{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:07:25Z","timestamp":1789384045271,"version":"build-2803163510"},"reference-count":39,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["402688427"],"award-info":[{"award-number":["402688427"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"award":["402688427"],"award-info":[{"award-number":["402688427"]}],"id":[{"id":"https:\/\/ror.org\/018mejw64","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner Fresenius Foundation","doi-asserted-by":"publisher","award":["2022\\_EKCS.17"],"award-info":[{"award-number":["2022\\_EKCS.17"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Computer-aided vessel occlusion detection for acute ischemic stroke is typically developed on early-phase CT angiography (CTA). In late-phase CTA, enhanced venous contrast can mimic arterial occlusions and lead to incorrect occlusion detections. To counteract this, we propose a constraint-based post-processing framework that leverages anatomical and temporal vascular information from CT perfusion (CTP) scans. Methods: Vascular anatomy and relative contrast-arrival times were encoded as time\u2013vessel maps. Three complementary constraints worked on these maps to remove incorrect detections based on distance-to-vessel truncation points, contrast-arrival time, and spatial priors. Constraints were fixed on a 32-case late-phase development subset and applied to an external held-out cohort of late-phase CTA (N = 354). To enable application without CTP, an auxiliary CTA-to-time\u2013vessel map generator was designed to estimate maps directly from CTA. Results: In the external cohort, the framework reduced incorrect occlusions per scan from 3.9 (95% CI 3.6\u20134.2) to 2.1 (95% CI 1.9\u20132.3), preserving occlusion-level sensitivity at 80% (95% CI 69\u201391). The patient-level AUROC was 83 for the baseline versus 88 with post-processing. Improvements were also observed in detectors exposed to late-phase CTA, where post-processing reduced incorrect occlusions per scan from 2.8 to 1.9. As only 51 occlusion-positive cases were present in the external cohort, confidence intervals were wide. Consequently, these estimates should be interpreted with caution. Conclusions: Anatomically and temporally informed post-processing reduced incorrect occlusion detections in late-phase CTA without measurable loss of sensitivity, potentially improving robustness against CTA phase changes in external institutions.<\/jats:p>","DOI":"10.3390\/diagnostics16182972","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"2972","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anatomy- and Time-Based Post-Processing with CT Perfusion-Derived Time\u2013Vessel Maps to Reduce Incorrect Occlusion Detections in Late-Phase CT Angiography"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7293-8220","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Mart\u00ednez Mora","sequence":"first","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Quantitative Healthcare Analysis (QurAI) Group, Informatics Institute, University of Amsterdam, 1098 XH Amsterdam, The Netherlands"},{"name":"Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany"},{"name":"Konrad Zuse School of Excellence in Learning and Intelligent Systems (ELIZA), Technical University of Darmstadt, 64289 Darmstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1860-1114","authenticated-orcid":false,"given":"Mahsa","family":"Mojtahedi","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Neuroscience, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8117-9158","authenticated-orcid":false,"given":"Lucas","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Neuroscience, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Baumgartner","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Helmholtz Imaging,  German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Faculty of Mathematics and Computer Science, University of Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannick","family":"Kirchhoff","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Faculty of Mathematics and Computer Science, University of Heidelberg, 69120 Heidelberg, Germany"},{"name":"HIDSS4Health\u2014Helmholtz Information and Data Science School for Health, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany"},{"name":"HIDSS4Health\u2014Helmholtz Information and Data Science School for Health, Karlsruhe Institute of Technology, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Zenk","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Eckstein","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany"},{"name":"German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Core Center Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3851-2848","authenticated-orcid":false,"given":"Jessica","family":"K\u00e4chele","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany"},{"name":"German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Core Center Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Brugnara","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Clinic for Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bendszus","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Radbruch","sequence":"additional","affiliation":[{"name":"Clinic for Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany"},{"name":"Medical Faculty, University of Bonn, 53113 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvo","family":"Roos","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1631-7056","authenticated-orcid":false,"given":"Wim","family":"van Zwam","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"},{"name":"School for Cardiovascular Diseases (CARIM), Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"van Oostenbrugge","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"},{"name":"School for Cardiovascular Diseases (CARIM), Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9234-3515","authenticated-orcid":false,"given":"Diederik 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J.","family":"Dippel","sequence":"additional","affiliation":[{"name":"Department of Neurorology, Erasmus Medical Center, 3015 MD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8462-4037","authenticated-orcid":false,"given":"Bart J.","family":"Emmer","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7600-9568","authenticated-orcid":false,"given":"Charles","family":"Majoie","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Vollmuth","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Clinic for Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara I.","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Quantitative Healthcare Analysis (QurAI) Group, Informatics Institute, University of Amsterdam, 1098 XH Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus H.","family":"Maier-Hein","sequence":"additional","affiliation":[{"name":"Department of Medical Image Computing, German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany"},{"name":"Helmholtz Imaging,  German Cancer Research Center, 69120 Heidelberg, Germany"},{"name":"Faculty of Mathematics and Computer Science, University of Heidelberg, 69120 Heidelberg, Germany"},{"name":"German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Core Center Heidelberg, 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"},{"name":"Pattern Analysis and Learning Group, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1414-6313","authenticated-orcid":false,"given":"Henk A.","family":"Marquering","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","first-page":"e316","article-title":"2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke: A Guideline From the American Heart Association\/American Stroke Association","volume":"57","author":"Prabhakaran","year":"2026","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1161\/STROKEAHA.121.036091","article-title":"Machine Learning Automated Detection of Large Vessel Occlusion From Mobile Stroke Unit Computed Tomography Angiography","volume":"53","author":"Czap","year":"2022","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1148\/radiol.2020200334","article-title":"Detecting Large Vessel Occlusion at Multiphase CT Angiography by Using a Deep Convolutional Neural Network","volume":"297","author":"Stib","year":"2020","journal-title":"Radiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1148\/radiol.2021202734","article-title":"High-Performance Automated Anterior Circulation CT Angiographic Clot Detection in Acute Stroke: A Multireader Comparison","volume":"298","author":"Dehkharghani","year":"2021","journal-title":"Radiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"065016","DOI":"10.1088\/2057-1976\/ac9415","article-title":"An Algorithm for the Labeling and Interactive Visualization of the Cerebrovascular System of Ischemic Strokes","volume":"8","author":"Thamm","year":"2022","journal-title":"Biomed. 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