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Updated: Apr 26, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Development and validation of intracranial thrombus segmentation on CT angiography in patients with acute ischemic
Emilie M M Santos1, Henk A Marquering2, Olvert A Berkhemer3
1Dept. of Radiology, Erasmus MC, Rotterdam, the Netherlands; Dept. of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands; Dept. of Radiology, AMC, Amsterdam, the Netherlands; Dept. of Biomedical Engineering and Physics, AMC, Amsterdam, the Netherlands.
Insights
An automated method accurately measures thrombus length and volume in acute ischemic stroke patients using CT angiography. This technique offers a faster, more reliable alternative to manual delineation for improved treatment prediction.
Area of Science:
- Medical Imaging
- Neurology
- Biomedical Engineering
Background:
- Thrombus characterization is crucial for predicting treatment outcomes in acute ischemic stroke.
- Manual thrombus measurement on CT angiography is challenging due to poor contrast, making it time-consuming.
- Accurate thrombus quantification is essential for guiding stroke management.
Purpose of the Study:
- To develop and validate an automated method for thrombus segmentation and measurement on CT angiography.
- To compare the accuracy of automated measurements against manual delineations.
- To assess the feasibility of automated thrombus characterization for clinical application.
Main Methods:
- Automated thrombus segmentation using image intensity and contralateral artery shape priors.
- Measurement of thrombus length and volume in 53 acute ischemic stroke patients.
- Validation using intraclass correlation coefficients and Bland-Altman analyses against inter-observer manual measurements.
Main Results:
- Successful automated thrombus segmentation in all 53 patients.
- High intraclass correlation for automated vs. manual measurements (length: 0.89, volume: 0.84).
- Automated measurements showed comparable accuracy to the best inter-observer agreement.
Conclusions:
- The automated method provides accurate and efficient thrombus length and volume measurements.
- The technique is robust, insensitive to hematocrit and calcifications, and requires minimal user input.
- This automated approach has potential for assessing thrombus characteristics, including low-density thrombi.
Background And Purpose:
Thrombus characterization is increasingly considered important in predicting treatment success for patients with acute ischemic stroke. The lack of intensity contrast between thrombus and surrounding tissue in CT images makes manual delineation a difficult and time consuming task. Our aim was to develop an automated method for thrombus measurement on CT angiography and validate it against manual delineation.
Materials And Methods:
Automated thrombus segmentation was achieved using image intensity and a vascular shape prior derived from the segmentation of the contralateral artery. In 53 patients with acute ischemic stroke due to proximal intracranial arterial occlusion, automated length and volume measurements were performed. Accuracy was assessed by comparison with inter-observer variation of manual delineations using intraclass correlation coefficients and Bland-Altman analyses.
Results:
The automated method successfully segmented the thrombus for all 53 patients. The intraclass correlation of automated and manual length and volume measurements were 0.89 and 0.84. Bland-Altman analyses yielded a bias (limits of agreement) of -0.4 (-8.8, 7.7) mm and 8 (-126, 141) mm3 for length and volume, respectively. This was comparable to the best interobserver agreement, with an intraclass correlation coefficients of 0.90 and 0.85 and a bias (limits of agreement) of -0.1 (-11.2, 10.9) mm and -17 (-216, 185) mm3.
Conclusions:
The method facilitates automated thrombus segmentation for accurate length and volume measurements, is relatively fast and requires minimal user input, while being insensitive to high hematocrit levels and vascular calcifications. Furthermore, it has the potential to assess thrombus characteristics of low-density thrombi.
