Improved Segmentation and Detection Sensitivity of Diffusion-Weighted Brain Infarct Lesions with Synthetically Enhanced Deep Learning

Purpose: To compare the segmentation and detection performance of a deep learning model trained on a database of human-labelled clinical diffusion-weighted (DW) stroke lesions to a model trained on the same database enhanced with synthetic DW stroke lesions. Methods: In this institutional review board approved study, a stroke database of 962 cases (mean age 65+/-17 years, 255 males, 449 scans with DW positive stroke lesions) and a normal database of 2,027 patients (mean age 38+/-24 years,1088 females) were obtained. Brain volumes with synthetic DW stroke lesions were produced by warping the relative signal increase of real strokes to normal brain volumes. A generic 3D U-Net was trained on four different databases to generate four different models: (a) 375 neuroradiologist-labeled clinical DW positive stroke cases(CDB);(b) 2,000 synthetic cases(S2DB);(c) CDB+2,000 synthetic cases(CS2DB); or (d) CDB+40,000 synthetic cases(CS40DB). The models were tested on 20%(n=192) of the cases of the stroke database, which were excluded from the training set. Segmentation accuracy was characterized using Dice score and lesion volume of the stroke segmentation, and statistical significance was tested using a paired, two-tailed, Student's t-test. Detection sensitivity and specificity was compared to three neuroradiologists. Results: The performance of the 3D U-Net model trained on the CS40DB(mean Dice 0.72) was better than models trained on the CS2DB (0.70,P <0.001) or the CDB(0.65,P<0.001). The deep learning model was also more sensitive (91%[89%-93%]) than each of the three human readers(84%[81%-87%],78%[75%-81%],and 79%[76%-82%]), but less specific(75%[72%-78%] vs for the three human readers (96%[94%-97%],92%[90%-94%] and 89%[86%-91%]). Conclusion: Deep learning training for segmentation and detection of DW stroke lesions was significantly improved by enhancing the training set with synthetic lesions.