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International Journal of Computer Assisted Radiology and Surgery
Published in: International Journal of Computer Assisted Radiology and Surgery 9/2020

01-09-2020 | Stroke | Original Article

Automatic collateral circulation scoring in ischemic stroke using 4D CT angiography with low-rank and sparse matrix decomposition

Authors: Mumu Aktar, Donatella Tampieri, Hassan Rivaz, Marta Kersten-Oertel, Yiming Xiao

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 9/2020

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Abstract

Purpose

Sufficient collateral blood supply is crucial for favorable outcomes with endovascular treatment. The current practice of collateral scoring relies on visual inspection and thus can suffer from inter and intra-rater inconsistency. We present a robust and automatic method to score cerebral collateral blood supply to aid ischemic stroke treatment decision making. The developed method is based on 4D dynamic CT angiography (CTA) and the ASPECTS scoring protocol.

Methods

The proposed method, ACCESS (Automatic Collateral Circulation Evaluation in iSchemic Stroke), estimates a target patient’s unfilled cerebrovasculature in contrast-enhanced CTA using the lack of contrast agent due to clotting. To do so, the fast robust matrix completion algorithm with in-face extended Frank–Wolfe optimization is applied on a cohort of healthy subjects and a target patient, to model the patient’s unfilled vessels and the estimated full vasculature as sparse and low-rank components, respectively. The collateral score is computed as the ratio of the unfilled vessels to the full vasculature, mimicking existing clinical protocols.

Results

ACCESS was tested with 46 stroke patients and obtained an overall accuracy of 84.78%. The optimal threshold selection was evaluated using a receiver operating characteristics curve with the leave-one-out approach, and a mean area under the curve of 85.39% was obtained.

Conclusion

ACCESS automates collateral scoring to mitigate the shortcomings of the standard clinical practice. It is a robust approach, which resembles how radiologists score clinical scans, and can be used to help radiologists in clinical decisions of stroke treatment.
Footnotes
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Metadata
Title
Automatic collateral circulation scoring in ischemic stroke using 4D CT angiography with low-rank and sparse matrix decomposition
Authors
Mumu Aktar
Donatella Tampieri
Hassan Rivaz
Marta Kersten-Oertel
Yiming Xiao
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
International Journal of Computer Assisted Radiology and Surgery / Issue 9/2020
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI
https://doi.org/10.1007/s11548-020-02216-w

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