Article Text
Abstract
Background Carotid web (CaW) is a risk factor for ischemic stroke, mainly in young patients with stroke of undetermined etiology. Its detection is challenging, especially among non-experienced physicians.
Methods We included patients with CaW from six international trials and registries of patients with acute ischemic stroke. Identification and manual segmentations of CaW were performed by three trained radiologists. We designed a two-stage segmentation strategy based on a convolutional neural network (CNN). At the first stage, the two carotid arteries were segmented using a U-shaped CNN. At the second stage, the segmentation of the CaW was first confined to the vicinity of the carotid arteries. Then, the carotid bifurcation region was localized by the proposed carotid bifurcation localization algorithm followed by another U-shaped CNN. A volume threshold based on the derived CaW manual segmentation statistics was then used to determine whether or not CaW was present.
Results We included 58 patients (median (IQR) age 59 (50–75) years, 60% women). The Dice similarity coefficient and 95th percentile Hausdorff distance between manually segmented CaW and the algorithm segmented CaW were 63.20±19.03% and 1.19±0.9 mm, respectively. Using a volume threshold of 5 mm3, binary classification detection metrics for CaW on a single artery were as follows: accuracy: 92.2% (95% CI 87.93% to 96.55%), precision: 94.83% (95% CI 88.68% to 100.00%), sensitivity: 90.16% (95% CI 82.16% to 96.97%), specificity: 94.55% (95% CI 88.0% to 100.0%), F1 measure: 0.9244 (95% CI 0.8679 to 0.9692), area under the curve: 0.9235 (95%CI 0.8726 to 0.9688).
Conclusions The proposed two-stage method enables reliable segmentation and detection of CaW from head and neck CT angiography.
- Artery
- CT Angiography
- Embolic
- Stroke
- Vascular Malformation
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
X @FouziBala, @draravindganesh, @AlmekhlafiMa, @mihill68
HK, XT and FBa contributed equally.
Contributors HK, XT, and FBa contribute to this work equally. HK, XT, FBa, JH, JZ, IA, FBe, NS, AG, MDH, MG, SBC, MAA, WQ, and BKM had full access to all data in the study and take responsibility for the data integrity and accuracy of the analysis. HK, XT, FBa, and WQ participated in the concept and design. HK, XT, FBa, JH, JZ, IA, FBe, NS, AG, MDH, MG, SBC, MAA, WQ, and BKM participated in the acquisition, analysis, or interpretation of data, as well as review of testing data. HK, XT, FBa, BKM, and WQ were involved in drafting and critical revision of the article for important intellectual content. HK, XT, and FBa performed the statistical analysis. FBa obtained the funding. HK, XT, FBa, and WQ participated in administrative, technical, or material support. WQ and BKM acted as supervisors. WQ and BKM are guarantors of this work.
Funding FBa received a research grant from the Society of Vascular and Interventional Neurology (SVIN).FBa received a research grant from the Society of Vascular and Interventional Neurology (SVIN).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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