Identifying the presence and extent of early ischemic changes (EIC) on Non-Contrast Computed Tomography (NCCT) is key to diagnosing and making time-sensitive treatment decisions in patients that present with Acute Ischemic Stroke (AIS). Segmenting EIC on NCCT is however a challenging task. In this study, we investigated a 3D CNN based on nnU-Net, a self-adapting CNN technique that has become the state-of-the-art in medical image segmentation, for segmenting EIC in NCCT of AIS patients. We trained and tested this model on a sizeable and heterogenous dataset of 534 patients, split into 438 for training and validation and 96 for testing. On this test set, we additionally assessed the inter-rater performance by comparing the proposed approach against two reference segmentation annotations by expert neuroradiologist readers, using this as the benchmark against which to compare our model. In terms of spatial agreement, we report median Dice Similarity Coefficients (DSCs) of 39.8% for the model vs. Reader-1, 39.4% for the model vs. Reader-2, and 55.6% for Reader-2 vs. Reader-1. In terms of lesion volume agreement, we report Intraclass Correlation Coefficients (ICCs) of 83.4% for model vs. Reader-1, 80.4% for model vs. Reader-2, and 94.8% for Reader-2 vs. Reader-1. Based on these results, we conclude that our model performs well relative to expert human performance and therefore may be useful as a decision-aid for clinicians.

Circle Neurovascular Imaging Inc Calgary AB Canada

Department of Clinical Neurosciences Foothills Medical Center University of Calgary Calgary AB Canada

Department of Clinical Neurosciences Foothills Medical Center University of Calgary Calgary AB Canada; Department of Medical Imaging St Anne's University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic; Faculty of Medicine and University Hospital Hradec Kralove Czech Republic; Department of Radiology Cumming School of Medicine University of Calgary Canada

Department of Clinical Neurosciences Foothills Medical Center University of Calgary Calgary AB Canada; Department of Radiology Cumming School of Medicine University of Calgary Canada; Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Canada; Department of Community Health Sciences Cumming School of Medicine University of Calgary Canada

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