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Automated LVO detection and collateral scoring on CTA using a 3D self-configuring object detection network: a multi-center study

2023    Bagcilar, Omer; Alis, Deniz; Alis, Ceren; Seker, Mustafa Ege; Yergin, Mert; Ustundag, Ahmet; Hikmet, Emil; Tezcan, Alperen; Polat, Gokhan; Akkus, Ahmet Tugrul; Alper, Fatih; Velioglu, Murat; Yildiz, Omer; Selcuk, Hakan Hatem; Oksuz, Ilkay; Kizilkilic, Osman; Karaarslan, Ercan

The use of deep learning (DL) techniques for automated diagnosis of large vessel occlusion (LVO) and collateral scoring on computed tomography angiography (CTA) is gaining attention. In this study, a state-of-the-art self-configuring object detection network called nnDetection was used to detect LVO and assess collateralization on CTA scans using a multi-task 3D object detection approach. The model was trained on single-phase CTA scans of 2425 patients at five centers, and its performance was evaluated on an external test set of 345 patients from another center. Ground-truth labels for the presence of LVO and collateral scores were provided by three radiologists. The nnDetection model achieved a diagnostic accuracy of 98.26% (95% CI 96.25-99.36%) in identifying LVO, correctly classifying 339 out of 345 CTA scans in the external test set. The DL-based collateral scores had a kappa of 0.80, indicating good agreement with the consensus of the radiologists. These results demonstrate that the self-configuring 3D nnDetection model can accurately detect LVO on single-phase CTA scans and provide semi-quantitative collateral scores, offering a comprehensive approach for automated stroke diagnostics in patients with LVO.