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Meng S, Tran TML, Hu M, Wang P, Yi T, Zhong Z, Wang L, Vogt B, Jiao Z, Barman A, Cetintemel U, Chang K, Nguyen DT, Hui FK, Pan I, Xiao B, Yang L, Zhou H, Bai HX. End-to-end artificial intelligence platform for the management of large vessel occlusions: A preliminary study. J Stroke Cerebrovasc Dis 2022; 31:106753. [PMID: 36115105 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106753] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES In this study, we developed a deep learning pipeline that detects large vessel occlusion (LVO) and predicts functional outcome based on computed tomography angiography (CTA) images to improve the management of the LVO patients. METHODS A series identifier picked out 8650 LVO-protocoled studies from 2015 to 2019 at Rhode Island Hospital with an identified thin axial series that served as the data pool. Data were annotated into 2 classes: 1021 LVOs and 7629 normal. The Inception-V1 I3D architecture was applied for LVO detection. For outcome prediction, 323 patients undergoing thrombectomy were selected. A 3D convolution neural network (CNN) was used for outcome prediction (30-day mRS) with CTA volumes and embedded pre-treatment variables as inputs. RESULT For LVO-detection model, CTAs from 8,650 patients (median age 68 years, interquartile range (IQR): 58-81; 3934 females) were analyzed. The cross-validated AUC for LVO vs. not was 0.74 (95% CI: 0.72-0.75). For the mRS classification model, CTAs from 323 patients (median age 75 years, IQR: 63-84; 164 females) were analyzed. The algorithm achieved a test AUC of 0.82 (95% CI: 0.79-0.84), sensitivity of 89%, and specificity 66%. The two models were then integrated with hospital infrastructure where CTA was collected in real-time and processed by the model. If LVO was detected, interventionists were notified and provided with predicted clinical outcome information. CONCLUSION 3D CNNs based on CTA were effective in selecting LVO and predicting LVO mechanical thrombectomy short-term prognosis. End-to-end AI platform allows users to receive immediate prognosis prediction and facilitates clinical workflow.
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Affiliation(s)
- Shujuan Meng
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Thi My Linh Tran
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Mingzhe Hu
- Department of Computer Science and Informatics, Emory University, Atlanta, GA 30307, USA
| | - PanPan Wang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Thomas Yi
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Zhusi Zhong
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; School of Electronic Engineering, Xidian University, Xi'an, Shaanxi 710071, China
| | - Luoyun Wang
- Center for Computational Molecular Biology, Brown University, Providence, RI 02912, USA
| | - Braden Vogt
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Zhicheng Jiao
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI 02903, USA
| | - Arko Barman
- Center for Transforming Data to Knowledge, Rice University, Houston, TX 77005, USA; Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, USA
| | - Ugur Cetintemel
- Department of Computer Science, Brown University, Providence, RI 02912, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dat-Thanh Nguyen
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | | | - Ian Pan
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
| | - Hao Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Harrison X Bai
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Stib MT, Vasquez J, Dong MP, Kim YH, Subzwari SS, Triedman HJ, Wang A, Wang HLC, Yao AD, Jayaraman M, Boxerman JL, Eickhoff C, Cetintemel U, Baird GL, McTaggart RA. Detecting Large Vessel Occlusion at Multiphase CT Angiography by Using a Deep Convolutional Neural Network. Radiology 2020; 297:640-649. [PMID: 32990513 DOI: 10.1148/radiol.2020200334] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Large vessel occlusion (LVO) stroke is one of the most time-sensitive diagnoses in medicine and requires emergent endovascular therapy to reduce morbidity and mortality. Leveraging recent advances in deep learning may facilitate rapid detection and reduce time to treatment. Purpose To develop a convolutional neural network to detect LVOs at multiphase CT angiography. Materials and Methods This multicenter retrospective study evaluated 540 adults with CT angiography examinations for suspected acute ischemic stroke from February 2017 to June 2018. Examinations positive for LVO (n = 270) were confirmed by catheter angiography and LVO-negative examinations (n = 270) were confirmed through review of clinical and radiology reports. Preprocessing of the CT angiography examinations included vasculature segmentation and the creation of maximum intensity projection images to emphasize the contrast agent-enhanced vasculature. Seven experiments were performed by using combinations of the three phases (arterial, phase 1; peak venous, phase 2; and late venous, phase 3) of the CT angiography. Model performance was evaluated on the held-out test set. Metrics included area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Results The test set included 62 patients (mean age, 69.5 years; 48% women). Single-phase CT angiography achieved an AUC of 0.74 (95% confidence interval [CI]: 0.63, 0.85) with sensitivity of 77% (24 of 31; 95% CI: 59%, 89%) and specificity of 71% (22 of 31; 95% CI: 53%, 84%). Phases 1, 2, and 3 together achieved an AUC of 0.89 (95% CI: 0.81, 0.96), sensitivity of 100% (31 of 31; 95% CI: 99%, 100%), and specificity of 77% (24 of 31; 95% CI: 59%, 89%), a statistically significant improvement relative to single-phase CT angiography (P = .01). Likewise, phases 1 and 3 and phases 2 and 3 also demonstrated improved fit relative to single phase (P = .03). Conclusion This deep learning model was able to detect the presence of large vessel occlusion and its diagnostic performance was enhanced by using delayed phases at multiphase CT angiography examinations. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Ospel and Goyal in this issue.
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Affiliation(s)
- Matthew T Stib
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Justin Vasquez
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Mary P Dong
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Yun Ho Kim
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Sumera S Subzwari
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Harold J Triedman
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Amy Wang
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Hsin-Lei Charlene Wang
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Anthony D Yao
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Mahesh Jayaraman
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Jerrold L Boxerman
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Carsten Eickhoff
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Ugur Cetintemel
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Grayson L Baird
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
| | - Ryan A McTaggart
- From the Departments of Diagnostic Imaging (M.T.S., M.J., J.L.B., G.L.B., R.A.M.), Diagnostic Imaging (A.D.Y.), and Neurosurgery (M.J., R.A.M.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy St, APC 701, Providence, RI 02903; Department of Computer Science, Brown University, Providence, RI (J.V., M.P.D., Y.H.K., S.S.S., H.J.T., A.W., H.L.C.W., C.E., U.C.); and the Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI (M.J., R.A.M.)
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