用深度学习融合影像与临床数据,预测大血管闭塞性卒中患者预后和个体治疗效果。
Outcome prediction and individualized treatment effect estimation in patients with large vessel occlusion stroke
- 结合临床数据与CT影像,构建可解释的深度学习模型。
- 临床变量预测功能结局的AUC达0.719,加CTA后提升至0.737。
- 模型能估计个体治疗效应,但区分能力仍有待提升。
机械取栓已成为大血管闭塞性卒中(LVO)患者的常规治疗手段,但仅50%成功治疗患者获得良好预后。本研究基于449例随机对照试验患者的资料,开发并评估了可解释的深度学习模型,用于预测改良Rankin量表评分(mRS)及个体化治疗效应(ITE)。除临床变量外,还引入非增强CT(NCCT)与血管造影(CTA)扫描,并通过新型基础模型整合影像信息。临床变量对二分类功能结局预测具有良好性能(AUC 0.719 [0.666, 0.774]),加入CTA后略有提升(AUC 0.737 [0.687, 0.795]),而加入NCCT或联合影像未带来改善。预发病残是最重要的临床预测因子。所有模型中,估计的ITE与平均治疗效应校准良好,但判别能力有限(C-for-Benefit约0.55)。综上,模型成功整合了影像与临床特征,在预测性能与ITE估计方面达到当前最优水平,但需进一步改进ITE估计。
原文摘要 · Abstract (English)
Mechanical thrombectomy has become the standard of care in patients with stroke due to large vessel occlusion (LVO). However, only 50% of successfully treated patients show a favorable outcome. We developed and evaluated interpretable deep learning models to predict functional outcomes in terms of the modified Rankin Scale score alongside individualized treatment effects (ITEs) using data of 449 LVO stroke patients from a randomized clinical trial. Besides clinical variables, we considered non-contrast CT (NCCT) and angiography (CTA) scans which were integrated using novel foundation models to make use of advanced imaging information. Clinical variables had a good predictive power for binary functional outcome prediction (AUC of 0.719 [0.666, 0.774]) which could slightly be improved when adding CTA imaging (AUC of 0.737 [0.687, 0.795]). Adding NCCT scans or a combination of NCCT and CTA scans to clinical features yielded no improvement. The most important clinical predictor for functional outcome was pre-stroke disability. While estimated ITEs were well calibrated to the average treatment effect, discriminatory ability was limited indicated by a C-for-Benefit statistic of around 0.55 in all models. In summary, the models allowed us to jointly integrate CT imaging and clinical features while achieving state-of-the-art prediction performance and ITE estimates. Yet, further research is needed to particularly improve ITE estimation.
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