Automatic detection and vascular territory classification of hyperacute staged ischemic stroke on diffusion weighted...

Automated ischemic stroke detection and classification according to its vascular territory is an essential step in stroke image evaluation, especially at hyperacute stage where mechanical thrombectomy may improve patients' outcome. This study aimed to evaluate the performance of various convolutional neural network (CNN) models on hyperacute staged diffusion-weighted images (DWI) for detection of ischemic stroke and classification into anterior circulation infarct (ACI), posterior circulation infarct (PCI) and normal image slices. In this retrospective study, 253 cases of hyperacute staged DWI were identified, downloaded and reviewed. After exclusion, DWI from 127 cases were used and we created a dataset containing total of 2119 image slices, and separates it into three groups, namely ACI (618 slices), PCI (149 slices) and normal (1352 slices). Two transfer learning based CNN models, namely Inception-v3, EfficientNet-b0 and one self-derived modified LeNet model were used. The performance of the models was evaluated and activation maps using gradient-weighted class activation mapping (Grad-Cam) technique were made. Inception-v3 had the best overall accuracy (86.3%), weighted F1 score (86.2%) and kappa score (0.715), followed by the modified LeNet (85.2% accuracy, 84.7% weighted F1 score and 0.693 kappa score). The EfficientNet-b0 had the poorest performance of 83.6% accuracy, 83% weighted F1 score and 0.662 kappa score. The activation map showed that one possible explanation for misclassification is due to susceptibility artifact. A sufficiently high performance can be achieved by using CNN model to detect ischemic stroke on hyperacute staged DWI and classify it according to vascular territory.