Johansen Jacob, Offersen Cecilie Mørck, Carlsen Jonathan Frederik, Ingala Silvia, Hansen Adam Espe, Nielsen Michael Bachmann, Darkner Sune, Pai Akshay
Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark.
Cerebriu A/S, 1434 Copenhagen, Denmark.
Diagnostics (Basel). 2023 Dec 27;14(1):69. doi: 10.3390/diagnostics14010069.
DWI/FLAIR mismatch assessment for ischemic stroke patients shows promising results in determining if patients are eligible for recombinant tissue-type plasminogen activator (r-tPA) treatment. However, the mismatch criteria suffer from two major issues: binary classification of a non-binary problem and the subjectiveness of the assessor. In this article, we present a simple automatic method for segmenting stroke-related parenchymal hyperintensities on FLAIR, allowing for an automatic and continuous DWI/FLAIR mismatch assessment. We further show that our method's segmentations have comparable inter-rater agreement (DICE 0.820, SD 0.12) compared to that of two neuro-radiologists (DICE 0.856, SD 0.07), that our method appears robust to hyper-parameter choices (suggesting good generalizability), and lastly, that our methods continuous DWI/FLAIR mismatch assessment correlates to mismatch assessments made for a cohort of wake-up stroke patients at hospital submission. The proposed method shows promising results in automating the segmentation of parenchymal hyperintensity within ischemic stroke lesions and could help reduce inter-observer variability of DWI/FLAIR mismatch assessment performed in clinical environments as well as offer a continuous assessment instead of the current binary one.
对缺血性中风患者进行弥散加权成像（DWI）/液体衰减反转恢复序列（FLAIR）不匹配评估，在确定患者是否适合接受重组组织型纤溶酶原激活剂（r-tPA）治疗方面显示出了有前景的结果。然而，不匹配标准存在两个主要问题：将一个非二元问题进行二元分类以及评估者的主观性。在本文中，我们提出了一种简单的自动方法，用于在FLAIR上分割与中风相关的脑实质高信号，从而实现自动且连续的DWI/FLAIR不匹配评估。我们进一步表明，与两位神经放射科医生的分割结果相比（DICE系数为0.856，标准差为0.07），我们方法的分割结果具有相当的评分者间一致性（DICE系数为0.820，标准差为0.12），我们的方法对超参数选择似乎具有鲁棒性（表明具有良好的通用性），最后，我们方法的连续DWI/FLAIR不匹配评估与一组醒来时发病的中风患者在入院时进行的不匹配评估相关。所提出的方法在自动分割缺血性中风病变内的脑实质高信号方面显示出有前景的结果，并且有助于减少临床环境中进行的DWI/FLAIR不匹配评估的观察者间变异性，同时提供连续评估而非当前的二元评估。
