Deep-Learning-Based Thrombus Localization and Segmentation in Patients with Posterior Circulation Stroke

Diagnostics, vol. 12, pp. 1400

Abstract

Thrombus volume in posterior circulation stroke (PCS) has been associated with outcome, through recanalization. Manual thrombus segmentation is impractical for large scale analysis of image characteristics. Hence, in this study we develop the first automatic method for thrombus localization and segmentation on CT in patients with PCS. In this multi-center retrospective study, 187 patients with PCS from the MR CLEAN Registry were included. We developed a convolutional neural network (CNN) that segments thrombi and restricts the volume-of-interest (VOI) to the brainstem (Polar-UNet). Furthermore, we reduced false positive localization by removing small-volume objects, referred to as volume-based removal (VBR). Polar-UNet is benchmarked against a CNN that does not restrict the VOI (BL-UNet). Performance metrics included the intra-class correlation coefficient (ICC) between automated and manually segmented thrombus volumes, the thrombus localization precision and recall, and the Dice coefficient. The majority of the thrombi were localized. Without VBR, Polar-UNet achieved a thrombus localization recall of 0.82, versus 0.78 achieved by BL-UNet. This high recall was accompanied by a low precision of 0.14 and 0.09. VBR improved precision to 0.65 and 0.56 for Polar-UNet and BL-UNet, respectively, with a small reduction in recall to 0.75 and 0.69. The Dice coefficient achieved by Polar-UNet was 0.44, versus 0.38 achieved by BL-UNet with VBR. Both methods achieved ICCs of 0.41 (95% CI: 0.27-0.54). Restricting the VOI to the brainstem improved the thrombus localization precision, recall, and segmentation overlap compared to the benchmark. VBR improved thrombus localization precision but lowered recall.

Authors 20

1. Riaan Zoetmulder corresponding

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

   Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

   Informatics Institute, University of Amsterdam, 1012 WX Amsterdam, The Netherlands

2. Agnetha A.E. Bruggeman

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

3. Ivana Išgum

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

   Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

   Informatics Institute, University of Amsterdam, 1012 WX Amsterdam, The Netherlands

4. Efstratios Gavves

   University of Amsterdam

   Affiliation as printed

   Informatics Institute, University of Amsterdam, 1012 WX Amsterdam, The Netherlands

5. Charles B.L.M. Majoie

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

6. Ludo F.M. Beenen

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

7. Diederik W.J. Dippel

   Erasmus MC

   Affiliation as printed

   Department of Neurology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands

8. Nikki Boodt

   Erasmus MC

   Affiliation as printed

   Department of Neurology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands

   Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands

   Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands

9. Sanne J. den Hartog

   Erasmus MC

   Affiliation as printed

   Department of Neurology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands

   Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands

   Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands

10. Pieter‐Jan van Doormaal

    Erasmus MC

    Affiliation as printed

    Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands

11. Sandra Adriana Cornelissen

    Erasmus MC

    Affiliation as printed

    Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands

12. Yvo B.W.E.M. Roos

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

    Affiliation as printed

    Department of Neurology, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

13. Josje Brouwer

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

    Affiliation as printed

    Department of Neurology, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

14. Wouter J. Schonewille

    St. Antonius Ziekenhuis

    Affiliation as printed

    St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands

15. F.A.V. Pirson

    Maastricht University Medical Centre · Maastricht University

    Affiliation as printed

    Department of Neurology, Maastricht University Medical Center, School for Cardiovascular Diseases (CARIM), 6229 ER Maastricht, The Netherlands

16. Wim H. van Zwam

    Maastricht University Medical Centre · Maastricht University

    Affiliation as printed

    Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, School for Cardiovascular Diseases (CARIM), 6229 ER Maastricht, The Netherlands

17. Christiaan van der Leij

    Maastricht University Medical Centre · Maastricht University

    Affiliation as printed

    Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, School for Cardiovascular Diseases (CARIM), 6229 ER Maastricht, The Netherlands

18. Rutger Brans

    Maastricht University Medical Centre · Maastricht University

    Affiliation as printed

    Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, School for Cardiovascular Diseases (CARIM), 6229 ER Maastricht, The Netherlands

19. Adriaan C.G.M. van Es Aachen Department of Radiology and Nuclear Medicine

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiology and Nuclear Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

20. Henk A. Marquering

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

    Affiliation as printed

    Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands

    Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands