Medical AI Detects Hidden ‘Stroke’ in the Brain

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“If it weren’t for the doctor, I wouldn’t have been able to say thank you. Thank you so much.” “The best thing you did was to come to the hospital without delay when the symptoms of doubt appeared. You must be especially careful about the risk of recurrence after discharge.”

Seo Kyung-je (63, pseudonym) and his guardian, who were admitted to the neurology ward of Korea University Guro Hospital, held the hand of Professor Han Jeong-hoon, who was making rounds, and repeatedly wiped away tears. Recently, Seo started to feel numbness in his right arm and leg. He dismissed it as due to the sudden cold weather, but three days ago, while watching TV and talking with his wife, his pronunciation suddenly became unclear and he could not put strength into his right leg. Seo, who was going to endure and go to the hospital the next day because it was late at night, finally visited the emergency room of Korea University Guro Hospital through 119, unable to withstand his wife’s anger.

“It’s suspected of a stroke. A doctor who specializes in stroke is on the way, so please wait a little.” A series of tests, including MRI imaging, were conducted swiftly, and while the emergency medical team was considering whether to admit him, Professor Han, who received an emergency call, arrived.

Professor Han’s gaze stopped as he was diligently looking at two monitors side by side with the results of Mr. Seo’s brain MRI test. The lesion was not clear from the image on the left monitor alone. If he was not a stroke specialist, he might have passed it over without much thought. However, a red dot was marked in the image on the right monitor. It was the moment when the MRI-based cerebral infarction diagnosis solution, which was introduced by Korea University Guro Hospital through the AI voucher support project of the Information and Communication Industry Promotion Agency, shone.

Professor Han said, “If a very small lesion occurs in the medulla in the brain, it is easy to dismiss it as an image defect (artifact),” and “It’s dizzying to think that if the symptoms manifested in the patient were a little weaker, he might have been discharged without any special measures.”

Stroke is a common disease that produces one patient every 3 seconds worldwide. In Korea, 130,000 to 150,000 new patients occur every year. According to the Health Insurance Review and Assessment Service, the number of patients treated for stroke increased by 7.1% in five years, from 591,946 in 2018 to 634,177 in 2022. More than half, 362,586 (57.1%), are over 70 years old, but there are not a few patients in their 60s, 174,109 (27.5%). Stroke is divided into cerebral infarction, where the blood vessels that supply blood to the brain are blocked and the brain tissue necrotizes, and cerebral hemorrhage, where the brain blood vessels burst. 73% of patients suffer from permanent disabilities after the onset, so the burden of sequelae is also large.

Especially in cerebral infarction, the golden time is directly related to sequelae. The golden time of cerebral infarction is ‘within 4.5 hours after symptom onset’, the time when intravenous thrombolytic therapy is possible. Considering the time to visit the hospital, and prepare for tests and medication, treatment can be started if you visit within at least 3 hours after symptom onset. After administering the thrombolytic agent, if a large cerebral blood vessel is blocked, an intra-arterial thrombectomy is performed.

Professor Han said, “It is recommended to receive intra-arterial thrombectomy within 6 hours after symptom onset. Depending on the cerebral infarction lesion, it is performed up to 24 hours after symptom onset.” He explained, “If intravenous thrombolytic therapy is administered after the onset of cerebral infarction, the probability of being able to live alone after 3 months of onset is twice as high as that of patients who did not, and if intra-arterial thrombectomy is successfully performed, the probability of having a good prognosis after 3 months of onset is 2.5 times higher.”

Three neurologists can perform neuro-interventional procedures such as intra-arterial thrombectomy at Korea University Guro Hospital, including Professor Han. Even in the Seoul area, there are far less than 100, so they take ‘on-call (phone standby)’ duty, which is far away. They know better than anyone that the initial response determines the life of a stroke patient. As soon as symptoms of doubt appear, you must visit a hospital where a stroke specialist is resident as quickly as possible to minimize sequelae.

Professor Han Jeong-hoon of Korea University Guro Hospital is introducing his experience of using the MRI-based cerebral infarction diagnosis solution. Photo provided by Korea University Guro Hospital

Korea University Guro Hospital treats more than 500 cerebral infarction patients a year with an organic cooperation system of various medical departments such as neurology, neurosurgery, radiology, and rehabilitation medicine. Based on the accumulated clinical data in this process, we joined hands with domestic company JLK (322510) to develop a one-stop solution that presents AI reading results at the expert level along with the original image and introduced it to the clinical field. ‘JBS-01K’, which was awarded the first health insurance fee for AI medical solutions in October last year, not only detects suspected lesions of cerebral infarction from diffusion-weighted MR images, but also analyzes the size, location, and pattern of lesions to provide the probability values for large vessel cerebral infarction, cardiogenic cerebral infarction, and small vessel cerebral infarction, each at the expert level.

Professor Han said, “Even if you take an image, would you waste time deciding on treatment if you miss a lesion” and “If you use AI technology that assists doctors’ diagnosis and treatment process well, it could be a solution to the collapse of essential medical care, including stroke.”

After using the AI solution directly for about six months, he became convinced that it would be a useful alternative in rural medical centers and small and medium-sized hospitals that are struggling with chronic doctor shortages, not only at night and on weekends when there are not enough specialists to interpret emergency images. Of course, this is based on the premise that the patient visits the hospital immediately after the symptoms occur.

The Korean Stroke Society provides ‘neighbor’s hand and foot gaze’ as a simple test to diagnose stroke symptoms. Neighbor’s hand and foot gaze is an acronym for △if you can’t smile saying ‘this’ △if you can’t stretch both hands forward or there is more strength in one arm, leg △if pronunciation becomes unclear or there are symptoms of aphasia △if the gaze is biased to one side. He said, “The number of patients who visit the hospital within 3 hours after the onset of a stroke has not reached 30% for 10 years.” He emphasized, “If any of the suspected symptoms of stroke appear, you must immediately call 119 and visit a stroke center.”

By. Kyung Jin Ahn