StrokeTimer: Robust Representation Learning for Ischemic Stroke Onset-Time Estimation from Non-contrast CT
Authors: Weiru Wang, Susanne G. H. Olthuis, Elizaveta Lavrova, Robert J. van Oostenbrugge, Charles B. L. M. Majoie, Wim H. van Zwam, Ruisheng Su
Abstract
Ischemic stroke is a major global disease. Treatment decisions are highly time-sensitive, as eligibility for reperfusion therapies relies on the interval between stroke onset and intervention. However, the true onset time is often uncertain in clinical practice, necessitating imaging-based assessment of tissue age as a surrogate marker. Early ischemic changes on routinely acquired non-contrast CT (NCCT) are often subtle, and real-world clinical datasets exhibit pronounced onset-time class imbalance and center-scanner-related heterogeneity. In this work, we propose StrokeTimer, a fully automated framework for onset-time estimation in acute ischemic stroke. StrokeTimer integrates self-supervised disentanglement learning with energy-guided contrastive learning to capture subtle ischemic patterns while addressing long-tailed data distributions under acquisition variability. Onset time is categorized into three clinically relevant windows: <4.5 h, 4.5-6 h, and >6 h. Experimental results on a large multi-center NCCT dataset from two national cohorts, MR CLEAN Registry and MR CLEAN LATE, show that StrokeTimer achieves a macro AUC of 0.69 and a macro F1-score of 0.57, improving the strongest baseline by nearly 50% (p < 0.005). In this realistic, challenging setting, representative baseline approaches exhibit near-chance macro performance. Model explanations further highlight subtle gray-white matter blurring and hypodense regions consistent with established radiological biomarkers. These findings demonstrate the potential of StrokeTimer to support treatment decision-making in acute ischemic stroke. Code is available at https://github.com/BrainVas/StrokeTimer.
Accurate segmentation of brain stroke lesions in non-contrast computed tomography (NCCT) scans is critical for rapid clinical decision-making, yet remains difficult due to the low contrast between lesion and normal brain tissue, heterogeneous lesion morphology across ischemic and hemorrhagic subtypes, and ambiguous boundaries caused by partial volume effects. Current deep learning approaches primarily optimize region-level overlap but lack explicit boundary modeling, leading to imprecise delineation that can affect volumetric assessment and treatment planning. We propose FSB-Net, a frequency-spatial boundary network that leverages frequency-domain analysis for boundary-aware stroke lesion segmentation. FSB-Net introduces three components: (i) a Wavelet Boundary Detection Head (WBDH) that applies the discrete wavelet transform to multi-scale encoder features, extracting high-frequency sub-bands as boundary representations; (ii) a Frequency-Spatial Cross-Attention Module (FSCAM) that performs bidirectional attention between wavelet boundary features and spatial decoder features for selective boundary enhancement; and (iii) a Spectral Boundary Loss that penalizes high-frequency discrepancies in the Fourier domain to optimize boundary sharpness. Built on a PVTv2-B2 encoder, FSB-Net is evaluated on a public Brain Stroke CT dataset containing both ischemic and hemorrhagic cases. Experimental results show that FSB-Net outperforms U-Net, UNet++, MANet, and DeepLabV3+ across all metrics, achieving state-of-the-art performance in mean Dice, mean IoU, and HD95.
Deep learning frameworks like nnU-Net achieve state-of-theart brain lesion segmentation performance but remain difficult to deploy in clinical research environments due to, among other reasons, software dependencies and computational requirements. We introduce StrokeSeg2, a lightweight, modular, cross-platform C++/Qt framework designed to adapt resource-intensive 3D stroke segmentation pipelines into portable and reproducible applications. To improve compatibility with standard clinical workstations, we investigate the combined effect of architectural compression through knowledge distillation and inference optimisation using ONNX Runtime with Float16 quantisation. Across heterogeneous hardware configurations (CPU, integrated GPU, and dedicated GPU) architectural distillation emerged as the primary contributor to efficiency gains, contributing to over 90% reduction in energy consumption and an average 84% reduction in inference time. Specifically, we identify a 0.84M-parameter student model as the most favourable trade-off, reducing the original 102.3M-parameter teacher architecture to a 2.1 MB disk footprint while preserving robust lesion localisation and competitive segmentation performance. This small footprint supports the development of a self-contained installer for clinical workstation targets. Finally, StrokeSeg2 packages these optimisations into standalone installers for Windows, macOS, and Linux. By providing both graphical and commandline interfaces without Docker or external environment dependencies, StrokeSeg2 facilitates deployment of high-performance segmentation workflows for routine clinical research pipelines.
Youwan Mahé, Axel Plessis, Stéphanie Leplaideur +3
Stroke patient cross-subject electroencephalography (EEG) decoding of motor imagery (MI) brain-computer interface (BCI) is essential for motor rehabilitation, yet lesion-related abnormal temporal dynamics and pronounced inter-patient heterogeneity often undermine generalization. Existing adaptation methods are easily misled by pathological slow-wave activity and unstable target-domain pseudo-labels. To address this challenge, we propose PA-TCNet, a pathology-aware temporal calibration framework with physiology-guided target refinement for stroke motor imagery decoding. PA-TCNet integrates two coordinated components. The Pathology-aware Rhythmic State Mamba (PRSM) module decomposes EEG spatiotemporal features into slowly varying rhythmic context and fast transient perturbations, injecting the fused pathological context into selective state propagation to more effectively capture abnormal temporal dynamics. The Physiology-Guided Target Calibration (PGTC) module constructs source-domain sensorimotor region-of-interest templates, imposing physiological consistency constraints and dynamically refining target-domain pseudo-labels, thereby improving adaptation reliability. Leave-one-subject-out experiments on two independent stroke EEG datasets, XW-Stroke and 2019-Stroke, yielded mean accuracies of 66.56% and 72.75%, respectively, outperforming state-of-the-art baselines. These results indicate that jointly modeling pathological temporal dynamics and physiology-constrained pseudo-supervision can provide more robust cross-subject initialization for personalized post-stroke MI-BCI rehabilitation. The implemented code is available at https://github.com/wxk1224/PA-TCNet.