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ArXiv Preprint

Purpose: To evaluate a fully-automated deep-learning-based method for assessment of intracranial carotid artery calcification (ICAC). Methods: Two observers manually delineated ICAC in non-contrast CT scans of 2,319 participants (mean age 69 (SD 7) years; 1154 women) of the Rotterdam Study, prospectively collected between 2003 and 2006. These data were used to retrospectively develop and validate a deep-learning-based method for automated ICAC delineation and volume measurement. To evaluate the method, we compared manual and automatic assessment (computed using ten-fold cross-validation) with respect to 1) the agreement with an independent observer's assessment (available in a random subset of 47 scans); 2) the accuracy in delineating ICAC as judged via blinded visual comparison by an expert; 3) the association with first stroke incidence from the scan date until 2012. All method performance metrics were computed using 10-fold cross-validation. Results: The automated delineation of ICAC reached sensitivity of 83.8% and positive predictive value (PPV) of 88%. The intraclass correlation between automatic and manual ICAC volume measures was 0.98 (95% CI: 0.97, 0.98; computed in the entire dataset). Measured between the assessments of independent observers, sensitivity was 73.9%, PPV was 89.5%, and intraclass correlation was 0.91 (95% CI: 0.84, 0.95; computed in the 47-scan subset). In the blinded visual comparisons, automatic delineations were more accurate than manual ones (p-value = 0.01). The association of ICAC volume with incident stroke was similarly strong for both automated (hazard ratio, 1.38 (95% CI: 1.12, 1.75) and manually measured volumes (hazard ratio, 1.48 (95% CI: 1.20, 1.87)). Conclusions: The developed model was capable of automated segmentation and volume quantification of ICAC with accuracy comparable to human experts.

Gerda Bortsova, Daniel Bos, Florian Dubost, Meike W. Vernooij, M. Kamran Ikram, Gijs van Tulder, Marleen de Bruijne