通过双时间点分析,揭示脑卒中组织演化的影像特征差异。
Beyond Core and Penumbra: Bi-Temporal Image-Driven Stroke Evolution Analysis
- 结合CTP与DWI,从双时间点提取统计、纹理和深度特征。
- 缺血半暗带区域特征随结局不同显著分化,核心区则无明显差异。
- mJ-Net深度特征能有效区分可挽救与不可挽救组织,适合临床预后研究。
入院时的计算机断层扫描灌注成像(CTP)常用于评估缺血核心与半暗带,而随访的弥散加权MRI(DWI)则提供最终梗死结果。然而单时间点分割无法捕捉卒中生物异质性与动态演变。本文提出一种双时间点分析框架,利用统计描述符、放射组学纹理特征及两种架构(mJ-Net与nnU-Net)的深度特征表征缺血组织。双时间点指入院(T1)与治疗后随访(T2)。所有特征在T1从CTP提取,随访DWI经配准确保空间对应。人工勾画的T1与T2掩膜相交生成六个兴趣区域(ROIs),编码初始状态与最终结局。各区域特征聚合后在特征空间分析。18例成功再灌注患者评估显示,区域级表征具有有意义聚类:入院为半暗带或正常组织但最终恢复的区域,其特征与保留脑组织相似;梗死边界区域形成独立聚类。基线灰度共生矩阵(GLCM)与深度嵌入均显示:半暗带特征依最终结局显著差异,而核心区无显著差异。尤其mJ-Net深度特征空间在可挽救与不可挽救组织间呈现强分离,半暗带分离指数显著异于零(Wilcoxon符号秩检验)。结果表明,编码器生成的特征流形反映潜在组织表型与状态转换,为基于影像的卒中演化量化提供新思路。
原文摘要 · Abstract (English)
Computed tomography perfusion (CTP) at admission is routinely used to estimate the ischemic core and penumbra, while follow-up diffusion-weighted MRI (DWI) provides the definitive infarct outcome. However, single time-point segmentations fail to capture the biological heterogeneity and temporal evolution of stroke. We propose a bi-temporal analysis framework that characterizes ischemic tissue using statistical descriptors, radiomic texture features, and deep feature embeddings from two architectures (mJ-Net and nnU-Net). Bi-temporal refers to admission (T1) and post-treatment follow-up (T2). All features are extracted at T1 from CTP, with follow-up DWI aligned to ensure spatial correspondence. Manually delineated masks at T1 and T2 are intersected to construct six regions of interest (ROIs) encoding both initial tissue state and final outcome. Features were aggregated per region and analyzed in feature space. Evaluation on 18 patients with successful reperfusion demonstrated meaningful clustering of region-level representations. Regions classified as penumbra or healthy at T1 that ultimately recovered exhibited feature similarity to preserved brain tissue, whereas infarct-bound regions formed distinct groupings. Both baseline GLCM and deep embeddings showed a similar trend: penumbra regions exhibit features that are significantly different depending on final state, whereas this difference is not significant for core regions. Deep feature spaces, particularly mJ-Net, showed strong separation between salvageable and non-salvageable tissue, with a penumbra separation index that differed significantly from zero (Wilcoxon signed-rank test). These findings suggest that encoder-derived feature manifolds reflect underlying tissue phenotypes and state transitions, providing insight into imaging-based quantification of stroke evolution.
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