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Fully Automated and Real-Time Volumetric Measurement of Infarct Core and Penumbra in Diffusion- and Perfusion-Weighted MRI of Patients with Hyper-Acute Stroke

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Abstract

Multimodal magnetic resonance imaging (MRI) has emerged as a promising tool for diagnosing ischemic stroke and for determining treatment strategies in the acute phase. The detection and quantification of the penumbra and the infarct core regions aid the assessment of the potential risks and benefits of thrombolysis by providing information on salvageable tissue or ischemic lesion age. In this study, we proposed a fully automated and real-time algorithm to compute parameter maps of perfusion-weighted images (PWIs) and to identify an infarct core from diffusion-weighted images (DWIs). DWI and PWI were obtained using a 1.5 Tesla MRI scanner for 15 patients with acute ischemic stroke. Parameter maps of PWI were computed using restricted gamma-variate curve fitting and Fourier-based deconvolution. The ischemic penumbra was identified using time-to-maximum (Tmax) > 6 s as the mutual optimal threshold, while the infarct core was segmented using an adaptive thresholding on DWI. When the penumbra on PWI was compared with that generated using commercial software Pearson’s linear correlation coefficient between penumbra volumes was 0.601 (p = 0.030), and the Dice coefficient was 0.51 ± 0.15. The infarct core on DWI was compared with the manually segmented gold standard. Dice coefficient between the manually drawn and automated segmented infarct cores was 0.62 ± 0.18. The processing times for PWI and DWI were 222.9 ± 16.4 and 53.4 ± 4.8 s, respectively. In conclusion, we demonstrate a fully automated and real-time algorithm to segment the penumbra and the infarct core regions based on PWI and DWI.

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Funding

This research was financially supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI12C1847).

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Author notes

  1. Hyunna Lee and Kyesam Jung contributed equally to this work.

Authors and Affiliations

  1. Health Innovation Big Data Center, Asan Institute for Life Science, Asan Medical Center, Seoul, 05505, South Korea

    Hyunna Lee

  2. Institute of Neuroscience and Medicine - Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, 52425, Germany

    Kyesam Jung

  3. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    Dong-Wha Kang

  4. Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    Namkug Kim

  5. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    Namkug Kim

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  1. Hyunna Lee
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  2. Kyesam Jung
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  3. Dong-Wha Kang
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Correspondence to Namkug Kim.

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The study was approved by the local institutional review board. Due to the retrospective nature of the study, written informed consent was waived.

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Lee, H., Jung, K., Kang, DW. et al. Fully Automated and Real-Time Volumetric Measurement of Infarct Core and Penumbra in Diffusion- and Perfusion-Weighted MRI of Patients with Hyper-Acute Stroke. J Digit Imaging 33, 262–272 (2020). https://doi.org/10.1007/s10278-019-00222-2

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  • DOI: https://doi.org/10.1007/s10278-019-00222-2

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