A deep learning approach for quantifying CT perfusion parameters in stroke

Objective. Computed tomography perfusion (CTP) imaging is widely used for assessing acute ischemic stroke. However, conventional methods for quantifying CTP images, such as singular value decomposition (SVD), often lead to oscillations in the estimated residue function and underestimation of tissue perfusion. In addition, the use of global arterial input function (AIF) potentially leads to erroneous parameter estimates. We aim to develop a method for accurately estimating physiological parameters from CTP images.Approach. We introduced a Transformer-based network to learn voxel-wise temporal features of CTP images. With global AIF and concentration time curve (CTC) of brain tissue as inputs, the network estimated local AIF and flow-scaled residue function. The derived parameters, including cerebral blood flow (CBF) and bolus arrival delay (BAD), were validated on both simulated and patient data (ISLES18 dataset), and were compared with multiple SVD-based methods, including standard SVD (sSVD), block-circulant SVD (cSVD) and oscillation-index SVD (oSVD).Main results.On data simulating multiple scenarios, local AIF estimated by the proposed method correlated with true AIF with a coefficient of 0.97 ± 0.04 (P < 0.001), estimated CBF with a mean error of 4.95 ml/100 g min^-1, and estimated BAD with a mean error of 0.51 s; the latter two errors were significantly lower than those of the SVD-based methods (P < 0.001). The CBF estimated by the SVD-based methods were underestimated by 10% ∼ 15%. For patient data, the CBF estimates of the proposed method were significantly higher than those of the sSVD method in both normally perfused and ischemic tissues, by 13.83 ml/100 g min^-1or 39.33% and 8.55 ml/100 g min^-1or 57.73% (P < 0.001), respectively, which was in agreement with the simulation results.Significance. The proposed method is capable of estimating local AIF and perfusion parameters from CTP images with high accuracy, potentially improving CTP's performance and efficiency in diagnosing and treating ischemic stroke.