Non-inferiority of Deep Learning Model to Segment Acute Stroke on Non-contrast CT Compared to Neuroradiologists

Purpose: To develop a deep learning model to segment the acute ischemic infarct on non-contrast Computed Tomography (NCCT). Materials and Methods In this retrospective study, 227 Head NCCT examinations from 200 patients enrolled in the multicenter DEFUSE 3 trial were included. Three experienced neuroradiologists (experts A, B and C) independently segmented the acute infarct on each study. The dataset was randomly split into 5 folds with training and validation cases. A 3D deep Convolutional Neural Network (CNN) architecture was optimized for the data set properties and task needs. The input to the model was the NCCT and the output was a segmentation mask. The model was trained and optimized on expert A. The outcome was assessed by a set of volume, overlap and distance metrics. The predicted segmentations of the best model and expert A were compared to experts B and C. Then we used a paired Wilcoxon signed-rank test in a one-sided test procedure for all metrics to test for non-inferiority in terms of bias and precision. Results: The best performing model reached a Surface Dice at Tolerance (SDT)5mm of 0.68 \pm 0.04. The predictions were non-inferior when compared to independent experts in terms of bias and precision (paired one-sided test procedure for differences in medians and bootstrapped standard deviations with non-inferior boundaries of -0.05, 2ml, and 2mm, p < 0.05, n=200). Conclusion: For the segmentation of acute ischemic stroke on NCCT, our 3D CNN trained with the annotations of one neuroradiologist is non-inferior when compared to two independent neuroradiologists.

Evaluation of Medical Image Segmentation Models for Uncertain, Small or Empty Reference Annotations

Performance metrics for medical image segmentation models are used to measure agreement between the reference annotation and the prediction. A common set of metrics is used in the development of such models to make results more comparable. However, there is a mismatch between the distributions in public data sets and cases encountered in clinical practice. Many common metrics fail to measure the impact of this mismatch, especially for clinical data sets containing uncertain, small or empty reference annotation. Thus, models may not be validated for clinically meaningful agreement by such metrics. Dimensions of evaluating clinical value include independence from reference annotation volume size, consideration of uncertainty of reference annotations, reward of volumetric and/or location agreement and reward of correct classification of empty reference annotations. Unlike common public data sets, our in-house data set is more representative. It contains uncertain, small or empty reference annotations. We examine publicly available metrics on the predictions of a deep learning framework in order to identify for which settings common metrics provide clinical meaningful results. We compare to a public benchmark data set without uncertain, small or empty reference annotations. https://github.com/SophieOstmeier/UncertainSmallEmpty

Isometric force pillow: using air pressure to quantify involuntary finger flexion in the presence of hypertonia

Survivors of central nervous system injury commonly present with spastic hypertonia. The affected muscles are hyperexcitable and can display involuntary static muscle tone and an exaggerated stretch reflex. These symptoms affect posture and disrupt activities of daily living. Symptoms are typically measured using subjective manual tests such as the Modified Ashworth Scale; however, more quantitative measures are necessary to evaluate potential treatments. The hands are one of the most common targets for intervention, but few investigators attempt to quantify symptoms of spastic hypertonia affecting the fingers. We present the isometric force pillow (IFP) to quantify involuntary grip force. This lightweight, computerized tool provides a holistic measure of finger flexion force and can be used in various orientations for clinical testing and to measure the impact of assistive devices.