Automated Assessment of Leptomeningeal Collaterals on CT Angiograms

DESCRIPTION provided by applicant The primary goal of this study is to develop an automated scoring system of leptomeningeal collaterals based on CT angiography CTA as a quantitative assessment of acute stroke Leptomeningeal collaterals provide an alternate path of blood flow in the setting of a proximal occlusion The presence and effectiveness of leptomeningeal collaterals i e andquot collateral statusandquot will vary significantly from patient to patint Collateral status has been shown to be correlated with both patient outcome and risk of hemorrhagic transformation suggesting that rapid and accurate assessment of the collaterals would provide a powerful tool for treatment evaluation The current gold standard for collateral scoring is performed by subjective analysis of retrograde filling in invasive digital subtraction angiograms DSA Though CTA is more limited than DSA in the direct evaluation of collaterals the presence of collaterals may also be evaluated in CTA by the degree of vessel filling beyond the site of occlusion Several manual assessment techniques based on CTA have been proposed in the literature but all are subjective and require significant human intervention Thus we propose to develop an automated CTA based collateral status assessment The aims of our work are as follows adapt our vessel segmentation algorithms to collateral vessel assessment perform retrospective evaluation of the CTA derived collateral measurements against DSA in patients and conduct preliminary retrospective clinical evaluation of the CTA derived collateral measurements against patient outcome This work brings together a strong yet diverse team addresses a significant clinical problem with an innovative solution and uses a two pronged approach to commercialization involving protected IP and an open source platform that promotes consulting revenue PUBLIC HEALTH RELEVANCE Leptomeningeal collateral vessels provide connections between vascular territories in the brain in the presence of occlusions such as in stroke The number of collateral vessels varies significantly from patient to patient and they have been shown to play an important role in stroke outcomes providing blood flow to tissue at risk Rapid and effective patient specific determination of the presence of collaterals is needed in acute stroke situations We propose to develop an automated system to evaluate collateral blood flow from computed tomography angiography CTA images This system would be a powerful analysis tool for guiding the treatment of stroke patients within the critical window of opportunit that is only open immediately after a stroke occurs