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Published on: September 22, 2023
Automatic collateral circulation scoring in ischemic stroke using 4D CT angiography with low-rank and sparse matrix
Mumu Aktar1, Donatella Tampieri2, Hassan Rivaz3
1Department of Computer Science and Software Engineering, Concordia University, 1455 boul. De Maisonneuve O., Montreal, Québec, H3G 1M8, Canada. m_ktar@encs.concordia.ca.
Insights
A new automated method, ACCESS, accurately scores cerebral collateral blood supply from CT angiography, improving stroke treatment decisions. This approach enhances consistency and aids radiologists in clinical practice.
Area of Science:
- Medical Imaging
- Neurology
- Artificial Intelligence
Background:
- Effective endovascular treatment for ischemic stroke relies on adequate collateral blood supply.
- Current collateral scoring methods based on visual inspection exhibit inter- and intra-rater variability.
- Objective and consistent collateral assessment is needed for optimal stroke treatment decisions.
Purpose of the Study:
- To develop and validate a robust, automated method for scoring cerebral collateral blood supply.
- To improve the accuracy and consistency of collateral assessment in ischemic stroke patients.
- To aid clinical decision-making in endovascular stroke treatment.
Main Methods:
- The Automatic Collateral Circulation Evaluation in iSchemic Stroke (ACCESS) method utilizes 4D dynamic CT angiography (CTA).
- It employs a fast robust matrix completion algorithm with Frank-Wolfe optimization to model unfilled and full cerebrovasculature.
- The collateral score is calculated as the ratio of unfilled to full vasculature, mirroring clinical protocols.
Main Results:
- ACCESS achieved an overall accuracy of 84.78% in a cohort of 46 stroke patients.
- Leave-one-out cross-validation yielded a mean area under the receiver operating characteristics curve of 85.39%.
- The method demonstrates high performance in differentiating collateral supply levels.
Conclusions:
- ACCESS provides an automated and objective approach to collateral scoring, overcoming limitations of manual assessment.
- The method's robustness and resemblance to radiologist scoring facilitate its integration into clinical workflows.
- This tool can assist radiologists in making more informed treatment decisions for ischemic stroke.
Purpose:
Sufficient collateral blood supply is crucial for favorable outcomes with endovascular treatment. The current practice of collateral scoring relies on visual inspection and thus can suffer from inter and intra-rater inconsistency. We present a robust and automatic method to score cerebral collateral blood supply to aid ischemic stroke treatment decision making. The developed method is based on 4D dynamic CT angiography (CTA) and the ASPECTS scoring protocol.
Methods:
The proposed method, ACCESS (Automatic Collateral Circulation Evaluation in iSchemic Stroke), estimates a target patient's unfilled cerebrovasculature in contrast-enhanced CTA using the lack of contrast agent due to clotting. To do so, the fast robust matrix completion algorithm with in-face extended Frank-Wolfe optimization is applied on a cohort of healthy subjects and a target patient, to model the patient's unfilled vessels and the estimated full vasculature as sparse and low-rank components, respectively. The collateral score is computed as the ratio of the unfilled vessels to the full vasculature, mimicking existing clinical protocols.
Results:
ACCESS was tested with 46 stroke patients and obtained an overall accuracy of 84.78%. The optimal threshold selection was evaluated using a receiver operating characteristics curve with the leave-one-out approach, and a mean area under the curve of 85.39% was obtained.
Conclusion:
ACCESS automates collateral scoring to mitigate the shortcomings of the standard clinical practice. It is a robust approach, which resembles how radiologists score clinical scans, and can be used to help radiologists in clinical decisions of stroke treatment.
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