Skip to main content
Top
Published in: European Radiology 8/2022

18-02-2022 | Intracranial Aneurysm | Vascular-Interventional

Morphology-aware multi-source fusion–based intracranial aneurysms rupture prediction

Authors: Chubin Ou, Caizi Li, Yi Qian, Chuan-Zhi Duan, Weixin Si, Xin Zhang, Xifeng Li, Michael Morgan, Qi Dou, Pheng-Ann Heng

Published in: European Radiology | Issue 8/2022

Login to get access

Abstract

Objectives

We proposed a new approach to train deep learning model for aneurysm rupture prediction which only uses a limited amount of labeled data.

Method

Using segmented aneurysm mask as input, a backbone model was pretrained using a self-supervised method to learn deep embeddings of aneurysm morphology from 947 unlabeled cases of angiographic images. Subsequently, the backbone model was finetuned using 120 labeled cases with known rupture status. Clinical information was integrated with deep embeddings to further improve prediction performance. The proposed model was compared with radiomics and conventional morphology models in prediction performance. An assistive diagnosis system was also developed based on the model and was tested with five neurosurgeons.

Result

Our method achieved an area under the receiver operating characteristic curve (AUC) of 0.823, outperforming deep learning model trained from scratch (0.787). By integrating with clinical information, the proposed model’s performance was further improved to AUC = 0.853, making the results significantly better than model based on radiomics (AUC = 0.805, p = 0.007) or model based on conventional morphology parameters (AUC = 0.766, p = 0.001). Our model also achieved the highest sensitivity, PPV, NPV, and accuracy among the others. Neurosurgeons’ prediction performance was improved from AUC=0.877 to 0.945 (p = 0.037) with the assistive diagnosis system.

Conclusion

Our proposed method could develop competitive deep learning model for rupture prediction using only a limited amount of data. The assistive diagnosis system could be useful for neurosurgeons to predict rupture.

Key Points

A self-supervised learning method was proposed to mitigate the data-hungry issue of deep learning, enabling training deep neural network with a limited amount of data.
Using the proposed method, deep embeddings were extracted to represent intracranial aneurysm morphology. Prediction model based on deep embeddings was significantly better than conventional morphology model and radiomics model.
An assistive diagnosis system was developed using deep embeddings for case-based reasoning, which was shown to significantly improve neurosurgeons’ performance to predict rupture.
Appendix
Available only for authorised users
Literature
16.
go back to reference (2014) Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 13:59–66 (2014) Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 13:59–66
17.
go back to reference Bijlenga P, Gondar R, Schilling S et al (2017) PHASES score for the management of intracranial aneurysm a cross-sectional population-based retrospective study. Stroke. 48:2105–2112 Bijlenga P, Gondar R, Schilling S et al (2017) PHASES score for the management of intracranial aneurysm a cross-sectional population-based retrospective study. Stroke. 48:2105–2112
18.
go back to reference Shi Z, Hu B, Schoepf UJ, et al (2020) Artificial intelligence in the management of intracranial aneurysms: current status and future perspectives. AJNR Am J Neuroradiol 41(3):373–379 Shi Z, Hu B, Schoepf UJ, et al (2020) Artificial intelligence in the management of intracranial aneurysms: current status and future perspectives. AJNR Am J Neuroradiol 41(3):373–379
19.
go back to reference Nakao T, Hanaoka S, Nomura Y et al (2018) Deep neural network-based computer-assisted detection of cerebral aneurysms in MR angiography. J Magn Reson Imaging 47:948–953CrossRef Nakao T, Hanaoka S, Nomura Y et al (2018) Deep neural network-based computer-assisted detection of cerebral aneurysms in MR angiography. J Magn Reson Imaging 47:948–953CrossRef
20.
go back to reference Stember JN, Chang P, Stember DM et al (2019) Convolutional neural networks for the detection and measurement of cerebral aneurysms on magnetic resonance angiography. J Digit Imaging 32:808–815CrossRef Stember JN, Chang P, Stember DM et al (2019) Convolutional neural networks for the detection and measurement of cerebral aneurysms on magnetic resonance angiography. J Digit Imaging 32:808–815CrossRef
21.
go back to reference Sichtermann T, Faron A, Sijben R et al (2019) Deep learning–based detection of intracranial aneurysms in 3D TOF-MRA. AJNR Am J Neuroradiol 40:25–32 Sichtermann T, Faron A, Sijben R et al (2019) Deep learning–based detection of intracranial aneurysms in 3D TOF-MRA. AJNR Am J Neuroradiol 40:25–32
22.
go back to reference Ueda D, Yamamoto A, Nishimori M et al (2019) Deep learning for MR angiography: automated detection of cerebral aneurysms. Radiology 290:187–194CrossRef Ueda D, Yamamoto A, Nishimori M et al (2019) Deep learning for MR angiography: automated detection of cerebral aneurysms. Radiology 290:187–194CrossRef
23.
go back to reference Park A, Chute C, Rajpurkar P et al (2019) Deep learning–assisted diagnosis of cerebral aneurysms using the HeadXNet model. JAMA Netw Open 2:e195600CrossRef Park A, Chute C, Rajpurkar P et al (2019) Deep learning–assisted diagnosis of cerebral aneurysms using the HeadXNet model. JAMA Netw Open 2:e195600CrossRef
24.
go back to reference Shi Z, Miao C, Schoepf UJ et al (2020) A clinically applicable deep-learning model for detecting intracranial aneurysm in computed tomography angiography images. Nat Commun 11(1):1–1 Shi Z, Miao C, Schoepf UJ et al (2020) A clinically applicable deep-learning model for detecting intracranial aneurysm in computed tomography angiography images. Nat Commun 11(1):1–1
25.
go back to reference Yang J, Xie M, Hu C et al (2020) Deep learning for detecting cerebral aneurysms with CT angiography. Radiology. 3:192154 Yang J, Xie M, Hu C et al (2020) Deep learning for detecting cerebral aneurysms with CT angiography. Radiology. 3:192154
26.
go back to reference Dai X, Huang L, Qian Y et al (2020) Deep learning for automated cerebral aneurysm detection on computed tomography images. Int J Comput Assist Radiol Surg 13:1–9 Dai X, Huang L, Qian Y et al (2020) Deep learning for automated cerebral aneurysm detection on computed tomography images. Int J Comput Assist Radiol Surg 13:1–9
27.
go back to reference Hu T, Yang H, Ni W et al (2020 Dec) Automatic detection of intracranial aneurysms in 3D-DSA based on a Bayesian optimized filter. Biomed Eng Online 19(1):1–8 Hu T, Yang H, Ni W et al (2020 Dec) Automatic detection of intracranial aneurysms in 3D-DSA based on a Bayesian optimized filter. Biomed Eng Online 19(1):1–8
28.
go back to reference Liu J, Chen Y, Lan L et al (2018) Prediction of rupture risk in anterior communicating artery aneurysms with a feed-forward artificial neural network. Eur Radiol 28:3268–3275CrossRef Liu J, Chen Y, Lan L et al (2018) Prediction of rupture risk in anterior communicating artery aneurysms with a feed-forward artificial neural network. Eur Radiol 28:3268–3275CrossRef
29.
go back to reference Detmer FJ, Lückehe D, Mut F et al (2019) Comparison of statistical learning approaches for cerebral aneurysm rupture assessment. Int J Comput Assist Radiol Surg 15:141–150CrossRef Detmer FJ, Lückehe D, Mut F et al (2019) Comparison of statistical learning approaches for cerebral aneurysm rupture assessment. Int J Comput Assist Radiol Surg 15:141–150CrossRef
30.
go back to reference Liu Q, Jiang P, Jiang Y et al (2019) Prediction of aneurysm stability using a machine learning model based on PyRadiomics-derived morphological features. Stroke 50:2314–2321CrossRef Liu Q, Jiang P, Jiang Y et al (2019) Prediction of aneurysm stability using a machine learning model based on PyRadiomics-derived morphological features. Stroke 50:2314–2321CrossRef
31.
go back to reference Ou C, Chong W, Duan CZ, Zhang X, Morgan M, Qian Y (2021) A preliminary investigation of radiomics differences between ruptured and unruptured intracranial aneurysms. Eur Radiol 31(5):2716–2725 Ou C, Chong W, Duan CZ, Zhang X, Morgan M, Qian Y (2021) A preliminary investigation of radiomics differences between ruptured and unruptured intracranial aneurysms. Eur Radiol 31(5):2716–2725
32.
go back to reference Silva MA, Patel J, Kavouridis V et al (2019) Machine learning models can detect aneurysm rupture and identify clinical features associated with rupture. World Neurosurg 131:e46–e51CrossRef Silva MA, Patel J, Kavouridis V et al (2019) Machine learning models can detect aneurysm rupture and identify clinical features associated with rupture. World Neurosurg 131:e46–e51CrossRef
33.
go back to reference Kim HC, Rhim JK, Ahn JH et al (2019) Machine learning application for rupture risk assessment in small-sized intracranial aneurysm. J Clin Med 8(5):683 Kim HC, Rhim JK, Ahn JH et al (2019) Machine learning application for rupture risk assessment in small-sized intracranial aneurysm. J Clin Med 8(5):683
34.
go back to reference Ahn JH, Kim HC, Rhim JK et al (2021) Multi-view convolutional neural networks in rupture risk assessment of small, unruptured intracranial aneurysms. J Pers Med 11(4):239 Ahn JH, Kim HC, Rhim JK et al (2021) Multi-view convolutional neural networks in rupture risk assessment of small, unruptured intracranial aneurysms. J Pers Med 11(4):239
35.
go back to reference Heo J, Park SJ, Kang SH, Oh CW, Bang JS, Kim T (2020) Prediction of intracranial aneurysm risk using machine learning. Sci Rep 10(1):6921 1-0 Heo J, Park SJ, Kang SH, Oh CW, Bang JS, Kim T (2020) Prediction of intracranial aneurysm risk using machine learning. Sci Rep 10(1):6921 1-0
36.
go back to reference Skodvin TO, Johnsen LH, Gjertsen O, Isaksen JG, Sorteberg A (2017) Cerebral aneurysm morphology before and after rupture: nationwide case series of 29 aneurysms. Stroke. 48(4):880–886CrossRef Skodvin TO, Johnsen LH, Gjertsen O, Isaksen JG, Sorteberg A (2017) Cerebral aneurysm morphology before and after rupture: nationwide case series of 29 aneurysms. Stroke. 48(4):880–886CrossRef
37.
go back to reference Wiebers DO (2003) International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362(9378):103–110 Wiebers DO (2003) International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362(9378):103–110
38.
go back to reference Japan Investigators UCAS (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366(26):2474–2482 Japan Investigators UCAS (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366(26):2474–2482
39.
go back to reference Ivantsits M, Goubergrits L, Kuhnigk JM et al (2022) Detection and analysis of cerebral aneurysms based on X-ray rotational angiography-the CADA 2020 challenge. Medical Image Analysis 77:102333 Ivantsits M, Goubergrits L, Kuhnigk JM et al (2022) Detection and analysis of cerebral aneurysms based on X-ray rotational angiography-the CADA 2020 challenge. Medical Image Analysis 77:102333
40.
go back to reference Timmins KM, van der Schaaf IC, Bennink E et al (2021) Comparing methods of detecting and segmenting unruptured intracranial aneurysms on TOF-MRAS: The ADAM challenge. NeuroImage 238:118216 Timmins KM, van der Schaaf IC, Bennink E et al (2021) Comparing methods of detecting and segmenting unruptured intracranial aneurysms on TOF-MRAS: The ADAM challenge. NeuroImage 238:118216
42.
go back to reference Demšar J (2006) Statistical comparisons of classifiers over multiple data sets. J Mach Learn Res 7(Jan):1–30 Demšar J (2006) Statistical comparisons of classifiers over multiple data sets. J Mach Learn Res 7(Jan):1–30
43.
go back to reference Xiang J, Yu J, Choi H et al (2015) Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic–morphological discriminants. J Neurointerv Surg 7(7):490–495 Xiang J, Yu J, Choi H et al (2015) Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic–morphological discriminants. J Neurointerv Surg 7(7):490–495
44.
go back to reference Jiang P, Liu Q, Wu J et al (2018) A novel scoring system for rupture risk stratification of intracranial aneurysms: a hemodynamic and morphological study. Front Neurosci 12:596 Jiang P, Liu Q, Wu J et al (2018) A novel scoring system for rupture risk stratification of intracranial aneurysms: a hemodynamic and morphological study. Front Neurosci 12:596
Metadata
Title
Morphology-aware multi-source fusion–based intracranial aneurysms rupture prediction
Authors
Chubin Ou
Caizi Li
Yi Qian
Chuan-Zhi Duan
Weixin Si
Xin Zhang
Xifeng Li
Michael Morgan
Qi Dou
Pheng-Ann Heng
Publication date
18-02-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08608-7

Other articles of this Issue 8/2022

European Radiology 8/2022 Go to the issue