen activator (r-tPA) treatment. However, the mismatch criteria suffer from two major issues: binary classification of a non-binary problem and the subjectiveness of the assessor. In this article, we present a simple automatic method for segmenting stroke-related parenchymal hyperintensities on FLAIR, allowing for an automatic and continuous DWI/FLAIR mismatch assessment. We further show that our method's segmentations have comparable inter-rater agreement (DICE 0.820, SD 0.12) compared to that of two neuro-radiologists (DICE 0.856, SD 0.07), that our method appears robust to hyper-parameter choices (suggesting good generalizability), and lastly, that our methods continuous DWI/FLAIR mismatch assessment correlates to mismatch assessments made for a cohort of wake-up stroke patients at hospital submission. The proposed method shows promising results in automating the segmentation of parenchymal hyperintensity within ischemic stroke lesions and could help reduce inter-observer variability of DWI/FLAIR mismatch assessment performed in clinical environments as well as offer a continuous assessment instead of the current binary one.
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Affiliation(s)
- Jacob Johansen
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark; (S.D.); (A.P.)
- Cerebriu A/S, 1434 Copenhagen, Denmark;
| | - Cecilie Mørck Offersen
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (J.F.C.); (A.E.H.); (M.B.N.)
- Department of Radiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jonathan Frederik Carlsen
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (J.F.C.); (A.E.H.); (M.B.N.)
- Department of Radiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Silvia Ingala
- Cerebriu A/S, 1434 Copenhagen, Denmark;
- Department of Radiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (J.F.C.); (A.E.H.); (M.B.N.)
- Department of Radiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (J.F.C.); (A.E.H.); (M.B.N.)
- Department of Radiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Sune Darkner
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark; (S.D.); (A.P.)
| | - Akshay Pai
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark; (S.D.); (A.P.)
- Cerebriu A/S, 1434 Copenhagen, Denmark;
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