Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI

Marijn Borghouts; Richard McKinley; Manuel Köstner; Josien Pluim; Roland Wiest; Ruisheng Su

doi:10.1007/978-3-032-07945-9_7

Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI

Marijn Borghouts (Corresponding author)
, Richard McKinley
, Manuel Köstner
, Josien Pluim
, Roland Wiest
, Ruisheng Su

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › Academic › peer-review

Abstract

Distinguishing acute ischemic strokes (AIS) from stroke mimics (SMs), particularly in cases involving medium and small vessel occlusions, remains a significant diagnostic challenge. While computed tomography (CT) based protocols are commonly used in emergency settings, their sensitivity for detecting distal occlusions is limited. This study explores the potential of magnetic resonance perfusion (MRP) imaging as a tool for differentiating distal AIS from epileptic seizures, a prevalent SM. Using a retrospective dataset of 162 patients (129 AIS, 33 seizures), we extracted region-wise perfusion map descriptors (PMDs) from dynamic susceptibility contrast (DSC) images. Statistical analyses identified several brain regions, located mainly in the temporal and occipital lobe, exhibiting significant group differences in certain PMDs. Hemispheric asymmetry analyses further highlighted these regions as discriminative. A logistic regression model trained on PMDs achieved an area under the receiver operating characteristic (AUROC) curve of 0.90, and an area under the precision recall curve (AUPRC) of 0.74, with a specificity of 92% and a sensitivity of 73%, suggesting strong performance in distinguishing distal AIS from seizures. These findings support further exploration of MRP-based PMDs as interpretable features for distinguishing true strokes from various mimics. The code is openly available at our GitHub github.com/Marijn311/PMD_extraction_and_analysis.

Original language	English
Title of host publication	Image Analysis in Stroke Diagnosis and Interventions
Subtitle of host publication	International Workshop, SWITCH 2025, Held in Conjunction with MICCAI 2025, Daejeon, South Korea, September 23, 2025, Proceedings
Editors	Ruisheng Su, Ezequiel de la Rosa, Linda Vorberg, Jiong Zhang, Adam Hilbert, Leonhard Rist, Theo van Walsum
Place of Publication	Cham
Publisher	Springer
Pages	62-72
Number of pages	11
ISBN (Electronic)	978-3-032-07945-9
ISBN (Print)	978-3-032-07944-2
DOIs	https://doi.org/10.1007/978-3-032-07945-9_7
Publication status	Published - 10 Oct 2025
Event	5th International Workshop on Imaging and Treatment Challenges, SWITCH 2025, Held in Conjunction with Medical Image Computing and Computer Assisted Intervention, MICCAI 2025 - Daejeon, Korea, Republic of Duration: 23 Sept 2025 → 23 Sept 2025

Publication series

Name	Lecture Notes in Computer Science (LNCS)
Volume	16098
ISSN (Print)	0302-9743
ISSN (Electronic)	1611-3349

Conference

Conference	5th International Workshop on Imaging and Treatment Challenges, SWITCH 2025, Held in Conjunction with Medical Image Computing and Computer Assisted Intervention, MICCAI 2025
Country/Territory	Korea, Republic of
City	Daejeon
Period	23/09/25 → 23/09/25

Bibliographical note

Publisher Copyright:
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2026.

Keywords

Acute Ischemic Stroke
Distal Strokes
Dynamic Susceptibility Contrast MRI
Epileptic Seizures
Perfusion Analysis
Quantitative Brain Perfusion
Stroke Mimic

Access to Document

10.1007/978-3-032-07945-9_7

Cite this

Borghouts, M., McKinley, R., Köstner, M., Pluim, J., Wiest, R., & Su, R. (2025). Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI. In R. Su, E. de la Rosa, L. Vorberg, J. Zhang, A. Hilbert, L. Rist, & T. van Walsum (Eds.), Image Analysis in Stroke Diagnosis and Interventions: International Workshop, SWITCH 2025, Held in Conjunction with MICCAI 2025, Daejeon, South Korea, September 23, 2025, Proceedings (pp. 62-72). (Lecture Notes in Computer Science (LNCS); Vol. 16098). Springer. https://doi.org/10.1007/978-3-032-07945-9_7

Borghouts, Marijn ; McKinley, Richard ; Köstner, Manuel et al. / Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI. Image Analysis in Stroke Diagnosis and Interventions: International Workshop, SWITCH 2025, Held in Conjunction with MICCAI 2025, Daejeon, South Korea, September 23, 2025, Proceedings. editor / Ruisheng Su ; Ezequiel de la Rosa ; Linda Vorberg ; Jiong Zhang ; Adam Hilbert ; Leonhard Rist ; Theo van Walsum. Cham : Springer, 2025. pp. 62-72 (Lecture Notes in Computer Science (LNCS)).

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abstract = "Distinguishing acute ischemic strokes (AIS) from stroke mimics (SMs), particularly in cases involving medium and small vessel occlusions, remains a significant diagnostic challenge. While computed tomography (CT) based protocols are commonly used in emergency settings, their sensitivity for detecting distal occlusions is limited. This study explores the potential of magnetic resonance perfusion (MRP) imaging as a tool for differentiating distal AIS from epileptic seizures, a prevalent SM. Using a retrospective dataset of 162 patients (129 AIS, 33 seizures), we extracted region-wise perfusion map descriptors (PMDs) from dynamic susceptibility contrast (DSC) images. Statistical analyses identified several brain regions, located mainly in the temporal and occipital lobe, exhibiting significant group differences in certain PMDs. Hemispheric asymmetry analyses further highlighted these regions as discriminative. A logistic regression model trained on PMDs achieved an area under the receiver operating characteristic (AUROC) curve of 0.90, and an area under the precision recall curve (AUPRC) of 0.74, with a specificity of 92\% and a sensitivity of 73\%, suggesting strong performance in distinguishing distal AIS from seizures. These findings support further exploration of MRP-based PMDs as interpretable features for distinguishing true strokes from various mimics. The code is openly available at our GitHub github.com/Marijn311/PMD\_extraction\_and\_analysis.",

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Borghouts, M, McKinley, R, Köstner, M, Pluim, J, Wiest, R & Su, R 2025, Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI. in R Su, E de la Rosa, L Vorberg, J Zhang, A Hilbert, L Rist & T van Walsum (eds), Image Analysis in Stroke Diagnosis and Interventions: International Workshop, SWITCH 2025, Held in Conjunction with MICCAI 2025, Daejeon, South Korea, September 23, 2025, Proceedings. Lecture Notes in Computer Science (LNCS), vol. 16098, Springer, Cham, pp. 62-72, 5th International Workshop on Imaging and Treatment Challenges, SWITCH 2025, Held in Conjunction with Medical Image Computing and Computer Assisted Intervention, MICCAI 2025, Daejeon, Korea, Republic of, 23/09/25. https://doi.org/10.1007/978-3-032-07945-9_7

Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI. / Borghouts, Marijn (Corresponding author); McKinley, Richard; Köstner, Manuel et al.
Image Analysis in Stroke Diagnosis and Interventions: International Workshop, SWITCH 2025, Held in Conjunction with MICCAI 2025, Daejeon, South Korea, September 23, 2025, Proceedings. ed. / Ruisheng Su; Ezequiel de la Rosa; Linda Vorberg; Jiong Zhang; Adam Hilbert; Leonhard Rist; Theo van Walsum. Cham: Springer, 2025. p. 62-72 (Lecture Notes in Computer Science (LNCS); Vol. 16098).

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › Academic › peer-review

TY - GEN

T1 - Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI

AU - Borghouts, Marijn

AU - McKinley, Richard

AU - Köstner, Manuel

AU - Pluim, Josien

AU - Wiest, Roland

AU - Su, Ruisheng

N1 - Publisher Copyright: © The Author(s), under exclusive license to Springer Nature Switzerland AG 2026.

PY - 2025/10/10

Y1 - 2025/10/10

N2 - Distinguishing acute ischemic strokes (AIS) from stroke mimics (SMs), particularly in cases involving medium and small vessel occlusions, remains a significant diagnostic challenge. While computed tomography (CT) based protocols are commonly used in emergency settings, their sensitivity for detecting distal occlusions is limited. This study explores the potential of magnetic resonance perfusion (MRP) imaging as a tool for differentiating distal AIS from epileptic seizures, a prevalent SM. Using a retrospective dataset of 162 patients (129 AIS, 33 seizures), we extracted region-wise perfusion map descriptors (PMDs) from dynamic susceptibility contrast (DSC) images. Statistical analyses identified several brain regions, located mainly in the temporal and occipital lobe, exhibiting significant group differences in certain PMDs. Hemispheric asymmetry analyses further highlighted these regions as discriminative. A logistic regression model trained on PMDs achieved an area under the receiver operating characteristic (AUROC) curve of 0.90, and an area under the precision recall curve (AUPRC) of 0.74, with a specificity of 92% and a sensitivity of 73%, suggesting strong performance in distinguishing distal AIS from seizures. These findings support further exploration of MRP-based PMDs as interpretable features for distinguishing true strokes from various mimics. The code is openly available at our GitHub github.com/Marijn311/PMD_extraction_and_analysis.

AB - Distinguishing acute ischemic strokes (AIS) from stroke mimics (SMs), particularly in cases involving medium and small vessel occlusions, remains a significant diagnostic challenge. While computed tomography (CT) based protocols are commonly used in emergency settings, their sensitivity for detecting distal occlusions is limited. This study explores the potential of magnetic resonance perfusion (MRP) imaging as a tool for differentiating distal AIS from epileptic seizures, a prevalent SM. Using a retrospective dataset of 162 patients (129 AIS, 33 seizures), we extracted region-wise perfusion map descriptors (PMDs) from dynamic susceptibility contrast (DSC) images. Statistical analyses identified several brain regions, located mainly in the temporal and occipital lobe, exhibiting significant group differences in certain PMDs. Hemispheric asymmetry analyses further highlighted these regions as discriminative. A logistic regression model trained on PMDs achieved an area under the receiver operating characteristic (AUROC) curve of 0.90, and an area under the precision recall curve (AUPRC) of 0.74, with a specificity of 92% and a sensitivity of 73%, suggesting strong performance in distinguishing distal AIS from seizures. These findings support further exploration of MRP-based PMDs as interpretable features for distinguishing true strokes from various mimics. The code is openly available at our GitHub github.com/Marijn311/PMD_extraction_and_analysis.

KW - Acute Ischemic Stroke

KW - Distal Strokes

KW - Dynamic Susceptibility Contrast MRI

KW - Epileptic Seizures

KW - Perfusion Analysis

KW - Quantitative Brain Perfusion

KW - Stroke Mimic

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SN - 978-3-032-07944-2

T3 - Lecture Notes in Computer Science (LNCS)

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EP - 72

BT - Image Analysis in Stroke Diagnosis and Interventions

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A2 - Rist, Leonhard

A2 - van Walsum, Theo

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Borghouts M, McKinley R, Köstner M, Pluim J, Wiest R, Su R. Discriminating Distal Ischemic Stroke from Seizure-Induced Stroke Mimics Using Dynamic Susceptibility Contrast MRI. In Su R, de la Rosa E, Vorberg L, Zhang J, Hilbert A, Rist L, van Walsum T, editors, Image Analysis in Stroke Diagnosis and Interventions: International Workshop, SWITCH 2025, Held in Conjunction with MICCAI 2025, Daejeon, South Korea, September 23, 2025, Proceedings. Cham: Springer. 2025. p. 62-72. (Lecture Notes in Computer Science (LNCS)). doi: 10.1007/978-3-032-07945-9_7