ISLES'24: Improving final infarct prediction in ischemic stroke using multimodal imaging and clinical data

Accurate estimation of core (irreversibly damaged tissue) and penumbra (salvageable tissue) volumes is essential for ischemic stroke treatment decisions. Perfusion CT, the clinical standard, estimates these volumes but is affected by variations in deconvolution algorithms, implementations, and thresholds. Core tissue expands over time, with growth rates influenced by thrombus location, collateral circulation, and inherent patient-specific factors. Understanding this tissue growth is crucial for determining the need to transfer patients to comprehensive stroke centers, predicting the benefits of additional reperfusion attempts during mechanical thrombectomy, and forecasting final clinical outcomes. This work presents the ISLES'24 challenge, which addresses final post-treatment stroke infarct prediction from pre-interventional acute stroke imaging and clinical data. ISLES'24 establishes a unique 360-degree setting where all feasibly accessible clinical data are available for participants, including full CT acute stroke imaging, sub-acute follow-up MRI, and clinical tabular data. The contributions of this work are two-fold: first, we introduce a standardized benchmarking of final stroke infarct segmentation algorithms through the ISLES'24 challenge; second, we provide insights into infarct segmentation using multimodal imaging and clinical data strategies by identifying outperforming methods on a finely curated dataset. The outputs of this challenge are anticipated to enhance clinical decision-making and improve patient outcome predictions. All ISLES'24 materials, including data, performance evaluation scripts, and leading algorithmic strategies, are available to the research community following \url{https://isles-24.grand-challenge.org/}.

ISLES 2024: The first longitudinal multimodal multi-center real-world dataset in (sub-)acute stroke

Stroke remains a leading cause of global morbidity and mortality, placing a heavy socioeconomic burden. Over the past decade, advances in endovascular reperfusion therapy and the use of CT and MRI imaging for treatment guidance have significantly improved patient outcomes and are now standard in clinical practice. To develop machine learning algorithms that can extract meaningful and reproducible models of brain function for both clinical and research purposes from stroke images - particularly for lesion identification, brain health quantification, and prognosis - large, diverse, and well-annotated public datasets are essential. While only a few datasets with (sub-)acute stroke data were previously available, several large, high-quality datasets have recently been made publicly accessible. However, these existing datasets include only MRI data. In contrast, our dataset is the first to offer comprehensive longitudinal stroke data, including acute CT imaging with angiography and perfusion, follow-up MRI at 2-9 days, as well as acute and longitudinal clinical data up to a three-month outcome. The dataset includes a training dataset of n = 150 and a test dataset of n = 100 scans. Training data is publicly available, while test data will be used exclusively for model validation. We are making this dataset available as part of the 2024 edition of the Ischemic Stroke Lesion Segmentation (ISLES) challenge (https://www.isles-challenge.org/), which continuously aims to establish benchmark methods for acute and sub-acute ischemic stroke lesion segmentation, aiding in creating open stroke imaging datasets and evaluating cutting-edge image processing algorithms.

DSCA: A Digital Subtraction Angiography Sequence Dataset and Spatio-Temporal Model for Cerebral Artery Segmentation

Cerebrovascular diseases (CVDs) remain a leading cause of global disability and mortality. Digital Subtraction Angiography (DSA) sequences, recognized as the golden standard for diagnosing CVDs, can clearly visualize the dynamic flow and reveal pathological conditions within the cerebrovasculature. Therefore, precise segmentation of cerebral arteries (CAs) and classification between their main trunks and branches are crucial for physicians to accurately quantify diseases. However, achieving accurate CA segmentation in DSA sequences remains a challenging task due to small vessels with low contrast, and ambiguity between vessels and residual skull structures. Moreover, the lack of publicly available datasets limits exploration in the field. In this paper, we introduce a DSA Sequence-based Cerebral Artery segmentation dataset (DSCA), the first publicly accessible dataset designed specifically for pixel-level semantic segmentation of CAs. Additionally, we propose DSANet, a spatio-temporal network for CA segmentation in DSA sequences. Unlike existing DSA segmentation methods that focus only on a single frame, the proposed DSANet introduces a separate temporal encoding branch to capture dynamic vessel details across multiple frames. To enhance small vessel segmentation and improve vessel connectivity, we design a novel TemporalFormer module to capture global context and correlations among sequential frames. Furthermore, we develop a Spatio-Temporal Fusion (STF) module to effectively integrate spatial and temporal features from the encoder. Extensive experiments demonstrate that DSANet outperforms other state-of-the-art methods in CA segmentation, achieving a Dice of 0.9033.

UDCR: Unsupervised Aortic DSA/CTA Rigid Registration Using Deep Reinforcement Learning and Overlap Degree Calculation

The rigid registration of aortic Digital Subtraction Angiography (DSA) and Computed Tomography Angiography (CTA) can provide 3D anatomical details of the vasculature for the interventional surgical treatment of conditions such as aortic dissection and aortic aneurysms, holding significant value for clinical research. However, the current methods for 2D/3D image registration are dependent on manual annotations or synthetic data, as well as the extraction of landmarks, which is not suitable for cross-modal registration of aortic DSA/CTA. In this paper, we propose an unsupervised method, UDCR, for aortic DSA/CTA rigid registration based on deep reinforcement learning. Leveraging the imaging principles and characteristics of DSA and CTA, we have constructed a cross-dimensional registration environment based on spatial transformations. Specifically, we propose an overlap degree calculation reward function that measures the intensity difference between the foreground and background, aimed at assessing the accuracy of registration between segmentation maps and DSA images. This method is highly flexible, allowing for the loading of pre-trained models to perform registration directly or to seek the optimal spatial transformation parameters through online learning. We manually annotated 61 pairs of aortic DSA/CTA for algorithm evaluation. The results indicate that the proposed UDCR achieved a Mean Absolute Error (MAE) of 2.85 mm in translation and 4.35{\deg} in rotation, showing significant potential for clinical applications.

Image-Guided Autonomous Guidewire Navigation in Robot-Assisted Endovascular Interventions using Reinforcement Learning

Autonomous robots in endovascular interventions possess the potential to navigate guidewires with safety and reliability, while reducing human error and shortening surgical time. However, current methods of guidewire navigation based on Reinforcement Learning (RL) depend on manual demonstration data or magnetic guidance. In this work, we propose an Image-guided Autonomous Guidewire Navigation (IAGN) method. Specifically, we introduce BDA-star, a path planning algorithm with boundary distance constraints, for the trajectory planning of guidewire navigation. We established an IAGN-RL environment where the observations are real-time guidewire feeding images highlighting the position of the guidewire tip and the planned path. We proposed a reward function based on the distances from both the guidewire tip to the planned path and the target to evaluate the agent's actions. Furthermore, in policy network, we employ a pre-trained convolutional neural network to extract features, mitigating stability issues and slow convergence rates associated with direct learning from raw pixels. Experiments conducted on the aortic simulation IAGN platform demonstrated that the proposed method, targeting the left subclavian artery and the brachiocephalic artery, achieved a 100% guidewire navigation success rate, along with reduced movement and retraction distances and trajectories tend to the center of the vessels.

An automated framework for brain vessel centerline extraction from CTA images

Accurate automated extraction of brain vessel centerlines from CTA images plays an important role in diagnosis and therapy of cerebrovascular diseases, such as stroke. However, this task remains challenging due to the complex cerebrovascular structure, the varying imaging quality, and vessel pathology effects. In this paper, we consider automatic lumen segmentation generation without additional annotation effort by physicians and more effective use of the generated lumen segmentation for improved centerline extraction performance. We propose an automated framework for brain vessel centerline extraction from CTA images. The framework consists of four major components: (1) pre-processing approaches that register CTA images with a CT atlas and divide these images into input patches, (2) lumen segmentation generation from annotated vessel centerlines using graph cuts and robust kernel regression, (3) a dual-branch topology-aware UNet (DTUNet) that can effectively utilize the annotated vessel centerlines and the generated lumen segmentation through a topology-aware loss (TAL) and its dual-branch design, and (4) post-processing approaches that skeletonize the predicted lumen segmentation. Extensive experiments on a multi-center dataset demonstrate that the proposed framework outperforms state-of-the-art methods in terms of average symmetric centerline distance (ASCD) and overlap (OV). Subgroup analyses further suggest that the proposed framework holds promise in clinical applications for stroke treatment. Code is publicly available at https://github.com/Liusj-gh/DTUNet.

An Automatic Cascaded Model for Hemorrhagic Stroke Segmentation and Hemorrhagic Volume Estimation

Hemorrhagic Stroke (HS) has a rapid onset and is a serious condition that poses a great health threat. Promptly and accurately delineating the bleeding region and estimating the volume of bleeding in Computer Tomography (CT) images can assist clinicians in treatment planning, leading to improved treatment outcomes for patients. In this paper, a cascaded 3D model is constructed based on UNet to perform a two-stage segmentation of the hemorrhage area in CT images from rough to fine, and the hemorrhage volume is automatically calculated from the segmented area. On a dataset with 341 cases of hemorrhagic stroke CT scans, the proposed model provides high-quality segmentation outcome with higher accuracy (DSC 85.66%) and better computation efficiency (6.2 second per sample) when compared to the traditional Tada formula with respect to hemorrhage volume estimation.

AngioMoCo: Learning-based Motion Correction in Cerebral Digital Subtraction Angiography

Cerebral X-ray digital subtraction angiography (DSA) is the standard imaging technique for visualizing blood flow and guiding endovascular treatments. The quality of DSA is often negatively impacted by body motion during acquisition, leading to decreased diagnostic value. Time-consuming iterative methods address motion correction based on non-rigid registration, and employ sparse key points and non-rigidity penalties to limit vessel distortion. Recent methods alleviate subtraction artifacts by predicting the subtracted frame from the corresponding unsubtracted frame, but do not explicitly compensate for motion-induced misalignment between frames. This hinders the serial evaluation of blood flow, and often causes undesired vasculature and contrast flow alterations, leading to impeded usability in clinical practice. To address these limitations, we present AngioMoCo, a learning-based framework that generates motion-compensated DSA sequences from X-ray angiography. AngioMoCo integrates contrast extraction and motion correction, enabling differentiation between patient motion and intensity changes caused by contrast flow. This strategy improves registration quality while being substantially faster than iterative elastix-based methods. We demonstrate AngioMoCo on a large national multi-center dataset (MR CLEAN Registry) of clinically acquired angiographic images through comprehensive qualitative and quantitative analyses. AngioMoCo produces high-quality motion-compensated DSA, removing motion artifacts while preserving contrast flow. Code is publicly available at https://github.com/RuishengSu/AngioMoCo.

DisAsymNet: Disentanglement of Asymmetrical Abnormality on Bilateral Mammograms using Self-adversarial Learning

Asymmetry is a crucial characteristic of bilateral mammograms (Bi-MG) when abnormalities are developing. It is widely utilized by radiologists for diagnosis. The question of 'what the symmetrical Bi-MG would look like when the asymmetrical abnormalities have been removed ?' has not yet received strong attention in the development of algorithms on mammograms. Addressing this question could provide valuable insights into mammographic anatomy and aid in diagnostic interpretation. Hence, we propose a novel framework, DisAsymNet, which utilizes asymmetrical abnormality transformer guided self-adversarial learning for disentangling abnormalities and symmetric Bi-MG. At the same time, our proposed method is partially guided by randomly synthesized abnormalities. We conduct experiments on three public and one in-house dataset, and demonstrate that our method outperforms existing methods in abnormality classification, segmentation, and localization tasks. Additionally, reconstructed normal mammograms can provide insights toward better interpretable visual cues for clinical diagnosis. The code will be accessible to the public.

DIAS: A Comprehensive Benchmark for DSA-sequence Intracranial Artery Segmentation

Automatic segmentation of the intracranial artery (IA) in digital subtraction angiography (DSA) sequence is an essential step in diagnosing IA-related diseases and guiding neuro-interventional surgery. However, the lack of publicly available datasets has impeded research in this area. In this paper, we release DIAS, an IA segmentation dataset, consisting of 120 DSA sequences from intracranial interventional therapy. In addition to pixel-wise annotations, this dataset provides two types of scribble annotations for weakly supervised IA segmentation research. We present a comprehensive benchmark for evaluating the performance of this challenging dataset by utilizing fully-, weakly-, and semi-supervised learning approaches. Specifically, we propose a method that incorporates a dimensionality reduction module into a 2D/3D model to achieve vessel segmentation in DSA sequences. For weakly-supervised learning, we propose a scribble learning-based image segmentation framework, SSCR, which comprises scribble supervision and consistency regularization. Furthermore, we introduce a random patch-based self-training framework that utilizes unlabeled DSA sequences to improve segmentation performance. Our extensive experiments on the DIAS dataset demonstrate the effectiveness of these methods as potential baselines for future research and clinical applications.