用临床知识优化CT图像预处理,提升低资源环境下的脑梗塞分割准确率。
Clinically-Informed Preprocessing Improves Stroke Segmentation in Low-Resource Settings
- 基于入院CT图像,结合临床先验知识设计预处理流程
- 相较基线模型,骰子系数提升38%(10折平均)
- 通过血管结构提取进一步提升21%,适合医疗影像算法研发者
中风是全球三大致死病因之一,准确识别缺血性中风病灶边界对诊断与治疗至关重要。主要影像手段包括磁共振成像(MRI),特别是弥散加权成像(DWI),以及基于计算机断层扫描(CT)的技术,如非增强CT(NCCT)、对比增强CT血管造影(CTA)和CT灌注(CTP)。DWI虽为病灶识别的金标准,但在低资源环境中因成本过高难以普及。而基于CT的成像在低资源环境中更具可行性,但特异性不及MRI。监督深度学习方法是自动化缺血性中风病灶分割的主流方案,可通过融合来自DWI的先验信息,提升从CT图像中分割病灶的质量。本文构建一系列模型,以入院时的CT图像为输入,预测2-9天后由DWI标注的随访病灶体积。此外,引入临床启发式预处理步骤,结果显示,相比使用基础预处理训练的nnU-Net模型,该流程在10折交叉验证下骰子系数提升38%。进一步地,通过对CTA图谱进行血管分割提取,使最佳模型在5折交叉验证下再提升21%。
原文摘要 · Abstract (English)
Stroke is among the top three causes of death worldwide, and accurate identification of ischemic stroke lesion boundaries from imaging is critical for diagnosis and treatment. The main imaging modalities used include magnetic resonance imaging (MRI), particularly diffusion weighted imaging (DWI), and computed tomography (CT)-based techniques such as non-contrast CT (NCCT), contrast-enhanced CT angiography (CTA), and CT perfusion (CTP). DWI is the gold standard for the identification of lesions but has limited applicability in low-resource settings due to prohibitive costs. CT-based imaging is currently the most practical imaging method in low-resource settings due to low costs and simplified logistics, but lacks the high specificity of MRI-based methods in monitoring ischemic insults. Supervised deep learning methods are the leading solution for automated ischemic stroke lesion segmentation and provide an opportunity to improve diagnostic quality in low-resource settings by incorporating insights from DWI when segmenting from CT. Here, we develop a series of models which use CT images taken upon arrival as inputs to predict follow-up lesion volumes annotated from DWI taken 2-9 days later. Furthermore, we implement clinically motivated preprocessing steps and show that the proposed pipeline results in a 38% improvement in Dice score over 10 folds compared to a nnU-Net model trained with the baseline preprocessing. Finally, we demonstrate that through additional preprocessing of CTA maps to extract vessel segmentations, we further improve our best model by 21% over 5 folds.
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