title: Fully automated stroke tissue estimation using random forest classifiers (FASTER).
abstract: Several clinical trials have recently proven the efficacy of mechanical thrombectomy for treating ischemic stroke, within a six-hour window for therapy. To move beyond treatment windows and toward personalized risk assessment, it is essential to accurately identify the extent of tissue-at-risk ("penumbra"). We introduce a fully automated method to estimate the penumbra volume using multimodal MRI (diffusion-weighted imaging, a T2w- and T1w contrast-enhanced sequence, and dynamic susceptibility contrast perfusion MRI). The method estimates tissue-at-risk by predicting tissue damage in the case of both persistent occlusion and of complete recanalization. When applied to 19 test cases with a thrombolysis in cerebral infarction grading of 1-2a, mean overestimation of final lesion volume was 30 ml, compared with 121 ml for manually corrected thresholding. Predicted tissue-at-risk volume was positively correlated with final lesion volume ( p < 0.05). We conclude that prediction of tissue damage in the event of either persistent occlusion or immediate and complete recanalization, from spatial features derived from MRI, provides a substantial improvement beyond predefined thresholds. It may serve as an alternative method for identifying tissue-at-risk that may aid in treatment selection in ischemic stroke.
authors: 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors: Richard
authors: R
authors: McKinley
authors: 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors: Levin
authors: L
authors: Häni
authors: 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors: Jan
authors: J
authors: Gralla
authors: 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors: M
authors: M
authors: El-Koussy
authors: 2 Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland.
authors: S
authors: S
authors: Bauer
authors: 3 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
authors: M
authors: M
authors: Arnold
authors: 3 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
authors: U
authors: U
authors: Fischer
authors: 3 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
authors: S
authors: S
authors: Jung
authors: 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors: Kaspar
authors: K
authors: Mattmann
authors: 2 Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland.
authors: Mauricio
authors: M
authors: Reyes
authors: 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors: Roland
authors: R
authors: Wiest
mesh_terms: D000465:Algorithms; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D002548:Cerebral Revascularization; D003287:Contrast Media; D016208:Databases, Factual; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D057510:Endovascular Procedures; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008962:Models, Theoretical; D010363:Pattern Recognition, Automated / Q000379:methods*; D010477:Perfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy
chemical_list: D003287:Contrast Media
keywords: Acute stroke; endovascular therapy; magnetic resonance diffusion imaging; magnetic resonance perfusion; mathematical modeling