1
|
Butler M, Shah P, Ozgen B, Michals EA, Geraghty JR, Testai FD, Maharathi B, Loeb JA. Automated segmentation of ventricular volumes and subarachnoid hemorrhage from computed tomography images: Evaluation of a rule-based pipeline approach. Neuroradiol J 2024:19714009241260791. [PMID: 38869365 DOI: 10.1177/19714009241260791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Changes in ventricular size, related to brain edema and hydrocephalus, as well as the extent of hemorrhage are associated with adverse outcomes in patients with subarachnoid hemorrhage (SAH). Frequently, these are measured manually using consecutive non-contrast computed tomography scans. Here, we developed a rule-based approach which incorporates both intensity and spatial normalization and utilizes user-defined thresholds and anatomical templates to segment both lateral ventricle (LV) and SAH blood volumes automatically from CT images. The algorithmic segmentations were evaluated against two expert neuroradiologists on representative slices from 20 admission scans from aneurysmal SAH patients. Previous methods have been developed to automate this time-consuming task, but they lack user feedback and are hard to implement due to large-scale data and complex design processes. Our results using automatic ventricular segmentation aligned well with expert reviewers with a median Dice coefficient of 0.81, AUC of 0.91, sensitivity of 81%, and precision of 84%. Automatic segmentation of SAH blood was most reliable near the base of the brain with a median Dice coefficient of 0.51, an AUC of 0.75, precision of 68%, and sensitivity of 50%. Ultimately, we developed a rule-based method that is easily adaptable through user feedback, generates spatially normalized segmentations that are comparable regardless of brain morphology or acquisition conditions, and automatically segments LV with good overall reliability and basal SAH blood with good precision. Our approach could benefit longitudinal studies in patients with SAH by streamlining assessment of edema and hydrocephalus progression, as well as blood resorption.
Collapse
Affiliation(s)
- Mitchell Butler
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Parin Shah
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| | - Burce Ozgen
- Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Edward A Michals
- Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Joseph R Geraghty
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| | - Biswajit Maharathi
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Liu S, Qin P, Wang Z, Liu Y. Improved hypertensive stroke classification based on multi-scale feature fusion of head axial CT angiogram and multimodal learning. Phys Med 2024; 121:103359. [PMID: 38688073 DOI: 10.1016/j.ejmp.2024.103359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE Strokes are severe cardiovascular and circulatory diseases with two main types: ischemic and hemorrhagic. Clinically, brain images such as computed tomography (CT) and computed tomography angiography (CTA) are widely used to recognize stroke types. However, few studies have combined imaging and clinical data to classify stroke or consider a factor as an Independent etiology. METHODS In this work, we propose a classification model that automatically distinguishes stroke types with hypertension as an independent etiology based on brain imaging and clinical data. We first present a preprocessing workflow for head axial CT angiograms, including noise reduction and feature enhancement of the images, followed by an extraction of regions of interest. Next, we develop a multi-scale feature fusion model that combines the location information of position features and the semantic information of deep features. Furthermore, we integrate brain imaging with clinical information through a multimodal learning model to achieve more reliable results. RESULTS Experimental results show our proposed models outperform state-of-the-art models on real imaging and clinical data, which reveals the potential of multimodal learning in brain disease diagnosis. CONCLUSION The proposed methodologies can be extended to create AI-driven diagnostic assistance technology for categorizing strokes.
Collapse
Affiliation(s)
- Shuting Liu
- School of Control Science and Engineering, Dalian University of Technology, Dalian, Liaoning 116024, China.
| | - Pan Qin
- School of Control Science and Engineering, Dalian University of Technology, Dalian, Liaoning 116024, China
| | - Zeyuan Wang
- School of Control Science and Engineering, Dalian University of Technology, Dalian, Liaoning 116024, China
| | - Yi Liu
- Central Hospital of Dalian University of Technology, Dalian, Liaoning 116033, China.
| |
Collapse
|
3
|
Marcus A, Bentley P, Rueckert D. Concurrent Ischemic Lesion Age Estimation and Segmentation of CT Brain Using a Transformer-Based Network. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:3464-3473. [PMID: 37335797 DOI: 10.1109/tmi.2023.3287361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The cornerstone of stroke care is expedient management that varies depending on the time since stroke onset. Consequently, clinical decision making is centered on accurate knowledge of timing and often requires a radiologist to interpret Computed Tomography (CT) of the brain to confirm the occurrence and age of an event. These tasks are particularly challenging due to the subtle expression of acute ischemic lesions and the dynamic nature of their appearance. Automation efforts have not yet applied deep learning to estimate lesion age and treated these two tasks independently, so, have overlooked their inherent complementary relationship. To leverage this, we propose a novel end-to-end multi-task transformer-based network optimized for concurrent segmentation and age estimation of cerebral ischemic lesions. By utilizing gated positional self-attention and CT-specific data augmentation, the proposed method can capture long-range spatial dependencies while maintaining its ability to be trained from scratch under low-data regimes commonly found in medical imaging. Furthermore, to better combine multiple predictions, we incorporate uncertainty by utilizing quantile loss to facilitate estimating a probability density function of lesion age. The effectiveness of our model is then extensively evaluated on a clinical dataset consisting of 776 CT images from two medical centers. Experimental results demonstrate that our method obtains promising performance, with an area under the curve (AUC) of 0.933 for classifying lesion ages ≤ 4.5 hours compared to 0.858 using a conventional approach, and outperforms task-specific state-of-the-art algorithms.
Collapse
|
4
|
Thomson BR, Gürlek F, Buzzi RM, Schwendinger N, Keller E, Regli L, van Doormaal TP, Schaer DJ, Hugelshofer M, Akeret K. Clinical potential of automated convolutional neural network-based hematoma volumetry after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:107357. [PMID: 37734180 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107357] [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: 06/08/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES Cerebrospinal fluid hemoglobin has been positioned as a potential biomarker and drug target for aneurysmal subarachnoid hemorrhage-related secondary brain injury (SAH-SBI). The maximum amount of hemoglobin, which may be released into the cerebrospinal fluid, is defined by the initial subarachnoid hematoma volume (ISHV). In patients without external ventricular or lumbar drain, there remains an unmet clinical need to predict the risk for SAH-SBI. The aim of this study was to explore automated segmentation of ISHV as a potential surrogate for cerebrospinal fluid hemoglobin to predict SAH-SBI. METHODS This study is based on a retrospective analysis of imaging and clinical data from 220 consecutive patients with aneurysmal subarachnoid hemorrhage collected over a five-year period. 127 annotated initial non-contrast CT scans were used to train and test a convolutional neural network to automatically segment the ISHV in the remaining cohort. Performance was reported in terms of Dice score and intraclass correlation. We characterized the associations between ISHV and baseline cohort characteristics, SAH-SBI, ventriculoperitoneal shunt dependence, functional outcome, and survival. Established clinical (World Federation of Neurosurgical Societies, Hunt & Hess) and radiological (modified Fisher, Barrow Neurological Institute) scores served as references. RESULTS A strong volume agreement (0.73 Dice, range 0.43 - 0.93) and intraclass correlation (0.89, 95% CI, 0.81-0.94) were shown. While ISHV was not associated with the use of antithrombotics or cardiovascular risk factors, there was strong evidence for an association with a lower Glasgow Coma Scale at hospital admission. Aneurysm size and location were not associated with ISHV, but the presence of intracerebral or intraventricular hemorrhage were independently associated with higher ISHV. Despite strong evidence for a positive association between ISHV and SAH-SBI, the discriminatory ability of ISHV for SAH-SBI was insufficient. The discriminatory ability of ISHV was, however, higher regarding ventriculoperitoneal shunt dependence and functional outcome at three-months follow-up. Multivariate survival analysis provided strong evidence for an independent negative association between survival probability and both ISHV and intraventricular hemorrhage. CONCLUSIONS The proposed algorithm demonstrates strong performance in volumetric segmentation of the ISHV on the admission CT. While the discriminatory ability of ISHV for SAH-SBI was similar to established clinical and radiological scores, it showed a high discriminatory ability for ventriculoperitoneal shunt dependence and functional outcome at three-months follow-up.
Collapse
Affiliation(s)
- Bart R Thomson
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland; Division of Internal Medicine, Universitätsspital and University of Zurich, Zurich, Switzerland
| | - Firat Gürlek
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland; Division of Internal Medicine, Universitätsspital and University of Zurich, Zurich, Switzerland
| | - Raphael M Buzzi
- Division of Internal Medicine, Universitätsspital and University of Zurich, Zurich, Switzerland
| | - Nina Schwendinger
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
| | - Emanuela Keller
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland; Neurointensive Care Unit, Department of Neurosurgery, and Institute of Intensive Care Medicine, Universitätsspital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
| | - Tristan Pc van Doormaal
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland; Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Translational Neuroscience, University Medical Center Utrecht, Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Dominik J Schaer
- Division of Internal Medicine, Universitätsspital and University of Zurich, Zurich, Switzerland
| | - Michael Hugelshofer
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
| | - Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital und University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland.
| |
Collapse
|
5
|
Street JS, Pandit AS, Toma AK. Predicting vasospasm risk using first presentation aneurysmal subarachnoid hemorrhage volume: A semi-automated CT image segmentation analysis using ITK-SNAP. PLoS One 2023; 18:e0286485. [PMID: 37262041 DOI: 10.1371/journal.pone.0286485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is a significant complication associated with poor neurological outcomes. We present a novel, semi-automated pipeline, implemented in the open-source medical imaging analysis software ITK-SNAP, to segment subarachnoid blood volume from initial CT head (CTH) scans and use this to predict future radiological vasospasm. METHODS 42 patients were admitted between February 2020 and December 2021 to our tertiary neurosciences center, and whose initial referral CTH scan was used for this retrospective cohort study. Blood load was segmented using a semi-automated random forest classifier and active contour evolution implemented in ITK-SNAP. Clinical data were extracted from electronic healthcare records in order to fit models aimed at predicting radiological vasospasm risk. RESULTS Semi-automated segmentations demonstrated excellent agreement with manual, expert-derived volumes (mean Dice coefficient = 0.92). Total normalized blood volume, extracted from CTH images at first presentation, was significantly associated with greater odds of later radiological vasospasm, increasing by approximately 7% for each additional cm3 of blood (OR = 1.069, 95% CI: 1.021-1.120; p < .005). Greater blood volume was also significantly associated with vasospasm of a higher Lindegaard ratio, of longer duration, and a greater number of discrete episodes. Total blood volume predicted radiological vasospasm with a greater accuracy as compared to the modified Fisher scale (AUC = 0.86 vs 0.70), and was of independent predictive value. CONCLUSION Semi-automated methods provide a plausible pipeline for the segmentation of blood from CT head images in aSAH, and total blood volume is a robust, extendable predictor of radiological vasospasm, outperforming the modified Fisher scale. Greater subarachnoid blood volume significantly increases the odds of subsequent vasospasm, its time course and its severity.
Collapse
Affiliation(s)
- James S Street
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
| | - Anand S Pandit
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- High-Dimensional Neurology, Institute of Neurology, University College London, London, United Kingdom
| | - Ahmed K Toma
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| |
Collapse
|
6
|
Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP): an ambulance-based, multicentre, randomised, open-label, blinded endpoint, phase 3 trial. Lancet Neurol 2022; 21:971-981. [PMID: 36058230 DOI: 10.1016/s1474-4422(22)00333-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pooled analyses of previous randomised studies have suggested that very early treatment with glyceryl trinitrate (also known as nitroglycerin) improves functional outcome in patients with acute ischaemic stroke or intracerebral haemorrhage, but this finding was not confirmed in a more recent trial (RIGHT-2). We aimed to assess whether patients with presumed acute stroke benefit from glyceryl tr initrate started within 3 h after symptom onset. METHODS MR ASAP was a phase 3, randomised, open-label, blinded endpoint trial done at six ambulance services serving 18 hospitals in the Netherlands. Eligible participants (aged ≥18 years) had a probable diagnosis of acute stroke (as assessed by a paramedic), a face-arm-speech-time test score of 2 or 3, systolic blood pressure of at least 140 mm Hg, and could start treatment within 3 h of symptom onset. Participants were randomly assigned (1:1) by ambulance personnel, using a secure web-based electronic application with random block sizes stratified by ambulance service, to receive either transdermal glyceryl trinitrate 5 mg/day for 24 h plus standard care (glyceryl trinitrate group) or to standard care alone (control group) in the prehospital setting. Informed consent was deferred until after arrival at the hospital. The primary outcome was functional outcome assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included death within 7 days, death within 90 days, and serious adverse events. Analyses were based on modified intention to treat, and treatment effects were expressed as odds ratios (ORs) or common ORs, with adjustment for baseline prognostic factors. We separately analysed the total population and the target population (ie, patients with intracerebral haemorrhage, ischaemic stroke, or transient ischaemic attack). The target sample size was 1400 patients. The trial is registered as ISRCTN99503308. FINDINGS On June 24, 2021, the MR ASAP trial was prematurely terminated on the advice of the data and safety monitoring board, with recruitment stopped because of safety concerns in patients with intracerebral haemorrhage. Between April 4, 2018, and Feb 12, 2021, 380 patients were randomly allocated to a study group. 325 provided informed consent or died before consent could be obtained, of whom 170 were assigned to the glyceryl trinitrate group and 155 to the control group. These patients were included in the total population. 201 patients (62%) had ischaemic stroke, 34 (10%) transient ischaemic attack, 56 (17%) intracerebral haemorrhage, and 34 (10%) a stroke-mimicking condition. In the total population (n=325), the median mRS score at 90 days was 2 (IQR 1-4) in both the glyceryl trinitrate and control groups (adjusted common OR 0·97 [95% CI 0·65-1·47]). In the target population (n=291), the 90-day mRS score was 2 (2-4) in the glyceryl trinitrate group and 3 (1-4) in the control group (0·92 [0·59-1·43]). In the total population, there were no differences between the two study groups with respect to death within 90 days (adjusted OR 1·07 [0·53-2·14]) or serious adverse events (unadjusted OR 1·23 [0·76-1·99]). In patients with intracerebral haemorrhage, 12 (34%) of 35 patients allocated to glyceryl trinitrate versus two (10%) of 21 allocated to the control group died within 7 days (adjusted OR 5·91 [0·78-44·81]); death within 90 days occurred in 16 (46%) of 35 in the glyceryl trinitrate group and 11 (55%) of 20 in the control group (adjusted OR 0·87 [0·18-4·17]). INTERPRETATION We found no sign of benefit of transdermal glyceryl trinitrate started within 3 h of symptom onset in the prehospital setting in patients with presumed acute stroke. The signal of potential early harm of glyceryl trinitrate in patients with intracerebral haemorrhage suggests that glyceryl trinitrate should be avoided in this setting. FUNDING The Collaboration for New Treatments of Acute Stroke consortium, the Brain Foundation Netherlands, the Ministry of Economic Affairs, Stryker, Medtronic, Cerenovus, and the Dutch Heart Foundation.
Collapse
|
7
|
van Voorst H, Konduri PR, van Poppel LM, van der Steen W, van der Sluijs PM, Slot EMH, Emmer BJ, van Zwam WH, Roos YBWEM, Majoie CBLM, Zaharchuk G, Caan MWA, Marquering HA. Unsupervised Deep Learning for Stroke Lesion Segmentation on Follow-up CT Based on Generative Adversarial Networks. AJNR Am J Neuroradiol 2022; 43:1107-1114. [PMID: 35902122 PMCID: PMC9575413 DOI: 10.3174/ajnr.a7582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Supervised deep learning is the state-of-the-art method for stroke lesion segmentation on NCCT. Supervised methods require manual lesion annotations for model development, while unsupervised deep learning methods such as generative adversarial networks do not. The aim of this study was to develop and evaluate a generative adversarial network to segment infarct and hemorrhagic stroke lesions on follow-up NCCT scans. MATERIALS AND METHODS Training data consisted of 820 patients with baseline and follow-up NCCT from 3 Dutch acute ischemic stroke trials. A generative adversarial network was optimized to transform a follow-up scan with a lesion to a generated baseline scan without a lesion by generating a difference map that was subtracted from the follow-up scan. The generated difference map was used to automatically extract lesion segmentations. Segmentation of primary hemorrhagic lesions, hemorrhagic transformation of ischemic stroke, and 24-hour and 1-week follow-up infarct lesions were evaluated relative to expert annotations with the Dice similarity coefficient, Bland-Altman analysis, and intraclass correlation coefficient. RESULTS The median Dice similarity coefficient was 0.31 (interquartile range, 0.08-0.59) and 0.59 (interquartile range, 0.29-0.74) for the 24-hour and 1-week infarct lesions, respectively. A much lower Dice similarity coefficient was measured for hemorrhagic transformation (median, 0.02; interquartile range, 0-0.14) and primary hemorrhage lesions (median, 0.08; interquartile range, 0.01-0.35). Predicted lesion volume and the intraclass correlation coefficient were good for the 24-hour (bias, 3 mL; limits of agreement, -64-59 mL; intraclass correlation coefficient, 0.83; 95% CI, 0.78-0.88) and excellent for the 1-week (bias, -4 m; limits of agreement,-66-58 mL; intraclass correlation coefficient, 0.90; 95% CI, 0.83-0.93) follow-up infarct lesions. CONCLUSIONS An unsupervised generative adversarial network can be used to obtain automated infarct lesion segmentations with a moderate Dice similarity coefficient and good volumetric correspondence.
Collapse
Affiliation(s)
- H van Voorst
- From the Departments of Radiology and Nuclear Medicine (H.v.V., P.R.K., L.M.v.P., B.J.E., C.B.L.M.M., H.A.M.) .,Biomedical Engineering and Physics (H.v.V., P.R.K., L.M.v.P., M.W.A.C., H.A.M.)
| | - P R Konduri
- From the Departments of Radiology and Nuclear Medicine (H.v.V., P.R.K., L.M.v.P., B.J.E., C.B.L.M.M., H.A.M.).,Biomedical Engineering and Physics (H.v.V., P.R.K., L.M.v.P., M.W.A.C., H.A.M.)
| | - L M van Poppel
- From the Departments of Radiology and Nuclear Medicine (H.v.V., P.R.K., L.M.v.P., B.J.E., C.B.L.M.M., H.A.M.).,Biomedical Engineering and Physics (H.v.V., P.R.K., L.M.v.P., M.W.A.C., H.A.M.)
| | - W van der Steen
- Departments of Neurology (W.v.d.S., P.M.v.d.S.).,Radiology and Nuclear Medicine (W.v.d.S., P.M.v.d.S.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P M van der Sluijs
- Departments of Neurology (W.v.d.S., P.M.v.d.S.).,Radiology and Nuclear Medicine (W.v.d.S., P.M.v.d.S.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E M H Slot
- Department of Neurology and Neurosurgery (E.M.H.S.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - B J Emmer
- From the Departments of Radiology and Nuclear Medicine (H.v.V., P.R.K., L.M.v.P., B.J.E., C.B.L.M.M., H.A.M.)
| | - W H van Zwam
- Department of Radiology and Nuclear Medicine (W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Y B W E M Roos
- Neurology (Y.B.W.E.M.R.), Faculty of Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - C B L M Majoie
- From the Departments of Radiology and Nuclear Medicine (H.v.V., P.R.K., L.M.v.P., B.J.E., C.B.L.M.M., H.A.M.)
| | - G Zaharchuk
- Department of Radiology (G.Z.), Stanford University, Stanford, California
| | - M W A Caan
- Biomedical Engineering and Physics (H.v.V., P.R.K., L.M.v.P., M.W.A.C., H.A.M.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Prediction and Risk Assessment Models for Subarachnoid Hemorrhage: A Systematic Review on Case Studies. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5416726. [PMID: 35111845 PMCID: PMC8802084 DOI: 10.1155/2022/5416726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 01/09/2023]
Abstract
Subarachnoid hemorrhage (SAH) is one of the major health issues known to society and has a higher mortality rate. The clinical factors with computed tomography (CT), magnetic resonance image (MRI), and electroencephalography (EEG) data were used to evaluate the performance of the developed method. In this paper, various methods such as statistical analysis, logistic regression, machine learning, and deep learning methods were used in the prediction and detection of SAH which are reviewed. The advantages and limitations of SAH prediction and risk assessment methods are also being reviewed. Most of the existing methods were evaluated on the collected dataset for the SAH prediction. In some researches, deep learning methods were applied, which resulted in higher performance in the prediction process. EEG data were applied in the existing methods for the prediction process, and these methods demonstrated higher performance. However, the existing methods have the limitations of overfitting problems, imbalance data problems, and lower efficiency in feature analysis. The artificial neural network (ANN) and support vector machine (SVM) methods have been applied for the prediction process, and considerably higher performance is achieved by using this method.
Collapse
|
9
|
Inamdar MA, Raghavendra U, Gudigar A, Chakole Y, Hegde A, Menon GR, Barua P, Palmer EE, Cheong KH, Chan WY, Ciaccio EJ, Acharya UR. A Review on Computer Aided Diagnosis of Acute Brain Stroke. SENSORS (BASEL, SWITZERLAND) 2021; 21:8507. [PMID: 34960599 PMCID: PMC8707263 DOI: 10.3390/s21248507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 01/01/2023]
Abstract
Amongst the most common causes of death globally, stroke is one of top three affecting over 100 million people worldwide annually. There are two classes of stroke, namely ischemic stroke (due to impairment of blood supply, accounting for ~70% of all strokes) and hemorrhagic stroke (due to bleeding), both of which can result, if untreated, in permanently damaged brain tissue. The discovery that the affected brain tissue (i.e., 'ischemic penumbra') can be salvaged from permanent damage and the bourgeoning growth in computer aided diagnosis has led to major advances in stroke management. Abiding to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we have surveyed a total of 177 research papers published between 2010 and 2021 to highlight the current status and challenges faced by computer aided diagnosis (CAD), machine learning (ML) and deep learning (DL) based techniques for CT and MRI as prime modalities for stroke detection and lesion region segmentation. This work concludes by showcasing the current requirement of this domain, the preferred modality, and prospective research areas.
Collapse
Affiliation(s)
- Mahesh Anil Inamdar
- Department of Mechatronics, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Udupi Raghavendra
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Anjan Gudigar
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Yashas Chakole
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (G.R.M.)
| | - Girish R. Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (G.R.M.)
| | - Prabal Barua
- School of Management & Enterprise, University of Southern Queensland, Toowoomba, QLD 4350, Australia;
- Faculty of Engineering and Information Technology, University of Technology, Sydney, NSW 2007, Australia
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW 2010, Australia
| | - Elizabeth Emma Palmer
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Kang Hao Cheong
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore;
| | - Wai Yee Chan
- Department of Biomedical Imaging, Research Imaging Centre, University of Malaya, Kuala Lumpur 59100, Malaysia;
| | - Edward J. Ciaccio
- Department of Medicine, Columbia University, New York, NY 10032, USA;
| | - U. Rajendra Acharya
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia;
- School of Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
- Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore 599491, Singapore
- Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
| |
Collapse
|
10
|
Praveen K, Sasikala M, Janani A, Shajil N, Nishanthi V H. A simplified framework for the detection of intracranial hemorrhage in CT brain images using deep learning. Curr Med Imaging 2021; 17:1226-1236. [PMID: 33602101 DOI: 10.2174/1573405617666210218100641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The need for accurate and timely detection of Intracranial hemorrhage (ICH) is utmost important to avoid untoward incidents that may even lead to death.Hence, this presented work leverages the ability of a pretrained deep convolutional neural network (CNN) for the detection of ICH in computed tomography (CT) brain images. METHODS Different frameworks have been analyzed for their effectiveness for the classification of CT brain images into hemorrhage or non-hemorrhage conditions. All these frameworks were investigated on CQ500 dataset. Furthermore, an exclusive preprocessing pipeline was designed for both normal and ICH CT images. Firstly, a framework involving the pretrained deep CNN, AlexNet, has been exploited for both feature extraction and classification using the transfer learning method, secondly, a modified AlexNet-Support vector machine (SVM) classifier is explored and finally, a feature selection method, Principal Component Analysis (PCA) has been introduced in the AlexNet-SVM classifier model and its efficacy is explored.These models were trained and tested on two different sets of CT images, one containing the original images without preprocessing and another set consisting of preprocessed images. RESULTS The modified AlexNet-SVM classifier has shown an improved performance in comparison to the other investigated frameworks and has achieved a classification accuracy of 99.86%, sensitivity and specificity of 0.9986 for the detection of ICH in brain CT images. CONCLUSION This research has given an overview of a simple and efficient framework for the classification of hemorrhage and non-hemorrhage images. Also, the proposed simplified deep learning framework manifests its ability as a screening tool to assist the radiological trainees for the accurate detection of ICH.
Collapse
Affiliation(s)
- Praveen K
- Department of Electronics and Communication Engineering, College of Engineering, Guindy, Anna University, Sardar Patel Road, Chennai-600 025. India
| | - Sasikala M
- Department of Electronics and Communication Engineering, College of Engineering, Guindy, Anna University, Sardar Patel Road, Chennai-600 025. India
| | - Janani A
- Department of Electronics and Communication Engineering, College of Engineering, Guindy, Anna University, Sardar Patel Road, Chennai-600 025. India
| | - Nijisha Shajil
- Department of Electronics and Communication Engineering, College of Engineering, Guindy, Anna University, Sardar Patel Road, Chennai-600 025. India
| | - Hari Nishanthi V
- Department of Electronics and Communication Engineering, College of Engineering, Guindy, Anna University, Sardar Patel Road, Chennai-600 025. India
| |
Collapse
|
11
|
Hu K, Chen K, He X, Zhang Y, Chen Z, Li X, Gao X. Automatic segmentation of intracerebral hemorrhage in CT images using encoder–decoder convolutional neural network. Inf Process Manag 2020. [DOI: 10.1016/j.ipm.2020.102352] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Sales Barros R, Tolhuisen ML, Boers AM, Jansen I, Ponomareva E, Dippel DWJ, van der Lugt A, van Oostenbrugge RJ, van Zwam WH, Berkhemer OA, Goyal M, Demchuk AM, Menon BK, Mitchell P, Hill MD, Jovin TG, Davalos A, Campbell BCV, Saver JL, Roos YBWEM, Muir KW, White P, Bracard S, Guillemin F, Olabarriaga SD, Majoie CBLM, Marquering HA. Automatic segmentation of cerebral infarcts in follow-up computed tomography images with convolutional neural networks. J Neurointerv Surg 2019; 12:848-852. [PMID: 31871069 PMCID: PMC7476369 DOI: 10.1136/neurintsurg-2019-015471] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022]
Abstract
Background and purpose Infarct volume is a valuable outcome measure in treatment trials of acute ischemic stroke and is strongly associated with functional outcome. Its manual volumetric assessment is, however, too demanding to be implemented in clinical practice. Objective To assess the value of convolutional neural networks (CNNs) in the automatic segmentation of infarct volume in follow-up CT images in a large population of patients with acute ischemic stroke. Materials and methods We included CT images of 1026 patients from a large pooling of patients with acute ischemic stroke. A reference standard for the infarct segmentation was generated by manual delineation. We introduce three CNN models for the segmentation of subtle, intermediate, and severe hypodense lesions. The fully automated infarct segmentation was defined as the combination of the results of these three CNNs. The results of the three-CNNs approach were compared with the results from a single CNN approach and with the reference standard segmentations. Results The median infarct volume was 48 mL (IQR 15–125 mL). Comparison between the volumes of the three-CNNs approach and manually delineated infarct volumes showed excellent agreement, with an intraclass correlation coefficient (ICC) of 0.88. Even better agreement was found for severe and intermediate hypodense infarcts, with ICCs of 0.98 and 0.93, respectively. Although the number of patients used for training in the single CNN approach was much larger, the accuracy of the three-CNNs approach strongly outperformed the single CNN approach, which had an ICC of 0.34. Conclusion Convolutional neural networks are valuable and accurate in the quantitative assessment of infarct volumes, for both subtle and severe hypodense infarcts in follow-up CT images. Our proposed three-CNNs approach strongly outperforms a more straightforward single CNN approach.
Collapse
Affiliation(s)
- Renan Sales Barros
- Department of Biomedical Engineering and Physics, Amsterdam UMC. location AMC, Amsterdam, the Netherlands
| | - Manon L Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC. location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Anna Mm Boers
- Department of Biomedical Engineering and Physics, Amsterdam UMC. location AMC, Amsterdam, the Netherlands.,Nico-lab, Amsterdam, Netherlands
| | - Ivo Jansen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | | | - Diederik W J Dippel
- Department of Neurology, Erasmus MC - University Medical Center, Rotterdam, Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,CArduivascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Olvert A Berkhemer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mayank Goyal
- Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy K Menon
- Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Tudor G Jovin
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Antoni Davalos
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, Badalona, Spain
| | - Bruce C V Campbell
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Phil White
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Neuroradiology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Serge Bracard
- CIC1433-Epidémiologie Clinique, Inserm, Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - Francis Guillemin
- CIC1433-Epidémiologie Clinique, Inserm, Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, Nancy, France
| | | | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC. location AMC, Amsterdam, the Netherlands .,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| |
Collapse
|