Tissue outcome prediction in hyperacute ischemic stroke: Comparison of machine learning models

J Cereb Blood Flow Metab. 2021 Nov;41(11):3085-3096. doi: 10.1177/0271678X211024371. Epub 2021 Jun 23.


Machine Learning (ML) has been proposed for tissue fate prediction after acute ischemic stroke (AIS), with the aim to help treatment decision and patient management. We compared three different ML models to the clinical method based on diffusion-perfusion thresholding for the voxel-based prediction of final infarct, using a large MRI dataset obtained in a cohort of AIS patients prior to recanalization treatment. Baseline MRI (MRI0), including diffusion-weighted sequence (DWI) and Tmax maps from perfusion-weighted sequence, and 24-hr follow-up MRI (MRI24h) were retrospectively collected in consecutive 394 patients AIS patients (median age = 70 years; final infarct volume = 28mL). Manually segmented DWI24h lesion was considered the final infarct. Gradient Boosting, Random Forests and U-Net were trained using DWI, apparent diffusion coefficient (ADC) and Tmax maps on MRI0 as inputs to predict final infarct. Tissue outcome predictions were compared to final infarct using Dice score. Gradient Boosting had significantly better predictive performance (median [IQR] Dice Score as for median age, maybe you can replace the comma with an equal sign for consistency 0.53 [0.29-0.68]) than U-Net (0.48 [0.18-0.68]), Random Forests (0.51 [0.27-0.66]), and clinical thresholding method (0.45 [0.25-0.62]) (P < 0.001). In this benchmark of ML models for tissue outcome prediction in AIS, Gradient Boosting outperformed other ML models and clinical thresholding method and is thus promising for future decision-making.

Keywords: MRI; biomarkers; neuroradiology; penumbra; stroke.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain / blood supply*
  • Brain / diagnostic imaging*
  • Brain / pathology
  • Clinical Decision-Making
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Infarction / diagnostic imaging*
  • Infarction / pathology
  • Ischemic Stroke / diagnostic imaging*
  • Ischemic Stroke / pathology
  • Ischemic Stroke / therapy
  • Machine Learning / statistics & numerical data*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Reperfusion / methods
  • Retrospective Studies