Exploiting 4D CT Perfusion for segmenting infarcted areas in patients with suspected acute ischemic stroke

Precise and fast prediction methods for ischemic areas (core and penumbra) in acute ischemic stroke (AIS) patients are of significant clinical interest: they play an essential role in improving diagnosis and treatment planning. Computed Tomography (CT) scan is one of the primary modalities for early assessment in patients with suspected AIS. CT Perfusion (CTP) is often used as a primary assessment to determine stroke location, severity, and volume of ischemic lesions. Current automatic segmentation methods for CTP mostly use already processed 3D color maps conventionally used for visual assessment by radiologists as input. Alternatively, the raw CTP data is used on a slice-by-slice basis as 2D+time input, where the spatial information over the volume is ignored. In this paper, we investigate different methods to utilize the entire 4D CTP as input to fully exploit the spatio-temporal information. This leads us to propose a novel 4D convolution layer. Our comprehensive experiments on a local dataset comprised of 152 patients divided into three groups show that our proposed models generate more precise results than other methods explored. A Dice Coefficient of 0.70 and 0.45 is achieved for penumbra and core areas, respectively. The code is available on https://github.com/Biomedical-Data-Analysis-Laboratory/4D-mJ-Net.git.