Development and clinical application of a deep learning model to identify acute infarct on magnetic resonance imaging

Stroke is a leading cause of death and disability. The ability to quickly identify the presence of acute infarct and quantify the volume on magnetic resonance imaging (MRI) has important treatment implications. We developed a machine learning model that used the apparent diffusion coefficient and diffusion weighted imaging series. It was trained on 6,657 MRI studies from Massachusetts General Hospital (MGH; Boston, USA). All studies were labelled positive or negative for infarct (classification annotation) with 377 having the region of interest outlined (segmentation annotation). The different annotation types facilitated training on more studies while not requiring the extensive time to manually segment every study. We initially validated the model on studies sequestered from the training set. We then tested the model on studies from three clinical scenarios: consecutive stroke team activations for 6-months at MGH, consecutive stroke team activations for 6-months at a hospital that did not provide training data (Brigham and Women's Hospital [BWH]; Boston, USA), and an international site (Diagnosticos da America SA [DASA]; Brazil). The model results were compared to radiologist ground truth interpretations. The model performed better when trained on classification and segmentation annotations (area under the receiver operating curve [AUROC] 0.995 [95% CI 0.992-0.998] and median Dice coefficient for segmentation overlap of 0.797 [IQR 0.642-0.861]) compared to segmentation annotations alone (AUROC 0.982 [95% CI 0.972-0.990] and Dice coefficient 0.776 [IQR 0.584-0.857]). The model accurately identified infarcts for MGH stroke team activations (AUROC 0.964 [95% CI 0.943-0.982], 381 studies), BWH stroke team activations (AUROC 0.981 [95% CI 0.966-0.993], 247 studies), and at DASA (AUROC 0.998 [95% CI 0.993-1.000], 171 studies). The model accurately segmented infarcts with Pearson correlation comparing model output and ground truth volumes between 0.968 and 0.986 for the three scenarios. Acute infarct can be accurately detected and segmented on MRI in real-world clinical scenarios using a machine learning model.