Deep learning to identify stroke within 4.5 h using DWI and FLAIR in a prospective multicenter study.

Journal: Scientific reports
Published Date:

Abstract

To enhance thrombolysis eligibility in acute ischemic stroke, we developed a deep learning model to estimate stroke onset within 4.5 h using diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images. Given the variability in human interpretation, our multimodal Res-U-Net (mRUNet) model integrates a modified U-Net and ResNet-34 to classify stroke onset as < 4.5 or ≥ 4.5 h. Using DWI and FLAIR images from patients scanned within 24 h of symptom onset, the modified U-Net generated a DWI-FLAIR mismatch image, while ResNet-34 performed the final classification. mRUNet was evaluated against ResNet-34 and DenseNet-121 on an internal test set (n = 123) and two external test sets: a single-center (n = 468) and a multi-center (n = 1151). mRUNet achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.903 on the internal set and 0.910 and 0.868 on external sets, significantly outperforming ResNet-34 and DenseNet-121. Our mRUNet model demonstrated robust and consistent classification of the 4.5-h onset-time window across datasets. By leveraging DWI and FLAIR images as a tissue clock, this model may support timely and individualized thrombolysis in patients with unclear stroke onset, such as those with wake-up stroke, in clinical settings.

Authors

  • Eun Namgung
    Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea.
  • Young Sun Kim
    Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medicine Science, Kyung Hee University, Yongin, Korea.
  • Eun-Jae Lee
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. (E.-J.L., H.-B.L., S.U.K., J.S.K., D.-W.K.).
  • Dae-Il Chang
    Department of Neurology, Kyung Hee University Medical Center, Seoul, South Korea.
  • Han Jin Cho
    Stroke Center, Pusan National University Hospital, School of Medicine, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Busan, Republic of Korea.
  • Jun Lee
    Nephrology Unit, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia.
  • Jae-Kwan Cha
    Department of Neurology (J.-K.C., D.-H.K.), Dong-A University Hospital, Busan, Republic of Korea.
  • Man-Seok Park
    Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Korea (the Republic of).
  • Kyung Ho Yu
    Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea.
  • Jin-Man Jung
    Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea; Korea University Zebrafish Translational Medical Research Center, Ansan, South Korea. Electronic address: sodium1975@korea.ac.kr.
  • Seong Hwan Ahn
    Department of Neurology, Chosun University Hospital, Gwangju, South Korea.
  • Dong-Eog Kim
    National Priority Research Center for Stroke and Department of Neurology (W.-S.R, J.C., S.-W.J., D.-S.G., D.-E.K.), Dongguk University Ilsan Hospital, Goyang, Republic of Korea kdongeog@duih.org.
  • Ju Hun Lee
    Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea.
  • Keun-Sik Hong
    Department of Neurology (K.-S.H., Y,-J.C.), Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
  • Sung-Il Sohn
    Department of Neurology, Keimyung University Medical Center, Daegu, South Korea.
  • Kyung-Pil Park
    Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
  • Jun Young Chang
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
  • Bum Joon Kim
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
  • Sun U Kwon
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. (E.-J.L., H.-B.L., S.U.K., J.S.K., D.-W.K.).
  • Gayoung Park
    Virginia Tech, 880 West Campus Drive, Blacksburg, VA 24061, USA.
  • Hye-Soo Jung
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
  • Jihoun Hong
    Nunaps Inc., Seoul, South Korea.
  • Dong-Wha Kang
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. (E.-J.L., H.-B.L., S.U.K., J.S.K., D.-W.K.).