Building Brains: Subvolume Recombination for Data Augmentation in Large Vessel Occlusion Detection

Ischemic strokes are often caused by large vessel occlusions (LVOs), which can be visualized and diagnosed with Computed Tomography Angiography scans. As time is brain, a fast, accurate and automated diagnosis of these scans is desirable. Human readers compare the left and right hemispheres in their assessment of strokes. A large training data set is required for a standard deep learning-based model to learn this strategy from data. As labeled medical data in this field is rare, other approaches need to be developed. To both include the prior knowledge of side comparison and increase the amount of training data, we propose an augmentation method that generates artificial training samples by recombining vessel tree segmentations of the hemispheres or hemisphere subregions from different patients. The subregions cover vessels commonly affected by LVOs, namely the internal carotid artery (ICA) and middle cerebral artery (MCA). In line with the augmentation scheme, we use a 3D-DenseNet fed with task-specific input, fostering a side-by-side comparison between the hemispheres. Furthermore, we propose an extension of that architecture to process the individual hemisphere subregions. All configurations predict the presence of an LVO, its side, and the affected subregion. We show the effect of recombination as an augmentation strategy in a 5-fold cross validated ablation study. We enhanced the AUC for patient-wise classification regarding the presence of an LVO of all investigated architectures. For one variant, the proposed method improved the AUC from 0.73 without augmentation to 0.89. The best configuration detects LVOs with an AUC of 0.91, LVOs in the ICA with an AUC of 0.96, and in the MCA with 0.91 while accurately predicting the affected side.

An Algorithm for the Labeling and Interactive Visualization of the Cerebrovascular System of Ischemic Strokes

During the diagnosis of ischemic strokes, the Circle of Willis and its surrounding vessels are the arteries of interest. Their visualization in case of an acute stroke is often enabled by Computed Tomography Angiography (CTA). Still, the identification and analysis of the cerebral arteries remain time consuming in such scans due to a large number of peripheral vessels which may disturb the visual impression. In previous work we proposed VirtualDSA++, an algorithm designed to segment and label the cerebrovascular tree on CTA scans. Especially with stroke patients, labeling is a delicate procedure, as in the worst case whole hemispheres may not be present due to impeded perfusion. Hence, we extended the labeling mechanism for the cerebral arteries to identify occluded vessels. In the work at hand, we place the algorithm in a clinical context by evaluating the labeling and occlusion detection on stroke patients, where we have achieved labeling sensitivities comparable to other works between 92\,\% and 95\,\%. To the best of our knowledge, ours is the first work to address labeling and occlusion detection at once, whereby a sensitivity of 67\,\% and a specificity of 81\,\% were obtained for the latter. VirtualDSA++ also automatically segments and models the intracranial system, which we further used in a deep learning driven follow up work. We present the generic concept of iterative systematic search for pathways on all nodes of said model, which enables new interactive features. Exemplary, we derive in detail, firstly, the interactive planning of vascular interventions like the mechanical thrombectomy and secondly, the interactive suppression of vessel structures that are not of interest in diagnosing strokes (like veins). We discuss both features as well as further possibilities emerging from the proposed concept.

Detection of Large Vessel Occlusions using Deep Learning by Deforming Vessel Tree Segmentations

Computed Tomography Angiography is a key modality providing insights into the cerebrovascular vessel tree that are crucial for the diagnosis and treatment of ischemic strokes, in particular in cases of large vessel occlusions (LVO). Thus, the clinical workflow greatly benefits from an automated detection of patients suffering from LVOs. This work uses convolutional neural networks for case-level classification trained with elastic deformation of the vessel tree segmentation masks to artificially augment training data. Using only masks as the input to our model uniquely allows us to apply such deformations much more aggressively than one could with conventional image volumes while retaining sample realism. The neural network classifies the presence of an LVO and the affected hemisphere. In a 5-fold cross validated ablation study, we demonstrate that the use of the suggested augmentation enables us to train robust models even from few data sets. Training the EfficientNetB1 architecture on 100 data sets, the proposed augmentation scheme was able to raise the ROC AUC to 0.85 from a baseline value of 0.56 using no augmentation. The best performance was achieved using a 3D-DenseNet yielding an AUC of 0.87. The augmentation had positive impact in classification of the affected hemisphere as well, where the 3D-DenseNet reached an AUC of 0.93 on both sides.