{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:49:21Z","timestamp":1760150961496,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T00:00:00Z","timestamp":1642636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST110-2314-B-016-008"],"award-info":[{"award-number":["MOST110-2314-B-016-008"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medical Affairs Bureau, Ministry of National Defense","award":["MND-MAB-110-041","MND-MAB-110-042"],"award-info":[{"award-number":["MND-MAB-110-041","MND-MAB-110-042"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>(1) Background: Posterior circulation ischemic stroke has high mortality and disability rates and requires an early prediction prognosis to provide the basis for an interventional approach. Current quantitative measures are only able to accurately assess the prognosis of patients using magnetic resonance imaging (MRI). However, it is difficult to obtain MRI images in critically urgent cases. Therefore, the development of a noncontrast CT-based rapid-assist tool is needed to enhance the value of the clinical application. (2) Objective: This study aimed to develop an auxiliary-annotating noncontrast CT-efficient tool, which is based on a deep learning model, to provide a quantitative scale and the prognosis of posterior circulation ischemic stroke patients. (3) Methods: A total of 31 patients with posterior circulation ischemic stroke, diagnosed in the stroke registry at the Tri-Service General Hospital from November 2019 to July 2020, were included in the study, with a total of 578 CT images collected from noncontrast CT and MRI that were \u2264 3 days apart. A 5-fold cross validation was used to develop an image segmentation model to identify nine posterior circulation structures, and intersection over union (IoU) was used to assess the ability of the model to identify each structure. A quantitative score was integrated to assess the importance of the proportion of ischemic lesions in each posterior circulation structure, and the ROC curve was compared with the semiquantitative score for prognostic power. The prognoses of the patients were defined into two groups of 18 patients. An mRS score of 0\u20132 at discharge was defined as a good prognosis, while an mRS score of 3\u20136 was deemed to be a poor prognosis. (4) Results: The performance of the image segmentation model for identifying the nine posterior circulation structures in noncontrast CT images was evaluated. The IoU of the left cerebellum was 0.78, the IoU of the right cerebellum was 0.79, the IoU of the left occipital lobe was 0.74, the IoU of the right occipital lobe was 0.68, the IoU of the left thalamus was 0.73, the IoU of the right thalamus was 0.75, the IoU of the medulla oblongata was 0.82, and the IoU of the midbrain was 0.83. The prognostic AUC of posterior circulation patients predicted using a quantitative integrated score was 0.74, which was significantly higher than that of the pc-ASPECTS (AUC = 0.63, p = 0.035), with a sensitivity of 0.67 and a specificity of 0.72. (5) Conclusions: In this study, a deep learning model was used to develop a noncontrast CT-based quantitative integrated score tool, which is an effective tool for clinicians to assess the prognosis of posterior circulation ischemic stroke.<\/jats:p>","DOI":"10.3390\/jpm12020138","type":"journal-article","created":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T22:51:06Z","timestamp":1642719066000},"page":"138","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Novel and Efficient Quantitative Posterior-Circulation-Structure-Based Scale via Noncontrast CT to Predict Ischemic Stroke Prognosis: A Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Wen-Hui","family":"Fang","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Chu","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Chen","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3195-7940","authenticated-orcid":false,"given":"Pi-Shao","family":"Ko","sequence":"additional","affiliation":[{"name":"School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan"},{"name":"Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ding-Lian","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3122-1116","authenticated-orcid":false,"given":"Sui-Lung","family":"Su","sequence":"additional","affiliation":[{"name":"School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"g3175","DOI":"10.1136\/bmj.g3175","article-title":"Posterior circulation ischaemic stroke","volume":"348","author":"Merwick","year":"2014","journal-title":"BMJ"},{"key":"ref_2","unstructured":"GBD 2016 Stroke Collaborators (2019). Global, regional, and national burden of stroke, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol., 18, 439\u2013458."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1002\/ana.23904","article-title":"Thrombolysis of basilar artery occlusion: Impact of baseline ischemia and time","volume":"73","author":"Strbian","year":"2013","journal-title":"Ann. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1161\/01.STR.0000143453.78005.44","article-title":"Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life","volume":"35","author":"Wardlaw","year":"2004","journal-title":"Stroke"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s13244-012-0185-9","article-title":"Comparison of CT and MR imaging in ischemic stroke","volume":"3","author":"Vymazal","year":"2012","journal-title":"Insights Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e012558","DOI":"10.1161\/JAHA.119.012558","article-title":"Use of Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke","volume":"8","author":"Yoshimoto","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref_8","unstructured":"Kingma, D.P., and Ba, J. (2014). Adam: A method for stochastic optimization. arXiv."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.1111\/ene.14934","article-title":"Diagnostic and prognostic utility of computed tomography perfusion imaging in posterior circulation acute ischemic stroke: A systematic review and meta-analysis","volume":"28","author":"Katyal","year":"2021","journal-title":"Eur. J. Neurol."},{"key":"ref_10","unstructured":"Anguita, D., Ghelardoni, L., Ghio, A., Oneto, L., and Ridella, S. (2012, January 25\u201327). The \u2018K\u2019 in K-fold Cross Validation. Proceedings of the 20th European Symposium on Artificial Neural Networks, Computational Intelligence and Machine Learning (ESANN), Bruges, Belgium."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Rezatofighi, H., Tsoi, N., Gwak, J., Sadeghian, A., Reid, I., and Savarese, S. (2019, January 16\u201321). Generalized intersection over union: A metric and a loss for bounding box regression. Proceedings of the IEEE\/CVF Conference on Computer Vision and Pattern Recognition (CVPR), Long Beach, CA, USA.","DOI":"10.1109\/CVPR.2019.00075"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chatterjee, A., Somayaji, N.R., and Kabakis, I.M. (2019). Artificial intelligence detection of cerebrovascular large vessel occlusion-nine month, 650 patient evaluation of the diagnostic accuracy and performance of the viz. Ai lvo algorithm. STROKE, Lippincott Williams & Wilkins.","DOI":"10.1161\/str.50.suppl_1.WMP16"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1148\/radiol.2019181228","article-title":"Automated Calculation of the Alberta Stroke Program Early CT Score: Feasibility and Reliability","volume":"291","author":"Maegerlein","year":"2019","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/jon.12562","article-title":"CT Reconstruction Levels Affect Automated and Reader-Based ASPECTS Ratings in Acute Ischemic Stroke","volume":"29","author":"Seker","year":"2019","journal-title":"J. Neuroimaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1111\/jon.12564","article-title":"Baseline ASPECTS and e-ASPECTS Correlation with Infarct Volume and Functional Outcome in Patients Undergoing Mechanical Thrombectomy","volume":"29","author":"Martins","year":"2019","journal-title":"J. Neuroimaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3277","DOI":"10.1161\/STROKEAHA.119.026430","article-title":"Automated Calculation of Alberta Stroke Program Early CT Score: Validation in Patients With Large Hemispheric Infarct","volume":"50","author":"Albers","year":"2019","journal-title":"Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/j.1600-0404.1995.tb05841.x","article-title":"Isolated acute vertigo in the elderly; vestibular or vascular disease?","volume":"91","author":"Norrving","year":"1995","journal-title":"Acta Neurol. Scand."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.annemergmed.2010.06.564","article-title":"Zero on the NIHSS does not equal the absence of stroke","volume":"57","author":"Albright","year":"2011","journal-title":"Ann. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1159\/000358869","article-title":"Lower NIH stroke scale scores are required to accurately predict a good prognosis in posterior circulation stroke","volume":"37","author":"Inoa","year":"2014","journal-title":"Cerebrovasc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e566","DOI":"10.1016\/j.wneu.2019.05.217","article-title":"Posterior Circulation Thrombectomy-pc-ASPECT Score Applied to Preintervention Magnetic Resonance Imaging Can Accurately Predict Functional Outcome","volume":"129","author":"Khatibi","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1007\/s00415-018-8746-6","article-title":"Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset","volume":"265","author":"Lin","year":"2018","journal-title":"J. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1111\/jon.12130","article-title":"Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study","volume":"25","author":"Pallesen","year":"2015","journal-title":"J. Neuroimaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1159\/000502084","article-title":"Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study","volume":"9","author":"Francalanza","year":"2019","journal-title":"Cerebrovasc. Dis. Extra"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.3174\/ajnr.A1723","article-title":"CT angiography source images predict final infarct extent in patients with basilar artery occlusion","volume":"30","author":"Puetz","year":"2009","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"105256","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105256","article-title":"Treatment Outcomes by Initial Neurological Deficits in Acute Stroke Patients with Basilar Artery Occlusion: The RESCUE Japan Registry 2","volume":"29","author":"Yoshimoto","year":"2020","journal-title":"J. Stroke Cerebrovasc. 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