MRI based objective ischemic core-penumbra quantification in adult clinical stroke

Area of Science:

• Medical Imaging
• Neurology
• Computer-Aided Diagnosis

Background:

• Accurate quantification of ischemic stroke and identification of salvageable tissue are crucial for effective treatment planning.
• Current Magnetic Resonance Imaging (MRI) techniques for stroke assessment are time-consuming and rely on manual analysis.
• Computer-aided tools can assist neuroradiologists in analyzing stroke lesions more efficiently.

Purpose of the Study:

• To extend the Hierarchical Region Splitting (HRS) method for automated segmentation and quantification of ischemic stroke lesions using DWI-PWI.
• To differentiate between salvageable (penumbra) and non-salvageable (core) tissue in acute stroke patients.
• To evaluate the performance of the PWI-DWI based HRS method against manual lesion demarcation.

Main Methods:

• An established Hierarchical Region Splitting (HRS) method was adapted to segment stroke lesions from DWI-PWI maps.
• The PWI-DWI/HRS method was used to automatically quantify lesion volume, core infarct, and penumbra.
• Validation was performed by comparing PWI-DWI/HRS results with manually delineated ground truth in 10 acute adult stroke patients.

Main Results:

• The PWI-DWI/HRS method achieved high accuracy (82.1%) in lesion volume quantification, with sensitivity (78.8%), specificity (99.3%), and similarity (78.54%) comparable to manual methods.
• The method successfully quantified core and penumbra, enabling estimation of salvageable brain tissue.
• Classification into severe, moderate, and mild stroke categories based on total lesion volume was feasible.

Conclusions:

• The proposed PWI-DWI/HRS method offers an accurate and automated approach for ischemic stroke lesion quantification and salvageable tissue assessment.
• This automated method demonstrates performance close to manual demarcation, with high indices for core and penumbra quantification, particularly in severe and moderate stroke cases.
• The PWI-DWI/HRS technique shows potential to assist neuroradiologists in stroke treatment planning by providing rapid and reliable lesion analysis.