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Basic science
Original research
Multimodal CT imaging of ischemic stroke thrombi identifies scale-invariant radiomic features that reflect clot biology
  1. Briana A Santo1,2,
  2. Seyyed Mostafa Mousavi Janbeh Sarayi2,
  3. Andrew D McCall3,
  4. Andre Monteiro2,4,
  5. Brianna Donnelly2,4,
  6. Adnan H Siddiqui2,4,
  7. Vincent M Tutino1,2,4
  1. 1 Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA
  2. 2 Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
  3. 3 Optical Imaging and Analysis Facility, University at Buffalo, Buffalo, NY, USA
  4. 4 Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
  1. Correspondence to Dr Vincent M Tutino, Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA; vincentt{at}buffalo.edu

Abstract

Background Biological interpretability of ischemic stroke clot imaging remains challenging.

Objective To carry out paired CT/micro-CT imaging of ischemic stroke clots retrieved by thrombectomy with the aim of identifying interpretable image features that are correlated among pretreatment image modalities and post-treatment histopathology.

Methods We performed multimodal CT imaging and histology for 10 stroke clots retrieved by mechanical thrombectomy. Clots were manually segmented from co-registered, pretreatment CT angiography (CTA) and non-contrast CT (NCCT). For the same cases, retrieved clots were iodine-stained, and imaged with a ScanCo micro-CT 100 (4.9 µm resolution). Afterwards, clots were subjected to histological processing (hematoxylin and eosin staining) and whole slide scanned (40X). Clot radiomic features (RFs) (n=93 per modality, 279 total) were extracted using PyRadiomics and histological composition was computed using Orbit Image Analysis. Correlation analysis was used to test associations between micro-CT and CTA (or NCCT) RFs as well as between RFs and histological composition. Statistical significance was considered at R≥0.65 and q<0.05.

Results From paired RF correlation analysis, we identified 23 scale-invariant RFs with significant correlation between micro-CT and CTA (18), and micro-CT and NCCT (5). Correlation of unpaired RFs identified 377 positively and 36 negatively correlated RFs between micro-CT and CTA, and 168 positively and 41 negatively correlated RFs between micro-CT and NCCT. Scale-invariant RFs computed from CTA and NCCT demonstrated significant correlation with red blood cell and fibrin-platelet components, while micro-CT RFs were found to be correlated with white blood cell percent composition.

Conclusion Multimodal CT, radiomic, and histological analysis of stroke clots can help to bridge the gap between pretreatment imaging and clot pathobiology.

  • stroke
  • thrombectomy
  • CT
  • CT angiography

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

https://doi.org/10.1136/jnis-2022-019967

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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    Footnotes

    • Twitter @andremonteiromd, @bdonnelly718

    • Contributors BAS conceptualized the study, performed micro-CT imaging and histology, analyzed medical images, and analyzed the study data. She also drafted the original manuscript. SMMJS assisted in analyzing medical images and segmentation. ADM performed and assisted in micro-CT imaging. AM assisted in collection of clinical samples and collection and preparation of medical images. BD assisted in collection and preparation of medical images. AHS assisted in collection of clinical samples and imaging. He also assisted in funding acquisition and supervision of the project. VMT conceptualized the study, analyzed the study data, assisted in funding acquisition, supervised the project, and is noted at the study guarantor. He also drafted the original manuscript. All authors edited and approved the final manuscript.

    • Funding Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo.

    • Competing interests AHS: Research funding: National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. Consultant/Advisory Board: Cerenovus, Penumbra, Q’Apel Medical, Inc., Stryker Neurovascular. National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial and CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial; MIVI neuroscience EVAQ Trial. Board membership: Secretary, Society of NeuroInterventional Surgery (SNIS) Board of Directors. Financial Interest/Investor/Stock Options/Ownership: Neurovascular Diagnostics, Inc., QAS.ai, Inc. VMT – Research funding: National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. Financial Interest/Investor/Stock Options/Ownership: Neurovascular Diagnostics, Inc., QAS.ai, Inc.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.