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Ma Y, Dai Y, Zhao Y, Song Z, Hu C, Zhang Y. Radiomics model based on dual-energy CT can determine the source of thrombus in strokes with middle cerebral artery occlusion. Neuroradiology 2024; 66:1681-1691. [PMID: 38985319 DOI: 10.1007/s00234-024-03422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/29/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE To develop thrombus radiomics models based on dual-energy CT (DECT) for predicting etiologic cause of stroke. METHODS We retrospectively enrolled patients with occlusion of the middle cerebral artery who underwent computed tomography (NCCT) and DECT angiography (DECTA). 70 keV virtual monoenergetic images (simulate conventional 120kVp CTA images) and iodine overlay maps (IOM) were reconstructed for analysis. Five logistic regression radiomics models for predicting cardioembolism (CE) were built based on the features extracted from NCCT, CTA and IOM images. From these, the best one was selected to integrate with clinical information for further construction of the combined model. The performance of the different models was evaluated and compared using ROC curve analysis, clinical decision curves (DCA), calibration curves and Delong test. RESULTS Among all the radiomic models, model NCCT+IOM performed the best, with AUC = 0.95 significantly higher than model NCCT, model CTA, model IOM and model NCCT+CTA in the training set (AUC = 0.88, 0.78, 0.90,0.87, respectively, P < 0.05), and AUC = 0.92 in the testing set, significantly higher than model CTA (AUC = 0.71, P < 0.05). Smoking and NIHSS score were independent predictors of CE (P < 0.05). The combined model performed similarly to the model NCCT+IOM, with no statistically significant difference in AUC either in the training or test sets. (0.96 vs. 0.95; 0.94 vs. 0.92, both P > 0.05). CONCLUSION Radiomics models constructed based on NCCT and IOM images can effectively determine the source of thrombus in stroke without relying on clinical information.
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Affiliation(s)
- Yuzhu Ma
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215124, China
| | - Yao Dai
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215124, China
| | - Ying Zhao
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215124, China
| | - Ziyang Song
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215124, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yu Zhang
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215124, China.
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Li M, Zhou J, Sheng K, Guan B, Gu H, Jiang J. Radiomics of intrathrombus and perithrombus regions for Post-EVT intracranial hemorrhage risk Prediction: A multicenter CT study. Eur J Radiol 2024; 178:111653. [PMID: 39094465 DOI: 10.1016/j.ejrad.2024.111653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/14/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study aimed to assess the predictive performance of radiomics derived from computed tomography (CT) images of thrombus regions in predicting the risk of intracranial hemorrhage (ICH) following endovascular thrombectomy (EVT). MATERIALS AND METHODS This retrospective multicenter study included 336 patients who underwent admission CT and EVT for acute anterior-circulation large vessel occlusion between December 2018 and December 2023. Follow-up imaging was performed 24 h post-procedure to evaluate the occurrence of ICH. 230 patients from centers A and B were randomly allocated into training and test groups in a 7:3 ratio, while the remaining 106 patients from center C comprised the validation cohort. Radiologists manually segmenting the thrombus on CT images, and the perithrombus region was defined by expanding the initial region of interest (ROI). A total of 428 radiomics features were extracted from both intrathrombus and perithrombus regions on CT images. The Mann-Whitney U test was used for feature selection, and least absolute shrinkage and selection operator (LASSO) regression was employed for model development, followed by validation using a 5-fold cross-validation approach. Model performance was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC). RESULTS Among the eligible patients, 128 (38.1 %) experienced ICH after EVT. The combined model exhibited superior performance in the training cohort (AUC: 0.913, 95 % CI: 0.861-0.965), test cohort (AUC: 0.868, 95 % CI: 0.775-0.962), and validation cohort (AUC: 0.850, 95 % CI: 0.768-0.912). Notably, in the validation group, both the perithrombus and combined models demonstrated higher predictive accuracy compared to the intrathrombus model (0.837 vs. 0.684, p = 0.02; AUC: 0.850 vs. 0.684, p = 0.01). CONCLUSIONS Radiomics features derived from the perithrombus region significantly enhance the prediction of ICH after EVT, providing valuable insights for optimizing post-procedural clinical decisions. CLINICAL RELEVANCE STATEMENT This study highlights the importance of radiomics extracted from intrathrombus and perithrombus region in predicting intracranial hemorrhagefollowing endovascular thrombectomy, which can aid in improving patient outcomes.
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Affiliation(s)
- Minda Li
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Jingyi Zhou
- Department of Radiology, Kunshan Second People's Hospital, Kunshan, China
| | - Kai Sheng
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baohui Guan
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongmei Gu
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Jingxuan Jiang
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, China; Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Beaudoin AM, Ho JK, Lam A, Thijs V. Radiomics Studies on Ischemic Stroke and Carotid Atherosclerotic Disease: A Reporting Quality Assessment. Can Assoc Radiol J 2024; 75:549-557. [PMID: 38420881 DOI: 10.1177/08465371241234545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Objective: To assess the reporting quality of radiomics studies on ischemic stroke, intracranial and carotid atherosclerotic disease using the Image Biomarker Standardization Initiative (IBSI) reporting guidelines with the aim of finding avenues of improvement for future publications. Method: PubMed database was searched to identify relevant radiomics studies. Of 560 articles, 41 original research articles were included in this analysis. Based on IBSI radiomics reporting guidelines, checklists for CT-based and MRI-based studies were created to allow a structured and comprehensive evaluation of each study's adherence to these guidelines. Results: The main topics covered included radiomics studies were ischemic stroke, intracranial artery disease, and carotid atherosclerotic disease. The reporting checklist median score was 17/40 for the 20 CT-based radiomics studies and 22.5/50 for the 20 MRI-based studies. Basic items like imaging modality, region of interest, and image biomarker set utilized were included in all studies. However, details regarding image acquisition and reconstruction, post-acquisition image processing, and image biomarkers computation were inconsistently detailed across studies. Conclusion: The overall reporting quality of the included radiomics studies was suboptimal. These findings underscore a pressing need for improved reporting practices in radiomics research, to ensure validation and reproducibility of results. Our study provides insights into current reporting standards and highlights specific areas where adherence to IBSI guidelines could be significantly improved.
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Affiliation(s)
- Ann-Marie Beaudoin
- Université de Sherbrooke, Sherbrooke, QC, Canada
- The Florey, Heidelberg, VIC, Australia
| | - Jan Kee Ho
- The Florey, Heidelberg, VIC, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | | | - Vincent Thijs
- The Florey, Heidelberg, VIC, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia
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Gupta R, Bilgin C, Jabal MS, Kandemirli S, Ghozy S, Kobeissi H, Kallmes DF. Quality Assessment of Radiomics Studies on Functional Outcomes After Acute Ischemic Stroke-A Systematic Review. World Neurosurg 2024; 183:164-171. [PMID: 38056625 DOI: 10.1016/j.wneu.2023.11.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Radiomics is a machine-learning method that extracts features from medical images. The objective of the present systematic review was to assess the quality of existing studies that use radiomics methods to predict functional outcomes in patients after acute ischemic stroke. METHODS Studies using radiomics-extracted features to predict functional outcomes among patients with acute ischemic stroke using the modified Rankin Scale were included. PubMed, Scopus, Web of Science, and Embase were screened using the terms "radiomics" and "texture" in combination with "stroke." Quality scores were calculated based on Radiomics Quality Score, the IBSI (Image Biomarkers Standardization Initiative), and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). RESULTS Fourteen studies were included. The median total Radiomics Quality Score was 14.5 (13-16) out of 36. Domains 1, 5, and 6 on protocol quality and stability of imaging and segmentation, level of evidence, and use of open science and data, respectively, were poor. Median IBSI score was 2.5 (1-5) out of 6. Few studies included bias-field correction algorithms, isovoxel resampling, skull stripping, or gray-level discretization. Of 14 studies, none received +6 points, 1 received +5 points, 5 received +4 points, 1 study received +3 points, 5 received +2 points, 2 received +1 points, and none received 0 points. As per the QUADAS-2, 6/14 (42.9%) studies had a risk of bias concern and 0/14 (0%) had applicability concern. CONCLUSIONS The quality of the included studies was low to moderate. With increasing use of radiomics, future studies should attempt to adhere to and report established radiomics quality guidelines.
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Affiliation(s)
- Rishabh Gupta
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed S Jabal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sedat Kandemirli
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Samaniego EA, Boltze J, Lyden PD, Hill MD, Campbell BCV, Silva GS, Sheth KN, Fisher M, Hillis AE, Nguyen TN, Carone D, Favilla CG, Deljkich E, Albers GW, Heit JJ, Lansberg MG. Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke. Stroke 2023; 54:3190-3201. [PMID: 37942645 PMCID: PMC10841844 DOI: 10.1161/strokeaha.123.044985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STAIR XII (12th Stroke Treatment Academy Industry Roundtable) included a workshop to discuss the priorities for advancements in neuroimaging in the diagnostic workup of acute ischemic stroke. The workshop brought together representatives from academia, industry, and government. The participants identified 10 critical areas of priority for the advancement of acute stroke imaging. These include enhancing imaging capabilities at primary and comprehensive stroke centers, refining the analysis and characterization of clots, establishing imaging criteria that can predict the response to reperfusion, optimizing the Thrombolysis in Cerebral Infarction scale, predicting first-pass reperfusion outcomes, improving imaging techniques post-reperfusion therapy, detecting early ischemia on noncontrast computed tomography, enhancing cone beam computed tomography, advancing mobile stroke units, and leveraging high-resolution vessel wall imaging to gain deeper insights into pathology. Imaging in acute ischemic stroke treatment has advanced significantly, but important challenges remain that need to be addressed. A combined effort from academic investigators, industry, and regulators is needed to improve imaging technologies and, ultimately, patient outcomes.
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Affiliation(s)
- Edgar A. Samaniego
- Department of Neurology, Radiology and Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Johannes Boltze
- School of Life Sciences, The University of Warwick, Coventry, United Kingdom
| | - Patrick D. Lyden
- Zilkha Neurogenetic Institute of the Keck School of Medicine at USC, Los Angeles, California, United States
| | - Michael D. Hill
- Department of Clinical Neuroscience & Hotchkiss Brain Institute, University of Calgary & Foothills Medical Centre, Calgary, Canada
| | - Bruce CV Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Kevin N Sheth
- Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, United States
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United Stated
| | - Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Massachusetts, United States
| | - Davide Carone
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher G. Favilla
- Department of Neurology, University of Pennsylvania Philadelphia, Pennsylvania, Unites States
| | | | - Gregory W. Albers
- Department of Neurology, Stanford University, Stanford, California, United States
| | - Jeremy J. Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, California, United States
| | - Maarten G Lansberg
- Department of Neurology, Stanford University, Stanford, California, United States
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Zheng M, Zhu G, Chen D, Xiao Q, Lei T, Ye C, Pan C, Miao S, Ye L. T1-weighted images-based radiomics for structural lesions evaluation in patients with suspected axial spondyloarthritis. LA RADIOLOGIA MEDICA 2023; 128:1398-1406. [PMID: 37731149 DOI: 10.1007/s11547-023-01717-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The aim of this study was to investigate the feasibility of radiomics based on T1-weighted images (T1WI) for assessing sacroiliac joint (SIJ) structural lesions in patients with suspected axial spondyloarthritis (axSpA). MATERIALS AND METHODS A total of 266 patients with clinical suspicion of axSpA between December 2016 and January 2022 were enrolled. Structural lesions were assessed on low-dose CT (ldCT) and MRI, respectively. Radiomic features, extracted from SIJ T1WI, were included to generate the radiomics model. The performance of the radiomics model was evaluated using receiver operating characteristic (ROC) curve. Furthermore, point-biserial correlation analysis was used to interpret the associations between the radiomic feature and structural lesions. RESULTS Using ldCT as the reference standard, the radiomics model showed favorable performance for detecting positive global structural lesions in the training cohort (AUC, 0.82 [95% CI: 0.76, 0.88]) and validation cohort (AUC, 0.82 [95% CI: 0.72, 0.91]. Experienced MRI raters yielded predictive AUCs of 0.73 (95% CI: 0.67, 0.79), and 0.74 (95% CI: 0.66, 0.83) in the training and validation cohort, respectively. The seven radiomic features included in the radiomics model showed significant correlation with different kinds of structural lesions (P all < 0.05). Among them, Wavelet.LHL_firstorder_90Percentile showed the strongest association with fat lesion (r = 0.48, P < 0.05). CONCLUSION The radiomics analysis with T1WI could effectively detect SIJ structural lesions and achieved expert-level performance. Each radiomic feature was correlated with different structural lesions significantly, which might inform radiomic-based applications for axSpA intelligent diagnosis.
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Affiliation(s)
- Mo Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China
| | - Guanxia Zhu
- Department of Radiology, Longgang People's Hospital, Wenzhou, 325802, Zhejiang, China
| | - Dan Chen
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China
| | - Qinqin Xiao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China
| | - Tao Lei
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Chenhao Ye
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Chenqiang Pan
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Shouliang Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China.
| | - Lusi Ye
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China.
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Abdelnaby R, Mohamed KA, ELgenidy A, Sonbol YT, Bedewy MM, Aboutaleb AM, Dardeer KT, Heikal HA, Gawish HM, Nikoubashman O, Reich A, Pinho J. Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion : Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:405-414. [PMID: 36264354 PMCID: PMC10220103 DOI: 10.1007/s00062-022-01221-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with isolated posterior cerebral artery occlusion (iPCAO) represent up to 6% of all acute ischemic stroke patients. Acute revascularization therapies for these patients were not tested in randomized controlled trials. The aim of this study was to evaluate outcomes of iPCAO patients who undergo endovascular treatment (EVT). METHODS A systematic search of MEDLINE, Web of Science, CENTRAL, Scopus (inception-03/2022) was conducted for studies reporting 3‑month outcome, symptomatic intracranial hemorrhage (sICH) and/or successful recanalization in iPCAO patients who underwent EVT. Random effect meta-analyses for pooled proportions were calculated. Double-arm meta-analyses for comparison of outcomes of iPCAO patients treated with EVT with age-, sex- and NIHSS-matched iPCAO patients treated with best medical treatment only were performed. RESULTS Fifteen studies reporting a total of 461 iPCAO patients who underwent EVT were included. Excellent and favorable 3‑month outcome proportions were 36% (95% confidence interval, CI 20-51%) and 57% (95% CI 40-73%), respectively. The 3‑month mortality was 9% (95% CI 5-13), sICH occurred in 1% (95% CI 0-2%), successful recanalization was achieved in 79% (95% CI 71-86%). No significant differences in favorable and excellent 3‑month outcomes, 3‑month mortality and symptomatic intracerebral hemorrhage were found between the groups of patients who underwent EVT and the group of patients who received best medical treatment only. CONCLUSION These results support the feasibility and safety of EVT in iPCAO, but do not show an outcome benefit with EVT compared to best medical treatment. Randomized trials are needed to evaluate treatment benefit of EVT in these patients.
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Affiliation(s)
- Ramy Abdelnaby
- Department of Neurology, University Hospital, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | | | | | | | | | | | | | | | | | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Arno Reich
- Department of Neurology, University Hospital, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - João Pinho
- Department of Neurology, University Hospital, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Patel TR, Santo BA, Baig AA, Waqas M, Monterio A, Levy EI, Siddiqui AH, Tutino VM. Histologically interpretable clot radiomic features predict treatment outcomes of mechanical thrombectomy for ischemic stroke. Neuroradiology 2023; 65:737-749. [PMID: 36600077 DOI: 10.1007/s00234-022-03109-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Radiomics features (RFs) extracted from CT images may provide valuable information on the biological structure of ischemic stroke blood clots and mechanical thrombectomy outcome. Here, we aimed to identify RFs predictive of thrombectomy outcomes and use clot histomics to explore the biology and structure related to these RFs. METHODS We extracted 293 RFs from co-registered non-contrast CT and CTA. RFs predictive of revascularization outcomes defined by first-pass effect (FPE, near to complete clot removal in one thrombectomy pass), were selected. We then trained and cross-validated a balanced logistic regression model fivefold, to assess the RFs in outcome prediction. On a subset of cases, we performed digital histopathology on the clots and computed 227 histomic features from their whole slide images as a means to interpret the biology behind significant RF. RESULTS We identified 6 significantly-associated RFs. RFs reflective of continuity in lower intensities, scattered higher intensities, and intensities with abrupt changes in texture were associated with successful revascularization outcome. For FPE prediction, the multi-variate model had high performance, with AUC = 0.832 ± 0.031 and accuracy = 0.760 ± 0.059 in training, and AUC = 0.787 ± 0.115 and accuracy = 0.787 ± 0.127 in cross-validation testing. Each of the 6 RFs was related to clot component organization in terms of red blood cell and fibrin/platelet distribution. Clots with more diversity of components, with varying sizes of red blood cells and fibrin/platelet regions in the section, were associated with RFs predictive of FPE. CONCLUSION Upon future validation in larger datasets, clot RFs on CT imaging are potential candidate markers for FPE prediction.
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Affiliation(s)
- Tatsat R Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Briana A Santo
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Ammad A Baig
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Andre Monterio
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA.
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA.
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA.
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA.
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA.
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