Automated Assessment of Leptomeningeal Collaterals on CT Angiograms

摘要 本研究的主要目标是开发一种软脑膜侧支的自动评分系统。 根据CT血管造影(CTA)对急性缺血性卒中进行定量评估。软脑膜 在近端血管闭塞的情况下，侧支提供了一种替代的血液流动路径。他的存在 软脑膜侧支的有效性(即“侧支状态”)在不同患者之间有显著差异。 有耐心的。侧支状态已被证明与患者预后和出血风险有关。 转型，这表明对抵押的快速和准确评估将提供一个强大的工具 用于治疗评估。目前抵押品评分的黄金标准是通过主观分析 有创数字减影血管造影(DSA)中的逆行充盈。尽管CTA比DSA在 对于侧支的直接评估，在CTA中也可以通过以下树模式来评估侧支的存在 闭塞部位周围血管充盈。几种基于CTA的人工评估技术已经被 文献中提出，但都是主观的，需要大量的人工干预。 在第一阶段，我们部署了一个基于网络的系统，用于自动评估中风侧支 在CTA上，我们将其用于中风评估的侧支状态的初步研究。 在这项第二阶段的建议中，我们的具体目标是：(1)改善我们的系统与 临床工作流程；(2)扩展系统以计算CT灌注卒中测量，从而提供 CTA附属品和CT灌注评估指标比较和结合的统一平台；以及(3) 测试联合使用CTA侧支和CT灌注措施的假设优于 方法独立预测卒中患者的治疗效果。

Abstract The primary goal of this study is to develop an automated scoring system of leptomeningeal collaterals based on CT angiography (CTA) as a quantitative assessment of acute ischemic stroke. Leptomeningeal collaterals provide an alternate path of blood flow in the setting of a proximal vessel occlusion. The presence and effectiveness of leptomeningeal collaterals (i.e., “collateral status”) varies significantly from patient to patient. Collateral status has been shown to be correlated with both patient outcome and risk of hemorrhagic transformation, suggesting that rapid and accurate assessment of the collaterals would provide a powerful tool for treatment evaluation. The current gold standard for collateral scoring is performed by subjective analysis of retrograde filling in invasive digital subtraction angiograms (DSA). Though CTA is more limited than DSA in the direct evaluation of collaterals, the presence of collaterals may also be evaluated in CTA by the tree-pattern of vessel filling around the site of occlusion. Several manual assessment techniques based on CTA have been proposed in the literature, but all are subjective and require significant human intervention. During Phase I, we deployed a web-based system for automated assessment of stroke collaterals based on CTA, and we used it in a preliminary study of collateral status for stroke assessment. In this Phase II STTR proposal, the specific aims are (1) to improve the integration of our system with clinical workflows; (2) expand the system to also compute CT perfusion stroke measures, so as to provide a unified platform for comparing and combining CTA collateral and CT perfusion assessment metrics; and (3) test the hypotheses that the combined use of CTA collateral and CT perfusion measures outperforms either method independently for treatment efficacy prediction in stroke patients.