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Winzeck S, Mocking SJT, Bezerra R, Bouts MJRJ, McIntosh EC, Diwan I, Garg P, Chutinet A, Kimberly WT, Copen WA, Schaefer PW, Ay H, Singhal AB, Kamnitsas K, Glocker B, Sorensen AG, Wu O. Ensemble of Convolutional Neural Networks Improves Automated Segmentation of Acute Ischemic Lesions Using Multiparametric Diffusion-Weighted MRI. AJNR Am J Neuroradiol 2019; 40:938-945. [PMID: 31147354 DOI: 10.3174/ajnr.a6077] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/19/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Accurate automated infarct segmentation is needed for acute ischemic stroke studies relying on infarct volumes as an imaging phenotype or biomarker that require large numbers of subjects. This study investigated whether an ensemble of convolutional neural networks trained on multiparametric DWI maps outperforms single networks trained on solo DWI parametric maps. MATERIALS AND METHODS Convolutional neural networks were trained on combinations of DWI, ADC, and low b-value-weighted images from 116 subjects. The performances of the networks (measured by the Dice score, sensitivity, and precision) were compared with one another and with ensembles of 5 networks. To assess the generalizability of the approach, we applied the best-performing model to an independent Evaluation Cohort of 151 subjects. Agreement between manual and automated segmentations for identifying patients with large lesion volumes was calculated across multiple thresholds (21, 31, 51, and 70 cm3). RESULTS An ensemble of convolutional neural networks trained on DWI, ADC, and low b-value-weighted images produced the most accurate acute infarct segmentation over individual networks (P < .001). Automated volumes correlated with manually measured volumes (Spearman ρ = 0.91, P < .001) for the independent cohort. For the task of identifying patients with large lesion volumes, agreement between manual outlines and automated outlines was high (Cohen κ, 0.86-0.90; P < .001). CONCLUSIONS Acute infarcts are more accurately segmented using ensembles of convolutional neural networks trained with multiparametric maps than by using a single model trained with a solo map. Automated lesion segmentation has high agreement with manual techniques for identifying patients with large lesion volumes.
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Affiliation(s)
- S Winzeck
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.,Division of Anaesthesia (S.W.), Department of Medicine, University of Cambridge, Cambridge, UK
| | - S J T Mocking
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - R Bezerra
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - M J R J Bouts
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - E C McIntosh
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - I Diwan
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - P Garg
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - A Chutinet
- Departments of Neurology (A.C., W.T.K., H.A., A.B.S.).,Department of Medicine (A.C.), Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - W T Kimberly
- Departments of Neurology (A.C., W.T.K., H.A., A.B.S.)
| | - W A Copen
- Radiology (W.A.C., P.W.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - P W Schaefer
- Radiology (W.A.C., P.W.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - H Ay
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.,Departments of Neurology (A.C., W.T.K., H.A., A.B.S.)
| | - A B Singhal
- Departments of Neurology (A.C., W.T.K., H.A., A.B.S.)
| | - K Kamnitsas
- Department of Computing (K.K., B.G.), Imperial College London, London, UK
| | - B Glocker
- Department of Computing (K.K., B.G.), Imperial College London, London, UK
| | - A G Sorensen
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - O Wu
- From the Department of Radiology (S.W., S.J.T.M., R.B., M.J.R.J.B., E.C.M., I.D., P.G., H.A., A.G.S., O.W.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
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Affiliation(s)
- P Srichomkwun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center in Diabetes, Hormones and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - N Houngngam
- Excellence Center in Diabetes, Hormones and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - P Boonchaya-Anant
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center in Diabetes, Hormones and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - A Chutinet
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - P Buranasupkajorn
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center in Diabetes, Hormones and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - T Snabboon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center in Diabetes, Hormones and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Chutinet A, Biffi A, Kanakis A, Fitzpatrick KM, Furie KL, Rost NS. Severity of leukoaraiosis in large vessel atherosclerotic disease. AJNR Am J Neuroradiol 2012; 33:1591-5. [PMID: 22422177 DOI: 10.3174/ajnr.a3015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The severity of white matter hyperintensity, or leukoaraiosis, is a marker of cerebrovascular disease. In stroke, WMH burden is strongly linked to lacunar infarction; however, impaired cerebral perfusion due to extracranial or intracranial atherosclerosis may also contribute to WMH burden. We sought to determine whether WMH burden is associated with extracranial or intracranial stenosis in patients with AIS. MATERIALS AND METHODS Patients with AIS with admission head/neck CTA and brain MR imaging were included in this analysis. "Extracranial stenosis" was defined as >50% stenosis in the extracranial ICA, and "intracranial," as >50% stenosis in either the middle, anterior, or posterior cerebral arteries on CTA, on either side. WMHV was determined by using a validated semiautomated protocol. Multiple regression was used to assess the relationship between WMHV and extracranial/intracranial atherosclerosis. RESULTS Of 201 subjects, 51 (25.4%) had extracranial and 63 (31.5%) had intracranial stenosis. Mean age was 62 ± 15 years; 36% were women. Mean WMHV was 12.87 cm(3) in the extracranial and 8.59 cm(3) in the intracranial stenosis groups. In univariate analysis, age (P < .0001), SBP and DBP (P = .004), and HTN (P = .0003) were associated with WMHV. Extracranial stenosis was associated with greater WMHV after adjustment for intracranial stenosis (P = .04). In multivariate analysis including extracranial stenosis, only age (P < .0001) and HTN (P = .03) demonstrated independent effects on WMHV. CONCLUSIONS In our cohort of patients with AIS, age and HTN were the strongest determinants of the WMHV severity. Future studies are warranted to unravel further association between WMHV and cerebral vessel atherosclerosis.
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Affiliation(s)
- A Chutinet
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
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