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Generating Synthetic MR Perfusion Maps from DWI and FLAIR in Acute Ischemic Stroke: Development and External Validation of a Deep Learning Model

Matsulevits A, Koch A, Mahé-Verdure C, Bendszus M, Hilbert A, Boullet M, Marnat G, Mutke MA et al.

2025

355 participants

Abstract

Background: Magnetic resonance imaging (MRI) is critical for acute stroke triage, but time-consuming, and often requires contrast injection for perfusion imaging. This study aimed to synthesize T-map perfusion maps from routinely available, non-contrast DWI and FLAIR using deep generative models. We hypothesized that relevant perfusion information could be inferred from these modalities to streamline imaging and reduce reliance on dynamic susceptibility contrast perfusion.

Methods: Acute MRI data from 355 patients with anterior circulation stroke, including dynamic susceptibility contrast perfusion, were retrospectively collected from two European centers (Heidelberg: 2010–2018; Bordeaux: 2021–2022). Six versions of a denoising diffusion probabilistic model (DDPM) and a GAN architecture were trained to generate synthetic T-max perfusion maps from DWI, FLAIR, and infarct core mask as inputs. Performance was assessed by comparing synthetic and ground truth T-max maps using image similarity metrics. Regions with T-max >6s were compared using Dice coefficients, and mismatch volume distributions were analyzed. An ablation study quantified the contribution of each input.

Results: The best performance was achieved by a DDPM with a 2.5D architecture using DWI, FLAIR, infarct core mask, and a perfusion-weighted loss function. It produced synthetic perfusion T-max maps with high similarity to ground truth under 110 seconds. The model showed strong spatial overlap for T-max >6s regions…

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