Computed tomography angiography-based deep learning method for treatment selection and infarct volume prediction in anterior cerebral circulation large vessel occlusion.

Background: Computed tomography perfusion (CTP) is the mainstay to determine possible eligibility for endovascular thrombectomy (EVT), but there is still a need for alternative methods in patient triage.

Purpose: To study the ability of a computed tomography angiography (CTA)-based convolutional neural network (CNN) method in predicting final infarct volume in patients with large vessel occlusion successfully treated with endovascular therapy.

Materials and methods: The accuracy of the CTA source image-based CNN in final infarct volume prediction was evaluated against follow-up CT or MR imaging in 89 patients with anterior circulation ischemic stroke successfully treated with EVT as defined by Thrombolysis in Cerebral Infarction category 2b or 3 using Pearson correlation coefficients and intraclass correlation coefficients. Convolutional neural network performance was also compared to a commercially available CTP-based software (RAPID, iSchemaView).

Results: A correlation with final infarct volumes was found for both CNN and CTP-RAPID in patients presenting 6-24 h from symptom onset or last known well, with r = 0.67 (p < 0.001) and r = 0.82 (p < 0.001), respectively. Correlations with final infarct volumes in the early time window (0-6 h) were r = 0.43 (p = 0.002) for the CNN and r = 0.58 (p < 0.001) for CTP-RAPID. Compared to CTP-RAPID predictions, CNN estimated eligibility for thrombectomy according to ischemic core size in the late time window with a sensitivity of 0.38 and specificity of 0.89.

Conclusion: A CTA-based CNN method had moderate correlation with final infarct volumes in the late time window in patients successfully treated with EVT.