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Lookup NU author(s): Professor Phil White
This is the authors' accepted manuscript of an article that has been published in its final definitive form by Lippincott Williams and Wilkins, 2021.
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© 2021 Lippincott Williams and Wilkins. All rights reserved.Background and Purpose: Prediction of infarct extent among patients with acute ischemic stroke using computed tomography perfusion is defined by predefined discrete computed tomography perfusion thresholds. Our objective is to develop a threshold-free computed tomography perfusion-based machine learning (ML) model to predict follow-up infarct in patients with acute ischemic stroke. Methods: Sixty-eight patients from the PRoveIT study (Measuring Collaterals With Multi-Phase CT Angiography in Patients With Ischemic Stroke) were used to derive a ML model using random forest to predict follow-up infarction voxel by voxel, and 137 patients from the HERMES study (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) were used to test the derived ML model. Average map, Tmax, cerebral blood flow, cerebral blood volume, and time variables including stroke onset-to-imaging and imaging-to-reperfusion time, were used as features to train the ML model. Spatial and volumetric agreement between the ML model predicted follow-up infarct and actual follow-up infarct were assessed. Relative cerebral blood flow <0.3 threshold using RAPID software and time-dependent Tmaxthresholds were compared with the ML model. Results: In the test cohort (137 patients), median follow-up infarct volume predicted by the ML model was 30.9 mL (interquartile range, 16.4-54.3 mL), compared with a median 29.6 mL (interquartile range, 11.1-70.9 mL) of actual follow-up infarct volume. The Pearson correlation coefficient between 2 measurements was 0.80 (95% CI, 0.74-0.86, P<0.001) while the volumetric difference was -3.2 mL (interquartile range, -16.7 to 6.1 mL). Volumetric difference with the ML model was smaller versus the relative cerebral blood flow <0.3 threshold and the time-dependent Tmaxthreshold (P<0.001). Conclusions: A ML using computed tomography perfusion data and time estimates follow-up infarction in patients with acute ischemic stroke better than current methods.
Author(s): Kuang H, Qiu W, Boers AM, Brown S, Muir K, Majoie CBLM, Dippel DWJ, White P, Epstein J, Mitchell PJ, Davalos A, Bracard S, Campbell B, Saver JL, Jovin TG, Rubiera M, Khaw AV, Shankar JJ, Fainardi E, Hill MD, Demchuk AM, Goyal M, Menon BK
Publication type: Article
Publication status: Published
Journal: Stroke
Year: 2021
Volume: 52
Issue: 1
Pages: 223-231
Print publication date: 01/01/2021
Online publication date: 07/12/2020
Acceptance date: 08/10/2020
Date deposited: 07/05/2021
ISSN (print): 0039-2499
ISSN (electronic): 1524-4628
Publisher: Lippincott Williams and Wilkins
URL: https://doi.org/10.1161/STROKEAHA.120.030092
DOI: 10.1161/STROKEAHA.120.030092
PubMed id: 33280549
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