KEYWORDS: Data modeling, Computed tomography, Performance modeling, Blood, Feature extraction, Deep learning, Process modeling, Image classification, Deep convolutional neural networks
Accurately predicting the clinical outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) presents notable challenges. This study sought to develop and assess a Computer-Aided Detection (CAD) scheme employing a deep-learning classification architecture, utilizing brain Computed Tomography (CT) images to forecast aSAH patients' prognosis. A retrospective dataset encompassing 60 aSAH patients was collated, each with two CT images acquired upon admission and after ten to 14 days of admission. The existing CAD scheme was utilized for preprocessing and data curation based on the presence of blood clot in the cisternal spaces. Two pre-trained architectures, DenseNet-121 and VGG16, were chosen as convolutional bases for feature extraction. The Convolution Based Attention Module (CBAM) was introduced atop the pre-trained architecture to enhance focus learning. Employing five-fold cross-validation, the developed prediction model assessed three clinical outcomes following aSAH, and its performance was evaluated using multiple metrics. A comparison was conducted to analyze the impact of CBAM. The prediction model trained using CT images acquired at admission demonstrated higher accuracy in predicting short-term clinical outcomes. Conversely, the model trained using CT images acquired on ten to 14 days accurately predicted long-term clinical outcomes. Notably, for short-term outcomes, high sensitivity performances (0.87 and 0.83) were reported from the first scan, while the sensitivity of (0.65 and 0.75) was reported from the last scan, showcasing the viability of predicting the prognosis of aSAH patients using novel deep learning-based quantitative image markers. The study demonstrated the potential of integrating deep-learning architecture with attention mechanisms to optimize predictive capabilities in identifying clinical complications among patients with aSAH.
Advent of advanced imaging technology and better neuro-interventional equipment have resulted in timely diagnosis and effective treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, objective clinicoradiologic correlate to identify appropriate candidates and their respective clinical outcome is largely unknown. The purpose of the study is to develop and test a new interactive decision-making support tool to predict severity of AIS prior to thrombectomy using CT perfusion imaging protocol. CT image data of 30 AIS patients with LVO assessed radiologically for their eligibility to undergo mechanical thrombectomy were retrospectively collected and analyzed in this study. First, a computer-aided scheme automatically categorizes images into multiple sequences followed by indexing each slice to specified brain location. Next, consecutive mapping is used for accurate brain region segmentation from skull. The brain is then split into left and right hemispheres, followed by detecting blood in each hemisphere. Additionally, visual tools including segmentation, blood correction, select sequence and index analyzer are implemented for deeper analysis. Last, comparison between blood-volume in each hemisphere over the sequences is made to observe wash-in and wash-out rate of blood flow to assess the extent of damaged and “at risk” brain tissue. By integrating computer-aided scheme into a user graphic interface, the study builds a unique image feature analysis and visualization tool to observe and quantify the delayed or reduced blood flow (brain “at-risk” to develop AIS) in the corresponding hemisphere, which has potential to assist radiologists to quickly visualize and more accurately assess extent of AIS.
Advent of advanced imaging technology and better neuro-interventional equipment have resulted in timely diagnosis and effective treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, objective clinicoradiologic correlate to identify appropriate candidates and their respective clinical outcome is largely unknown. The purpose of the study is to develop and test a new computer-aided detection algorithm to quantify region-specific AIS and “at risk” brain volumes prior to thrombectomy using CT perfusion imaging protocol. Fourteen patients with LVO related AIS and assessed radiologically for their eligibility to undergo mechanical thrombectomy was retrospectively analyzed for the study. First, the scheme automatically categorizes images into multiple series of scans acquired from a section of brain. Each image in series is labeled to a specified brain location. Next, image segmentation is performed to separate brain region from skull. The brain is then split into left and right hemispheres, followed by detecting amount of blood in each hemisphere. Last, comparison between amount of blood in each hemisphere over the series of scans is made to observe the wash-in and wash-out rate of blood to assess the extent of already damaged and “at risk” brain tissue. By integrating the scheme into a user graphic interface, the study builds a unique image feature analysis and visualization tool to observe and quantify the delayed or reduced blood flow (brain “at risk” to develop AIS) in the corresponding hemisphere, which has potential to assist radiologists to quickly visualize and more accurately assess the extent of AIS.
Aneurysmal subarachnoid hemorrhage (aSAH) is a form of hemorrhagic stroke that affects middle-aged individuals and associated with significant morbidity and/or mortality especially those presenting with higher clinical and radiologic grades at the time of admission. Previous studies suggested that blood extravasated after aneurysmal rupture was a potentially clinical prognosis factor. But all such studies used qualitative scales to predict prognosis. The purpose of this study is to develop and test a new interactive computer-aided detection (CAD) tool to detect, segment and quantify brain hemorrhage and ventricular cerebrospinal fluid on non-contrasted brain CT images. First, CAD segments brain skull using a multilayer region growing algorithm with adaptively adjusted thresholds. Second, CAD assigns pixels inside the segmented brain region into one of three classes namely, normal brain tissue, blood and fluid. Third, to avoid “black-box” approach and increase accuracy in quantification of these two image markers using CT images with large noise variation in different cases, a graphic User Interface (GUI) was implemented and allows users to visually examine segmentation results. If a user likes to correct any errors (i.e., deleting clinically irrelevant blood or fluid regions, or fill in the holes inside the relevant blood or fluid regions), he/she can manually define the region and select a corresponding correction function. CAD will automatically perform correction and update the computed data. The new CAD tool is now being used in clinical and research settings to estimate various quantitatively radiological parameters/markers to determine radiological severity of aSAH at presentation and correlate the estimations with various homeostatic/metabolic derangements and predict clinical outcome.
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