CT perfusion parameter estimation in stroke using neural network with transformer and physical model priors

Objectives: CT perfusion (CTP) imaging is vital in treating acute ischemic stroke by identifying salvageable tissue and the infarcted core. CTP images allow quantitative estimation of CT perfusion parameters, which can provide information on the degree of tissue hypoperfusion and its salvage potential. Traditional methods for estimating perfusion parameters, such as singular value decomposition (SVD) and its variations, are known to be sensitive to noise and inaccuracies in the arterial input function. To our knowledge, there has been no implementation of deep learning methods for CT perfusion parameter estimation. Materials & methods: In this work, we propose a deep learning method based on the Transformer model, named CTPerformer-Net, for CT perfusion parameter estimation. In addition, our method incorporates some physical priors. We integrate physical consistency prior, smoothness prior and the physical model prior through the design of the loss function. We also generate a simulation dataset based on physical model prior for training the network model. Results: In the simulation dataset, CTPerformer-Net exhibits a 23.4 % increase in correlation coefficients, a 95.2 % decrease in system error, and a 90.7 % reduction in random error when contrasted with block-circulant SVD. CTPerformer-Net successfully identifies hypoperfused and infarcted lesions in 103 real CTP images from the ISLES 2018 challenge dataset. It achieves a mean dice score of 0.36 for the infarct core segmentation, which is slightly higher than the commercially available software (dice coefficient: 0.34) used as a reference level by the challenge. Conclusion: Experimental results on the simulation dataset demonstrate that CTPerformer-Net achieves better performance compared to block-circulant SVD. The real-world patient dataset confirms the validity of CTPerformer-Net.