Key result
Spectral clustering of TCD waveforms identifies 4 distinct flow types, revealing 2 novel morphology patterns.
Why the study?
TIBI flow grades on TCD provide evidence for cerebrovascular occlusion and stenosis but require subjective assessment by expert evaluators to be reliable.
Can TCD waveform morphology be objectively assessed and categorized using an unsupervised machine learning approach?
Cross-Sectional (n=106)
Yes
Can TCD waveform morphology be objectively assessed and categorized using an unsupervised machine learning approach?
Automated spectral clustering of TCD waveforms can objectively identify pathological flow types associated with large vessel occlusion, potentially improving prehospital stroke assessment.
Supports objective TCD classification beyond TIBI; leaves open whether it enhances prehospital stroke triage.
Cerebral Blood Flow Velocity waveforms acquired via Transcranial Doppler (TCD) can provide evidence for cerebrovascular occlusion and stenosis. Thrombolysis in Brain Ischemia (TIBI) flow grades are widely used for this purpose, but require subjective assessment by expert evaluators to be reliable. In this work we seek to determine whether TCD morphology can be objectively assessed using an unsupervised machine learning approach to waveform categorization. TCD beat waveforms were recorded at multiple depths from the Middle Cerebral Arteries of 106 subjects; 33 with Large Vessel Occlusion (LVO). From each waveform, three morphological features were extracted, quantifying onset of maximal velocity, systolic canopy length, and the number/prominence of peaks/troughs. Spectral clustering identified groups implicit in the resultant three-dimensional feature space, with gap statistic criteria establishing the optimal cluster number. We found that gap statistic disparity was maximized at four clusters, referred to as flow types I, II, III, and IV. Types I and II were primarily composed of control subject waveforms, whereas types III and IV derived mainly from LVO patients. Cluster morphologies for types I and IV aligned clearly with Normal and Blunted TIBI flows, respectively. Types II and III represented commonly observed flow-types not delineated by TIBI, which nonetheless deviate from normal and blunted flows. We conclude that important morphological variability exists beyond that currently quantified by TIBI in populations experiencing or at-risk for acute ischemic stroke, and posit that the observed flow-types provide the foundation for objective methods of real-time automated flow type classification.
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Thorpe et al. (2020) conducted a cross-sectional in Large Vessel Occlusion (n=106). Spectral clustering of TCD waveform morphology vs. Control subjects (in-hospital and out-of-hospital) was evaluated on Optimal cluster number based on gap statistic criteria. Spectral clustering of TCD waveforms identified four distinct flow types, with types I and IV aligning with normal and blunted TIBI flows, while types II and III represented novel flow types.
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