1
|
Guo K, Zhu B, Li R, Xi J, Wang Q, Chen K, Shao Y, Liu J, Cao W, Liu Z, Di Z, Gu N. Machine learning-based nomogram: integrating MRI radiomics and clinical indicators for prognostic assessment in acute ischemic stroke. Front Neurol 2024; 15:1379031. [PMID: 38933326 PMCID: PMC11202100 DOI: 10.3389/fneur.2024.1379031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/29/2024] [Indexed: 06/28/2024] Open
Abstract
Background Acute Ischemic Stroke (AIS) remains a leading cause of mortality and disability worldwide. Rapid and precise prognostication of AIS is crucial for optimizing treatment strategies and improving patient outcomes. This study explores the integration of machine learning-derived radiomics signatures from multi-parametric MRI with clinical factors to forecast AIS prognosis. Objective To develop and validate a nomogram that combines a multi-MRI radiomics signature with clinical factors for predicting the prognosis of AIS. Methods This retrospective study involved 506 AIS patients from two centers, divided into training (n = 277) and validation (n = 229) cohorts. 4,682 radiomic features were extracted from T1-weighted, T2-weighted, and diffusion-weighted imaging. Logistic regression analysis identified significant clinical risk factors, which, alongside radiomics features, were used to construct a predictive clinical-radiomics nomogram. The model's predictive accuracy was evaluated using calibration and ROC curves, focusing on distinguishing between favorable (mRS ≤ 2) and unfavorable (mRS > 2) outcomes. Results Key findings highlight coronary heart disease, platelet-to-lymphocyte ratio, uric acid, glucose levels, homocysteine, and radiomics features as independent predictors of AIS outcomes. The clinical-radiomics model achieved a ROC-AUC of 0.940 (95% CI: 0.912-0.969) in the training set and 0.854 (95% CI: 0.781-0.926) in the validation set, underscoring its predictive reliability and clinical utility. Conclusion The study underscores the efficacy of the clinical-radiomics model in forecasting AIS prognosis, showcasing the pivotal role of artificial intelligence in fostering personalized treatment plans and enhancing patient care. This innovative approach promises to revolutionize AIS management, offering a significant leap toward more individualized and effective healthcare solutions.
Collapse
Affiliation(s)
- Kun Guo
- Xi'an Central Hospital, Xi’an, China
| | - Bo Zhu
- Xi'an Central Hospital, Xi’an, China
| | - Rong Li
- Xi'an Central Hospital, Xi’an, China
| | - Jing Xi
- Xi'an Central Hospital, Xi’an, China
| | - Qi Wang
- China-Japan Union Hospital of Jilin University, Changchun, China
| | - KongBo Chen
- Tongchuan Mining Bureau Central Hospital, Tongchuan, China
| | - Yuan Shao
- Tongchuan Mining Bureau Central Hospital, Tongchuan, China
| | - Jiaqi Liu
- Tongchuan Mining Bureau Central Hospital, Tongchuan, China
| | - Weili Cao
- Xi'an Central Hospital, Xi’an, China
| | | | | | | |
Collapse
|
2
|
Yang Y, Guo Y. Ischemic stroke outcome prediction with diversity features from whole brain tissue using deep learning network. Front Neurol 2024; 15:1394879. [PMID: 38765270 PMCID: PMC11099238 DOI: 10.3389/fneur.2024.1394879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024] Open
Abstract
Objectives This study proposed an outcome prediction method to improve the accuracy and efficacy of ischemic stroke outcome prediction based on the diversity of whole brain features, without using basic information about patients and image features in lesions. Design In this study, we directly extracted dynamic radiomics features (DRFs) from dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) and further extracted static radiomics features (SRFs) and static encoding features (SEFs) from the minimum intensity projection (MinIP) map, which was generated from the time dimension of DSC-PWI images. After selecting whole brain features Ffuse from the combinations of DRFs, SRFs, and SEFs by the Lasso algorithm, various machine and deep learning models were used to evaluate the role of Ffuse in predicting stroke outcomes. Results The experimental results show that the feature Ffuse generated from DRFs, SRFs, and SEFs (Resnet 18) outperformed other single and combination features and achieved the best mean score of 0.971 both on machine learning models and deep learning models and the 95% CI were (0.703, 0.877) and (0.92, 0.983), respectively. Besides, the deep learning models generally performed better than the machine learning models. Conclusion The method used in our study can achieve an accurate assessment of stroke outcomes without segmentation of ischemic lesions, which is of great significance for rapid, efficient, and accurate clinical stroke treatment.
Collapse
Affiliation(s)
- Yingjian Yang
- School of Electrical and Information Engineering, Northeast Petroleum University, Daqing, China
- Shenzhen Lanmage Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Yingwei Guo
- School of Electrical and Information Engineering, Northeast Petroleum University, Daqing, China
| |
Collapse
|
3
|
Zhou L, Pan W, Huang R, Wang T, Wei Z, Wang H, Zhang Y, Li Y. Amide Proton Transfer-Weighted MRI, Associations with Clinical Severity and Prognosis in Ischemic Strokes. J Magn Reson Imaging 2024. [PMID: 38426606 DOI: 10.1002/jmri.29333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) scores have important shortcomings. Amide proton transfer-weighted (APTw) imaging might offer more valuable information in ischemic strokes assessment. PURPOSE To utilize APTw, apparent diffusion coefficient (ADC), and computed tomography perfusion (CTP) for the assessment of clinical symptom severity and 90-day prognosis in patients diagnosed with ischemic stroke. STUDY TYPE Prospective. SUBJECTS 61 patients (mean age 63.2 ± 9.7 years; 46 males, 15 females) with ischemic strokes were included in the study. FIELD STRENGTH/SEQUENCE 3T/turbo spin echo (TSE) T1 -weighted imaging, T2 -weighted imaging, T2 -fluid attenuated inversion recovery (T2 -FLAIR), diffusion-weighted imaging (DWI), and single-shot TSE APTw imaging. ASSESSMENT APTw, ADC, and CTP were used to compare patient subgroups and construct a prognostic nomogram model. STATISTICAL TESTS Kolmogorov-Smirnov test, t-test, Mann-Whitney U test, chi-square test, Pearson correlation analysis, multivariate logistic regression analysis, decision curve analysis (DCA), receiver operating characteristic curves (ROCs). The significance threshold was set at P < 0.05. RESULTS Correlation analysis revealed that APTw and NIHSS exhibit the highest correlation (r = -0.634, 95% confidence interval [CI] -0.418 to -0.782), surpassing that of ADC and lesion size. Multivariable analysis revealed APTw (odds ratio [OR] 0.905, 95% CI 0.845-0.970), ADC (OR 0.745, 95% CI 0.609-0.911), and infarct core-cerebral blood volume (IC-CBV) (OR 0.547, 95% CI 0.310-0.964) as potential risk factors associated with a poor prognosis. The nomogram model demonstrated the highest predictive efficacy, with an area under the curve (AUC) of 0.960 (95% CI 0.911-0.988), exceeding that of APTw, ADC, and IC-CBV individually. DATA CONCLUSION The APTw technique holds potential value in categorizing and managing patients with ischemic stroke, offering guidance for the implementation of clinical treatment strategies. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Le Zhou
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou city, Jiangsu Province, China
| | - Wanqian Pan
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Renjun Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou city, Jiangsu Province, China
| | - Tianye Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zifan Wei
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Hui Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou city, Jiangsu Province, China
- Institute of Medical Imaging, Soochow University, Suzhou city, Jiangsu Province, China
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Zhang L, Wu J, Yu R, Xu R, Yang J, Fan Q, Wang D, Zhang W. Non-contrast CT radiomics and machine learning for outcomes prediction of patients with acute ischemic stroke receiving conventional treatment. Eur J Radiol 2023; 165:110959. [PMID: 37437435 DOI: 10.1016/j.ejrad.2023.110959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Accurate prediction of outcomes for patients with acute ischemic stroke (AIS) is crucial for clinical decision-making. In this study, we developed prediction models based on non-contrast computed tomography (NCCT) radiomics and clinical features to predict the modified Rankin Scale (mRS) six months after hospital discharge. METHOD A two-center retrospective cohort of 240 AIS patients receiving conventional treatment was included. Radiomics features of the infarct area were extracted from baseline NCCT scans. We applied Kruskal-Wallis (KW) test and recursive feature elimination (RFE) to select features for developing clinical, radiomics, and fusion models (with clinical data and radiomics features), using support vector machine (SVM) algorithm. The prediction performance of the models was assessed by accuracy, sensitivity, specificity, F1 score, and receiver operating characteristic (ROC) curve. Shapley Additive exPlanations (SHAP) was applied to analyze the interpretability and predictor importance of the model. RESULTS A total of 1454 texture features were extracted from the NCCT images. In the test cohort, the ROC analysis showed that the radiomics model and the fusion model showed AUCs of 0.705 and 0.857, which outperformed the clinical model (0.643), with the fusion model exhibiting the best performance. Additionally, the accuracy and sensitivity of the fusion model were also the best among the models (84.8% and 93.8%, respectively). CONCLUSIONS The model based on NCCT radiomics and machine learning has high predictive efficiency for the prognosis of AIS patients receiving conventional treatment, which can be used to assist early personalized clinical therapy.
Collapse
Affiliation(s)
- Limin Zhang
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Wu
- Department of Radiology, the 958th Hospital, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ruize Yu
- Institute of Research, Infervision Medical Technology Co., Ltd, 25F Building E, Yuanyang International Center, Chaoyang District, Beijing 100025, China
| | - Ruoyu Xu
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiawen Yang
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang 317000, China
| | - Qianrui Fan
- Institute of Research, Infervision Medical Technology Co., Ltd, 25F Building E, Yuanyang International Center, Chaoyang District, Beijing 100025, China
| | - Dawei Wang
- Institute of Research, Infervision Medical Technology Co., Ltd, 25F Building E, Yuanyang International Center, Chaoyang District, Beijing 100025, China
| | - Wei Zhang
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
6
|
MRI Radiomics and Predictive Models in Assessing Ischemic Stroke Outcome-A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13050857. [PMID: 36900001 PMCID: PMC10000411 DOI: 10.3390/diagnostics13050857] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Stroke is a leading cause of disability and mortality, resulting in substantial socio-economic burden for healthcare systems. With advances in artificial intelligence, visual image information can be processed into numerous quantitative features in an objective, repeatable and high-throughput fashion, in a process known as radiomics analysis (RA). Recently, investigators have attempted to apply RA to stroke neuroimaging in the hope of promoting personalized precision medicine. This review aimed to evaluate the role of RA as an adjuvant tool in the prognosis of disability after stroke. We conducted a systematic review following the PRISMA guidelines, searching PubMed and Embase using the keywords: 'magnetic resonance imaging (MRI)', 'radiomics', and 'stroke'. The PROBAST tool was used to assess the risk of bias. Radiomics quality score (RQS) was also applied to evaluate the methodological quality of radiomics studies. Of the 150 abstracts returned by electronic literature research, 6 studies fulfilled the inclusion criteria. Five studies evaluated predictive value for different predictive models (PMs). In all studies, the combined PMs consisting of clinical and radiomics features have achieved the best predictive performance compared to PMs based only on clinical or radiomics features, the results varying from an area under the ROC curve (AUC) of 0.80 (95% CI, 0.75-0.86) to an AUC of 0.92 (95% CI, 0.87-0.97). The median RQS of the included studies was 15, reflecting a moderate methodological quality. Assessing the risk of bias using PROBAST, potential high risk of bias in participants selection was identified. Our findings suggest that combined models integrating both clinical and advanced imaging variables seem to better predict the patients' disability outcome group (favorable outcome: modified Rankin scale (mRS) ≤ 2 and unfavorable outcome: mRS > 2) at three and six months after stroke. Although radiomics studies' findings are significant in research field, these results should be validated in multiple clinical settings in order to help clinicians to provide individual patients with optimal tailor-made treatment.
Collapse
|
7
|
Hu W, Li P, Zeng N, Tan S. DIA-based technology explores hub pathways and biomarkers of neurological recovery in ischemic stroke after rehabilitation. Front Neurol 2023; 14:1079977. [PMID: 36959823 PMCID: PMC10027712 DOI: 10.3389/fneur.2023.1079977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/06/2023] [Indexed: 03/09/2023] Open
Abstract
Objective Ischemic stroke (IS) is a common disease that causes severe and long-term neurological disability in people worldwide. Although rehabilitation is indispensable to promote neurological recovery in ischemic stroke, it is limited to providing a timely and efficient reference for developing and adjusting treatment strategies because neurological assessment after stroke treatment is mostly performed using scales and imaging. Therefore, there is an urgent need to find biomarkers that can help us evaluate and optimize the treatment plan. Methods We used data-independent acquisition (DIA) technology to screen differentially expressed proteins (DEPs) before and after ischemic stroke rehabilitation treatment, and then performed Gene Ontology (GO) and pathway enrichment analysis of DEPs using bioinformatics tools such as KEGG pathway and Reactome. In addition, the protein-protein interaction (PPI) network and modularity analysis of DEPs were integrated to identify the hub proteins (genes) and hub signaling pathways for neurological recovery in ischemic stroke. PRM-targeted proteomics was also used to validate some of the screened proteins of interest. Results Analyzing the serum protein expression profiles before and after rehabilitation, we identified 22 DEPs that were upregulated and downregulated each. Through GO and pathway enrichment analysis and subsequent PPI network analysis constructed using STRING data and subsequent Cytoscape MCODE analysis, we identified that complement-related pathways, lipoprotein-related functions and effects, thrombosis and hemostasis, coronavirus disease (COVID-19), and inflammatory and immune pathways are the major pathways involved in the improvement of neurological function after stroke rehabilitation. Conclusion Complement-related pathways, lipoprotein-related functions and effects, thrombosis and hemostasis, coronavirus disease (COVID-19), and inflammation and immunity pathways are not only key pathways in the pathogenesis of ischemic stroke but also the main pathways of action of rehabilitation therapy. In addition, IGHA1, LRG1, IGHV3-64D, and CP are upregulated in patients with ischemic stroke and downregulated after rehabilitation, which may be used as biomarkers to monitor neurological impairment and recovery after stroke.
Collapse
Affiliation(s)
- Wei Hu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, China
| | - Ping Li
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, China
| | - Nianju Zeng
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, China
- *Correspondence: Nianju Zeng
| | - Sheng Tan
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Sheng Tan
| |
Collapse
|