Measuring stroke treatment effect using images acquired during treatment

Q-Maestro: Quantification of brain reperfusion in X-ray images in endovascular treatment of stroke patients

Ischemic stroke is a worldwide major cause of death and permanent disability. In the Netherlands more than 26,000 ischemic stroke patients are admitted to a hospital per year. A recent breakthrough study showed that patient outcome in acute stroke caused by an occlusion of a large vessel could be improved with endovascular therapy. However, not all patients benefit from this intervention, and the current score to measure treatment success (TICI) measure recanalization, and does not match well with outcome. This project therefore aims to develop methods to quantify and assess reperfusion of small vessels (based on images during the intervention) as a treatment outcome.

To this end, Philips Healthcare will collaborate with the Interventional Neuroradiology Section and the Biomedical Imaging Group Rotterdam (both Erasmus MC) to address this challenge. Philips Healthcare is one of the largest players in interventional imaging systems, with great expertise in medical imaging. The Section of  Interventional Neuroradiology is one of the largest in The Netherlands (part of the Erasmus MC Stroke Center ), and has world-class expertise in treating stroke patients. The BIGR group, with great expertise in medical image processing, complete the expertise required to address this challenge.

In the approach, the replacement of the recanalisation concept, the current measure of treatment success, with a measure of reperfusion is a major innovation. In the first part of the project, perfusion biomarkers will be investigated that can potentially be quantified based on projection imaging. Simultaneously, it will be studied which perfusion parameters are most relevant in clinical practice. The results of both initial studies will guide the development of quantitative imaging biomarkers from interventional images. In the final year, the imaging biomarkers developed will be validated using clinical data.

The project results may help clinicians to select patients for additional pharmacological treatment in case of insufficient reperfusion after treatment. This may lead to improved outcome of stroke treatment. Per-procedural (in the angiosuite) identification of the absence of reperfusion of brain tissue by DSA image analysis is therefore of great importance for the patient and society.

This collaboration project is co-funded by the PPP Allowance made available by Health~Holland, Top Sector Life Sciences & Health, to EMC to stimulate public-private partnerships. For questions, please contact EMC directly via the following email address
Determining the effect of stroke treatment during treatment may help in selecting alternative therapies for patients where the intended treatment does not work. This project focuses on developing and assessing methods that compute brain perfusion from X-ray images during treatment, and investigates how therapy decisions and patient outcome can be improved.
Technology Readiness Level (TRL)
2 - 3
Time period
48 months