Automatic segmentation of cerebral infarcts in follow-up computed tomography images with convolutional neural networks

Background and purpose: Infarct volume is a valuable outcome measure in treatment trials of acute ischemic stroke and is strongly associated with functional outcome. Its manual volumetric assessment is, however, too demanding to be implemented in clinical practice. Objective: To assess the value of convolutional neural networks (CNNs) in the automatic segmentation of infarct volume in follow-up CT images in a large population of patients with acute ischemic stroke. Materials and methods: We included CT images of 1026 patients from a large pooling of patients with acute ischemic stroke. A reference standard for the infarct segmentation was generated by manual delineation. We introduce three CNN models for the segmentati

Automatic segmentation of cerebral infarcts in follow-up computed tomography images with convolutional neural networks

Background and purpose: Infarct volume is a valuable outcome measure in treatment trials of acute ischemic stroke and is strongly associated with functional outcome. Its manual volumetric assessment is, however, too demanding to be implemented in clinical practice. Objective: To assess the value of convolutional neural networks (CNNs) in the automatic segmentation of infarct volume in follow-up CT images in a large population of patients with acute ischemic stroke. Materials and methods: We included CT images of 1026 patients from a large pooling of patients with acute ischemic stroke. A reference standard for the infarct segmentation was generated by manual delineation. We introduce three CNN models for the segmentation of subtle, intermediate, and severe hypodense lesions. The fully automated infarct segmentation was defined as the combination of the results of these three CNNs. The results of the three-CNNs approach were compared with the results from a single CNN approach and with the reference standard segmentations. Results: The median infarct volume was 48 mL (IQR 15–125 mL). Comparison between the volumes of the three-CNNs approach and manually delineated infarct volumes showed excellent agreement, with an intraclass correlation coefficient (ICC) of 0.88. Even better agreement was found for severe and intermediate hypodense infarcts, with ICCs of 0.98 and 0.93, respectively. Although the number of patients used for training in the single CNN approach was much larger, the accuracy of the three-CNNs approach strongly outperformed the single CNN approach, which had an ICC of 0.34. Conclusion: Convolutional neural networks are valuable and accurate in the quantitative assessment of infarct volumes, for both subtle and severe hypodense infarcts in follow-up CT images. Our proposed three-CNNs approach strongly outperforms a more straightforward single CNN approach

Need for speed:Achieving fast image processing in acute stroke care

This thesis aims to investigate the use of high-performance computing (HPC) techniques in developing imaging biomarkers to support the clinical workflow of acute stroke patients. In the first part of this thesis, we evaluate different HPC technologies and how such technologies can be leveraged by different image analysis applications used in the context of acute stroke care. More specifically, we evaluated how computers with multiple computing devices can be used to accelerate medical imaging applications in Chapter 2. Chapter 3 proposes a novel data compression technique that efficiently processes CT perfusion (CTP) images in GPUs. Unfortunately, the size of CTP datasets makes data transfers to computing devices time-consuming and, therefore, unsuitable in acute situations. Chapter 4 further evaluates the algorithm's usefulness proposed in Chapter 3 with two different applications: a double threshold segmentation and a time-intensity profile similarity (TIPS) bilateral filter to reduce noise in CTP scans. Finally, Chapter 5 presents a cloud platform for deploying high-performance medical applications for acute stroke patients. In Part 2 of this thesis, Chapter 6 presents a convolutional neural network (CNN) for detecting and volumetric segmentation of subarachnoid hemorrhages (SAH) in non-contrast CT scans. Chapter 7 proposed another method based on CNNs to quantify the final infarct volumes in follow-up non-contrast CT scans from ischemic stroke patients