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Scicolone R, Vacca S, Pisu F, Benson JC, Nardi V, Lanzino G, Suri JS, Saba L. Radiomics and artificial intelligence: General notions and applications in the carotid vulnerable plaque. Eur J Radiol 2024; 176:111497. [PMID: 38749095 DOI: 10.1016/j.ejrad.2024.111497] [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: 03/16/2024] [Revised: 04/14/2024] [Accepted: 05/03/2024] [Indexed: 06/17/2024]
Abstract
Carotid atherosclerosis plays a substantial role in cardiovascular morbidity and mortality. Given the multifaceted impact of this disease, there has been increasing interest in harnessing artificial intelligence (AI) and radiomics as complementary tools for the quantitative analysis of medical imaging data. This integrated approach holds promise not only in refining medical imaging data analysis but also in optimizing the utilization of radiologists' expertise. By automating time consuming tasks, AI allows radiologists to focus on more pertinent responsibilities. Simultaneously, the capacity of AI in radiomics to extract nuanced patterns from raw data enhances the exploration of carotid atherosclerosis, advancing efforts in terms of (1) early detection and diagnosis, (2) risk stratification and predictive modeling, (3) improving workflow efficiency, and (4) contributing to advancements in research. This review provides an overview of general concepts related to radiomics and AI, along with their application in the field of carotid vulnerable plaque. It also offers insights into various research studies conducted on this topic across different imaging techniques.
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Affiliation(s)
- Roberta Scicolone
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Sebastiano Vacca
- University of Cagliari, School of Medicine and Surgery, Cagliari, Italy
| | - Francesco Pisu
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Cagliari, Italy
| | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Valentina Nardi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Cagliari, Italy.
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Vacca S, Scicolone R, Gupta A, Allan Wasserman B, Song J, Nardi V, Yang Q, Benson J, Lanzino G, Paraskevas K, Suri JS, Saba L. Atherosclerotic carotid artery disease Radiomics: A systematic review with meta-analysis and radiomic quality score assessment. Eur J Radiol 2024; 177:111547. [PMID: 38852329 DOI: 10.1016/j.ejrad.2024.111547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Stroke, a leading global cause of mortality and neurological disability, is often associated with atherosclerotic carotid artery disease. Distinguishing between symptomatic and asymptomatic carotid artery disease is crucial for appropriate treatment decisions. Radiomics, a quantitative image analysis technique, and ML have emerged as promising tools in medical imaging, including neuroradiology. This systematic review and meta-analysis aimed to evaluate the methodological quality of studies employing radiomics for atherosclerotic carotid artery disease analysis and ML algorithms for culprit plaque identification using CT or MRI. MATERIALS AND METHODS Pubmed, WoS and Scopus databases were searched for relevant studies published from January 2005 to May 2023. RQS assessed methodological quality of studies included in the review. QUADAS-2 assessed the risk of bias. A meta-analysis and three meta regressions were conducted on study performance based on model type, imaging modality and segmentation method. RESULTS RQS assessed methodological quality, revealing an overall low score and consistent findings with other radiology domains. QUADAS-2 indicated an overall low risk, except for a single study with high bias. The meta-analysis demonstrated that radiomics-based ML models for predicting culprit plaques had a satisfactory performance, with an AUC of 0.85, surpassing clinical models. However, combining radiomics with clinical features yielded the highest AUC of 0.89. Meta-regression analyses confirmed these findings. MRI-based models slightly outperformed CT-based ones, but the difference was not significant. CONCLUSION In conclusion, radiomics and ML hold promise for assessing carotid plaque vulnerability, aiding in early cerebrovascular event prediction. Combining radiomics with clinical data enhances predictive performance.
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Affiliation(s)
- Sebastiano Vacca
- University of Cagliari, School of Medicine and Surgery, Cagliari, Italy
| | - Roberta Scicolone
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Ajay Gupta
- Department of Radiology Weill, Cornell Medical College, New York, NY, USA
| | - Bruce Allan Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park building, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Jae Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Valentina Nardi
- Department of Cardiovascular Sciences, Mayo Clinic, Rochester, MN
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - John Benson
- Department of Radiology Mayo Clinic Rochester MN, USA
| | | | | | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Cagliari, Italy.
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Nie JY, Chen WX, Zhu Z, Zhang MY, Zheng YJ, Wu QD. Initial experience with radiomics of carotid perivascular adipose tissue in identifying symptomatic plaque. Front Neurol 2024; 15:1340202. [PMID: 38434202 PMCID: PMC10907991 DOI: 10.3389/fneur.2024.1340202] [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: 11/17/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background Carotid atherosclerotic ischemic stroke threatens human health and life. The aim of this study is to establish a radiomics model of perivascular adipose tissue (PVAT) around carotid plaque for evaluation of the association between Peri-carotid Adipose Tissue structural changes with stroke and transient ischemic attack. Methods A total of 203 patients underwent head and neck computed tomography angiography examination in our hospital. All patients were divided into a symptomatic group (71 cases) and an asymptomatic group (132 cases) according to whether they had acute/subacute stroke or transient ischemic attack. The radiomic signature (RS) of carotid plaque PVAT was extracted, and the minimum redundancy maximum correlation, recursive feature elimination, and linear discriminant analysis algorithms were used for feature screening and dimensionality reduction. Results It was found that the RS model achieved the best diagnostic performance in the Bagging Decision Tree algorithm, and the training set (AUC, 0.837; 95%CI: 0.775, 0.899), testing set (AUC, 0.834; 95%CI: 0.685, 0.982). Compared with the traditional feature model, the RS model significantly improved the diagnostic efficacy for identifying symptomatic plaques in the testing set (AUC: 0.834 vs. 0.593; Z = 2.114, p = 0.0345). Conclusion The RS model of PVAT of carotid plaque can be used as an objective indicator to evaluate the risk of plaque and provide a basis for risk stratification of carotid atherosclerotic disease.
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Affiliation(s)
- Ji-Yan Nie
- Department of Radiology, Shunde Hospital of Guangzhou University of Traditional Chinese Medicine, Shunde, China
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Xi Chen
- Department of Radiology, Shunde Hospital of Guangzhou University of Traditional Chinese Medicine, Shunde, China
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi Zhu
- Department of Radiology, Shunde Hospital of Guangzhou University of Traditional Chinese Medicine, Shunde, China
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Yu Zhang
- Department of Radiology, Shunde Hospital of Guangzhou University of Traditional Chinese Medicine, Shunde, China
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu-Jin Zheng
- Department of Radiology, Shunde Hospital of Guangzhou University of Traditional Chinese Medicine, Shunde, China
| | - Qing-De Wu
- Department of Radiology, Shunde Hospital of Guangzhou University of Traditional Chinese Medicine, Shunde, China
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Hou C, Li S, Zheng S, Liu LP, Nie F, Zhang W, He W. Quality assessment of radiomics models in carotid plaque: a systematic review. Quant Imaging Med Surg 2024; 14:1141-1154. [PMID: 38223070 PMCID: PMC10784017 DOI: 10.21037/qims-23-712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024]
Abstract
Background Although imaging techniques provide information about the morphology and stability of carotid plaque, they are operator dependent and may miss certain subtleties. A variety of radiomics models for carotid plaque have recently been proposed for identifying vulnerable plaques and predicting cardiovascular and cerebrovascular diseases. The purpose of this review was to assess the risk of bias, reporting, and methodological quality of radiomics models for carotid atherosclerosis plaques. Methods A systematic search was carried out to identify available literature published in PubMed, Web of Science, and the Cochrane Library up to March 2023. Studies that developed and/or validated machine learning models based on radiomics data to identify and/or predict unfavorable cerebral and cardiovascular events in carotid plaque were included. The basic information of each piece of included literature was identified, and the reporting quality, risk of bias, and radiomics methodology quality were assessed according the TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) checklist, the Prediction Model Risk of Bias Assessment Tool (PROBAST), and the radiomics quality score (RQS), respectively. Results A total of 2,738 patients from 19 studies were included. The mean overall TRIPOD adherence rate was 66.1% (standard deviation 12.8%), with a range of 45-87%. All studies had a high overall risk of bias, with the analysis domain being the most common source of bias. The mean RQS was 9.89 (standard deviation 5.70), accounting for 27.4% of the possible maximum value of 36. The mean area under the curve for diagnostic or predictive properties of these included radiomics models was 0.876±0.09, with a range of 0.741-0.989. Conclusions Radiomics models may have value in the assessment of carotid plaque, the overall scientific validity and reporting quality of current carotid plaque radiomics reports are still lacking, and many barriers must be overcome before these models can be applied in clinical practice.
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Affiliation(s)
- Chao Hou
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
- Department of Ultrasound, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuo Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lu-Ping Liu
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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He Z, Luo J, Lv M, Li Q, Ke W, Niu X, Zhang Z. Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques. Front Neurol 2023; 14:1159288. [PMID: 37900593 PMCID: PMC10603250 DOI: 10.3389/fneur.2023.1159288] [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: 02/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Atherosclerosis is an important cause of cerebrovascular and cardiovascular disease (CVD). Lipid infiltration, inflammation, and altered vascular stress are the critical mechanisms that cause atherosclerotic plaque formation. The hallmarks of the progression of atherosclerosis include plaque ulceration, rupture, neovascularization, and intraplaque hemorrhage, all of which are closely associated with the occurrence of CVD. Assessing the severity of atherosclerosis and plaque vulnerability is crucial for the prevention and treatment of CVD. Integrating imaging techniques for evaluating the characteristics of atherosclerotic plaques with computer simulations yields insights into plaque inflammation levels, spatial morphology, and intravascular stress distribution, resulting in a more realistic and accurate estimation of plaque state. Here, we review the characteristics and advancing techniques used to analyze intracranial and extracranial atherosclerotic plaques to provide a comprehensive understanding of atheroma.
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Affiliation(s)
- Zhiwei He
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiaying Luo
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengna Lv
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingwen Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Ke
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xuan Niu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaohui Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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