Evidence map›Paper›PMID 38870240›Full record

ArticlePloS one2024

Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion.

Adrian Mak, Charles C Matouk, Emily W Avery, Jonas Behland, Stefan P Haider, Dietmar Frey, Vince I Madai, Peter Vajkoczy, Christoph J Griessenauer, Ramin Zand and 9 more

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Article in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

19 authors.

Adrian MakDepartment of Radiology and Biomedical Imaging, Section of Neuroradiology, Yale School of Medicine, New Haven, CT, United States of America.ORCID 0000-0002-5696-6002
Charles C MatoukDepartment of Neurosurgery, Division of Neurovascular Surgery, Yale University School of Medicine, New Haven, CT, United States of America.
Emily W AveryDepartment of Radiology and Biomedical Imaging, Section of Neuroradiology, Yale School of Medicine, New Haven, CT, United States of America.
Jonas BehlandDepartment of Radiology and Biomedical Imaging, Section of Neuroradiology, Yale School of Medicine, New Haven, CT, United States of America.
Stefan P HaiderDepartment of Radiology and Biomedical Imaging, Section of Neuroradiology, Yale School of Medicine, New Haven, CT, United States of America.ORCID 0000-0002-7640-3645
Dietmar FreyCLAIM-Charité Lab for Artificial Intelligence in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Vince I MadaiQUEST Center for Responsible Research, Berlin Institute of Health (BIH), Charité Universitätsmedizin Berlin, Berlin, Germany.
Peter VajkoczyDepartment of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
Christoph J GriessenauerResearch Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
Ramin ZandDepartment of Neurology, Geisinger Medical Center, Danville, PA, United States of America.
Philipp HendrixDepartment of Neurosurgery, Geisinger Medical Center, Danville, PA, United States of America.ORCID 0000-0003-0017-5049
Vida AbediDepartment of Public Health Sciences, The Pennsylvania State University, Hershey, PA, United States of America.
Pina C SanelliDepartment of Radiology, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, United States of America.
Guido J FalconeDivision of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States of America.
Nils PetersenDivision of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States of America.
Lauren H SansingDivision of Stroke and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States of America.
Kevin N ShethDivision of Stroke and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States of America.
Seyedmehdi PayabvashDepartment of Radiology and Biomedical Imaging, Section of Neuroradiology, Yale School of Medicine, New Haven, CT, United States of America.
Ajay MalhotraDepartment of Radiology and Biomedical Imaging, Section of Neuroradiology, Yale School of Medicine, New Haven, CT, United States of America.

Funding

Yale Study Support Suite (YES3): Dashboard and Web Portal Software Supporting Research Workflow through integrated, customizable REDCap External ModulesP30AG021342 · NIA · YALE UNIVERSITY · PI Albert C Shaw · 2002 to 2026
$37.9M
Anticoagulation in ICH Survivors for Prevention and Recovery (ASPIRE)U01NS106513 · NINDS · YALE UNIVERSITY · PI Hooman Kamel, Kevin Navin Sheth · 2019 to 2026
$20.6M
Short-Term Reserch Training: Students in Health SchoolsT35HL007649 · NHLBI · YALE UNIVERSITY · PI Sarwat I Chaudhry, Erica L Herzog · 1987 to 2026
$5.7M
The Recovery in Stroke Using PAP (RISE UP) StudyR01NR018335 · NINR · YALE UNIVERSITY · PI REDEKER, NANCY S, SHETH, KEVIN NAVIN · 2019 to 2023
$3.4M
Southern New England Partnership In Stroke Research, Innovation and Treatment (SPIRIT)U24NS107215 · NINDS · YALE UNIVERSITY · PI MARK Jay ALBERTS, Karen L Furie · 2018 to 2026
$3.0M
Dynamic Neuroimmune Profiling in Patients with Acute Intracerebral HemorrhageR01NS097728 · NINDS · YALE UNIVERSITY · PI SANSING, LAUREN H · 2016 to 2020
$2.8M
Efferocytosis and the resolution of inflammation after intracerebral hemorrhageR01NS095993 · NINDS · YALE UNIVERSITY · PI SANSING, LAUREN H · 2016 to 2020
$1.8M
Yale Clinical Site: Investigations For Improved Neurological Treatments at Yale (INFINITY)U24NS107136 · NINDS · YALE UNIVERSITY · PI SHETH, KEVIN NAVIN, SPUDICH, SERENA S · 2018 to 2022
$1.7M
Precision blood pressure management after endovascular stroke therapy based on real-time autoregulation measurementsK23NS110980 · NINDS · YALE UNIVERSITY · PI PETERSEN, NILS H. · 2020 to 2024
$951k
Radiomics Signatures and Patient Outcomes in Intracerebral HemorrhageK23NS118056 · NINDS · YALE UNIVERSITY · PI Seyedmehdi Payabvash · 2021 to 2026
$780k
Electroencephalographic signatures of dysfunctional cerebrovascular autoregulation as biomarkers of brain injury in aneurysmal subarachnoid hemorrhage (SAH)R21NS128641 · NINDS · YALE UNIVERSITY · PI KIM, JENNIFER A, MATOUK, CHARLES · 2023 to 2024
$461k
Intensive Blood Pressure Reduction in Deep Intracerebral HemorrhageR03NS112859 · NINDS · YALE UNIVERSITY · PI FALCONE, GUIDO JOSE, SHETH, KEVIN NAVIN · 2019 to 2020
$84k
American Heart Association-American Stroke Association 18IDDG34280056NHLBI NIH HHS T35 HL007649NIA NIH HHS K76 AG059992NIA NIH HHS P30 AG021342NINDS NIH HHS K23 NS110980NINDS NIH HHS K23 NS118056NINDS NIH HHS R01 NS095993NINDS NIH HHS R01 NS097728NINDS NIH HHS R03 NS112859NINDS NIH HHS R21 NS128641NINDS NIH HHS U01 NS106513NINDS NIH HHS U24 NS107136NINDS NIH HHS U24 NS107215NINR NIH HHS R01 NR018335
6 · The paper itself

Abstract

purposeTo create and validate an automated pipeline for detection of early signs of irreversible ischemic change from admission CTA in patients with large vessel occlusion (LVO) stroke.

methodsWe retrospectively included 368 patients for training and 143 for external validation. All patients had anterior circulation LVO stroke, endovascular therapy with successful reperfusion, and follow-up diffusion-weighted imaging (DWI). We devised a pipeline to automatically segment Alberta Stroke Program Early CT Score (ASPECTS) regions and extracted their relative Hounsfield unit (rHU) values. We determined the optimal rHU cut points for prediction of final infarction in each ASPECT region, performed 10-fold cross-validation in the training set, and measured the performance via external validation in patients from another institute. We compared the model with an expert neuroradiologist for prediction of final infarct volume and poor functional outcome.

resultsWe achieved a mean area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of 0.69±0.13, 0.69±0.09, 0.61±0.23, and 0.72±0.11 across all regions and folds in cross-validation. In the external validation cohort, we achieved a median [interquartile] AUC, accuracy, sensitivity, and specificity of 0.71 [0.68-0.72], 0.70 [0.68-0.73], 0.55 [0.50-0.63], and 0.74 [0.73-0.77], respectively. The rHU-based ASPECTS showed significant correlation with DWI-based ASPECTS (rS = 0.39, p<0.001) and final infarct volume (rS = -0.36, p<0.001). The AUC for predicting poor functional outcome was 0.66 (95%CI: 0.57-0.75). The predictive capabilities of rHU-based ASPECTS were not significantly different from the neuroradiologist's visual ASPECTS for either final infarct volume or functional outcome.

conclusionsOur study demonstrates the feasibility of an automated pipeline and predictive model based on relative HU attenuation of ASPECTS regions on baseline CTA and its non-inferior performance in predicting final infarction on post-stroke DWI compared to an expert human reader.

Indexed as

Brain IschemiaAgedAged, 80 and overComputed Tomography AngiographyDiffusion Magnetic Resonance ImagingFemaleHumansIschemic StrokeMaleMiddle AgedRetrospective StudiesROC CurveStroke

Identifiers

PMID38870240
PMCPMC11175522

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