Abstract P319: Can Deep Learning Find the Ischemic Core on CT? Transfer Learning From Pre-Trained MRI-Based Networks

Abstract

Objective: Ischemic core prediction from CT perfusion (CTP) remains inaccurate compared with gold standard diffusion-weighted imaging (DWI). We evaluated if a deep learning model to predict the DWI lesion from MR perfusion (MRP) could facilitate ischemic core prediction on CTP. Method: Using the multi-center CRISP cohort of acute ischemic stroke patient with CTP before thrombectomy, we included patients with major reperfusion (TICI score≥2b), adequate image quality, and follow-up MRI at 3-7 days. Perfusion parameters including Tmax, mean transient time, cerebral blood flow (CBF), and cerebral blood volume were reconstructed by RAPID software. Core lab experts outlined the stroke lesion on the follow-up MRI. A previously trained MRI model in a separate group of patients was used as a starting point, which used MRP parameters as input and RAPID ischemic core on DWI as ground truth. We fine-tuned this model, using CTP parameters as input, and follow-up MRI as ground truth. Another model was also trained from scratch with only CTP data. 5-fold cross validation was used. Performance of the models was compared with ischemic core (rCBF≤30%) from RAPID software to identify the presence of a large infarct (volume>70 or >100ml). Results: 94 patients in the CRISP trial met the inclusion criteria (mean age 67±15 years, 52% male, median baseline NIHSS 18, median 90-day mRS 2). Without fine-tuning, the MRI model had an agreement of 73% in infarct >70ml, and 69% in >100ml; the MRI model fine-tuned on CT improved the agreement to 77% and 73%; The CT model trained from scratch had agreements of 73% and 71%; All of the deep learning models outperformed the rCBF segmentation from RAPID, which had agreements of 51% and 64%. See Table and figure. Conclusions: It is feasible to apply MRP-based deep learning model to CT. Fine-tuning with CTP data further improves the predictions. All deep learning models predict the stroke lesion after major recanalization better than thresholding approaches based on rCBF.