Robust Quantification of Affected Brain Volume from Computed Tomography Perfusion: A Hybrid Approach Combining Deep...

Volumetric estimation of affected brain volumes using computed tomography perfusion (CTP) is crucial in the management of acute ischemic stroke (AIS) and relies on commercial software, which has limitations such as variations in results due to image quality. To predict affected brain volume accurately and robustly, we propose a hybrid approach that integrates singular value decomposition (SVD), deep learning (DL), and machine learning (ML) techniques. We included 449 CTP images of patients with AIS with manually annotated vessel landmarks provided by expert radiologists, collected between 2021 and 2023. We developed a CNN-based approach for predicting eight vascular landmarks from CTP images, integrating ML components. We then used SVD-related methods to generate perfusion maps and compared the results with those of the RapidAI software (RapidAI, Menlo Park, California). The proposed CNN model achieved an average Euclidean distance error of 4.63 $\pm$ 2.00 mm on the vessel localization. Without the ML components, compared to RapidAI, our method yielded concordance correlation coefficient (CCC) scores of 0.898 for estimating volumes with cerebral blood flow (CBF) < 30% and 0.715 for Tmax > 6 s. Using the ML method, it achieved CCC scores of 0.905 for CBF < 30% and 0.879 for Tmax > 6 s. For the data assessment, it achieved 0.8 accuracy. We developed a robust hybrid model combining DL and ML techniques for volumetric estimation of affected brain volumes using CTP in patients with AIS, demonstrating improved accuracy and robustness compared to existing commercial solutions.