Artificial Intelligence and Acute Stroke Imaging

Abstract

Artificial intelligence technology is a rapidly expanding field with many applications in acute stroke imaging, including ischemic and hemorrhage subtypes. Early identification of acute stroke is critical for initiating prompt intervention to reduce morbidity and mortality. Artificial intelligence can help with various aspects of the stroke treatment paradigm, including infarct or hemorrhage detection, segmentation, classification, large vessel occlusion detection, Alberta Stroke Program Early CT Score grading, and prognostication. In particular, emerging artificial intelligence techniques such as convolutional neural networks show promise in performing these imaging-based tasks efficiently and accurately. The purpose of this review is twofold: first, to describe AI methods and available public and commercial platforms in stroke imaging, and second, to summarize the literature of current artificial intelligence-driven applications for acute stroke triage, surveillance, and prediction.

FIG 1.

AI uses computers to mimic human intelligence. ML is a subset of AI, and DL is a subset of ML.

FIG 2.

Aidoc stroke triage mobile interface. From left to right, a notification alert, a study list of cases, NCCT of an acute stroke, CTA of an LVO of the right MCA, CTP mean transit time in the right MCA territory, and a text messaging system. Images courtesy of Aidoc.

FIG 3.

Avicenna.AI DL-based ASPECTS tool demonstrating identification of ASPECTS and a heat map overlay (white). Image courtesy of Avicenna.AI.

FIG 4.

Brainomix e-CTA tool demonstrating identification and localization of an LVO of the right MCA, collateral score and collateral vessel attenuation, and a heat map of the collateral deficit (orange). Images courtesy of Brainomix.

FIG 5.

The RapidAI stroke triage or transfer mobile interface, which integrates the hub and spoke model. From left to right, ICH and ASPECTS scoring and alerts on NCCT, LVO detection on CTA, perfusion mismatch on MR imaging or CTP with FDA mechanical thrombectomy indication, and a mobile communication platform with “GO” notification system for rapid treatment decision making. Images courtesy of RapidAI.

FIG 6.

Viz.ai mobile interface showing a left MCA territory infarction with mismatch on CTP. Image courtesy of Viz.ai.