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Computed Tomography Perfusion–Based Machine Learning Model Better Predicts Follow-Up Infarction in Patients With Acute Ischemic Stroke

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.

For re-use rights please refer to the publisher's terms and conditions.


© 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.

Publication metadata

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


DOI: 10.1161/STROKEAHA.120.030092

PubMed id: 33280549


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