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Automated neuroradiological support systems for multiple cerebrovascular disease markers - A systematic review and
Jesse Phitidis1, Alison Q O'Neil2, William N Whiteley3
1Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH164SB, United Kingdom; Canon Medical Research Europe, Bonnington Bond, 2 Anderson Place, Edinburgh, EH65NP, United Kingdom.
Insights
Automated systems aid radiologists in detecting cerebrovascular disease (CVD) markers like white matter hyperintensities (WMH) and stroke lesions on brain scans. However, no current system comprehensively analyzes all CVD markers for improved stroke and dementia risk assessment.
Area of Science:
- Neurology and Radiology
- Medical Imaging Analysis
- Artificial Intelligence in Healthcare
Background:
- Cerebrovascular diseases (CVD) are major causes of death and disability, leading to stroke and dementia.
- Brain imaging reveals key CVD markers such as white matter hyperintensities (WMH), ischemic stroke lesions (ISL), lacunes, enlarged perivascular spaces (PVS), hemorrhagic lesions, cerebral microbleeds (CMB), and brain atrophy.
- These markers are crucial for assessing future stroke and dementia risk and guiding patient management.
Purpose of the Study:
- To systematically review automated systems that assist radiologists in identifying and analyzing CVD markers on brain imaging.
- To evaluate both commercially available software and research publications for their capabilities in detecting at least two CVD markers.
Main Methods:
- A systematic review was conducted on commercial products and research publications focused on automated CVD marker detection.
- Included systems identified a minimum of two CVD markers from brain imaging data.
- Data were synthesized to categorize system functionalities and the types of CVD markers analyzed.
Main Results:
- The review included 29 commercial products and 13 research publications.
- Commercial systems primarily focus on acute stroke lesion detection (CT) for triage or WMH and atrophy measurement (MRI) for neurodegeneration.
- Research systems most frequently analyze WMH and ISL together using MRI; lacunes, PVS, and CMB are analyzed less frequently.
- No openly validated systems currently offer comprehensive joint analysis of all major CVD markers.
Conclusions:
- Existing automated systems partially address the need for CVD marker analysis, with distinct focuses in commercial and research domains.
- Commercial systems are geared towards emergency stroke detection, while research systems explore broader applications including neurodegenerative diseases.
- A significant gap exists in the market and research for a comprehensive, validated system capable of jointly analyzing all key CVD markers for improved diagnostic and prognostic accuracy.
Abstract:
Cerebrovascular diseases (CVD) can lead to stroke and dementia. Stroke is the second leading cause of death world wide and dementia incidence is increasing by the year. There are several markers of CVD that are visible on brain imaging, including: white matter hyperintensities (WMH), acute and chronic ischaemic stroke lesions (ISL), lacunes, enlarged perivascular spaces (PVS), acute and chronic haemorrhagic lesions, and cerebral microbleeds (CMB). Brain atrophy also occurs in CVD. These markers are important for patient management and intervention, since they indicate elevated risk of future stroke and dementia. We systematically reviewed automated systems designed to support radiologists reporting on these CVD imaging findings. We considered commercially available software and research publications which identify at least two CVD markers. In total, we included 29 commercial products and 13 research publications. Two distinct types of commercial support system were available: those which identify acute stroke lesions (haemorrhagic and ischaemic) from computed tomography (CT) scans, mainly for the purpose of patient triage; and those which measure WMH and atrophy regionally and longitudinally. In research, WMH and ISL were the markers most frequently analysed together, from magnetic resonance imaging (MRI) scans; lacunes and PVS were each targeted only twice and CMB only once. For stroke, commercially available systems largely support the emergency setting, whilst research systems consider also follow-up and routine scans. The systems to quantify WMH and atrophy are focused on neurodegenerative disease support, where these CVD markers are also of significance. There are currently no openly validated systems, commercially, or in research, performing a comprehensive joint analysis of all CVD markers (WMH, ISL, lacunes, PVS, haemorrhagic lesions, CMB, and atrophy).
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