Evaluating Performance of a Deep Learning Multilabel Segmentation Model to Quantify Acute and Chronic Brain Lesions at MRI after Stroke and Predict Prognosis

“Just Accepted” papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To develop and evaluate a multilabel deep learning network to identify and quantify acute and chronic brain lesions on multisequence MRI after acute ischemic stroke (AIS) and assess relationships between clinical and model-extracted radiologic features of the lesions and patient prognosis. Materials and Methods This retrospective study included AIS patients from multiple centers (September 2008– October 2022) who underwent MRI and thrombolysis or antiplatelets and/or anticoagulants treatment. A SegResNet-based deep learning model was developed to segment core infarcts and white matter hyperintensity (WMH) burdens on diffusion-weighted imaging and fluid-attenuated inversion recovery images. The model was trained, validated and tested with manual labels ( n = 260, 60, and 40 patients in each dataset, respectively). Radiologic features extracted from the model, including regional infarct size and periventricular and deep WMH volumes and cluster numbers, combined with clinical variables, were used to predict favorable versus unfavorable patient outcomes at 7 days (modified Rankin scale [mRS] score). Mediation analyses explored associations between radiologic features and AIS outcomes within different treatment groups. Results A total of 1,008 patients (mean age, 67.0 ± 11.8 years; 686 male, 322 female) were included. The training and validation dataset comprised 702 patients with AIS, and the two external testing datasets included 206 and 100 patients, respectively. The prognostic model combining clinical and radiologic features achieved AUCs of 0.81 (95% CI: 0.74–0.88) and 0.77 (95% CI: 0.68–0.86) for predicting 7-day outcomes in the two external testing datasets, respectively. Mediation analyses revealed that deep WMH in patients treated with thrombolysis had a significant direct effect (17.7%, P = .01) and indirect effect (10.7%, P = .01) on unfavorable outcomes, as indicated by higher mRS scores, which was not observed in patients treated antiplatelets and/or anticoagulants. Conclusion The proposed deep learning model quantitatively analyzed radiologic features of acute and chronic brain lesions, and extracted radiologic features combined with clinical variables predicted short-term AIS outcomes. WMH burden, particularly deep WMH, emerged as a risk factor for poor outcomes in patients treated with thrombolysis. ©RSNA, 2025