Background Thrombus radiomics (TR) describe complex shape and textural thrombus imaging features. We aimed to study the relationship of TR extracted from non-contrast CT with procedural and functional outcome in endovascular-treated patients with acute ischemic stroke.
Methods Thrombi were segmented on thin-slice non-contrast CT (≤1 mm) from 699 patients included in the MR CLEAN Registry. In a pilot study, we selected 51 TR with consistent values across two raters’ segmentations (ICC >0.75). Random forest models using TR in addition or as a substitute to baseline clinical variables (CV) and manual thrombus measurements (MTM) were trained with 499 patients and evaluated on 200 patients for predicting successful reperfusion (extended Thrombolysis in Cerebral Ischemia (eTICI) ≥2B), first attempt reperfusion, reperfusion within three attempts, and functional independence (modified Rankin Scale (mRS) ≤2). Three texture and shape features were selected based on feature importance and related to eTICI ≥2B, number of attempts to eTICI ≥2B, and 90-day mRS with ordinal logistic regression.
Results Random forest models using TR, CV or MTM had comparable predictive performance. Thrombus texture (inverse difference moment normalized) was independently associated with reperfusion (adjusted common OR (acOR) 0.85, 95% CI 0.72 to 0.99). Thrombus volume and texture were also independently associated with the number of attempts to successful reperfusion (acOR 1.36, 95% CI 1.03 to 1.88 and acOR 1.24, 95% CI 1.04 to 1.49).
Conclusions TR describing thrombus volume and texture were associated with more attempts to successful reperfusion. Compared with models using CV and MTM, TR had no added value for predicting procedural and functional outcome.
Data availability statement
Data are available upon reasonable request. Data requests forms can be obtained at the MR CLEAN website: www.mrclean-trial.org. All code is made available on github: github.com/henkvanvoorst92/Radiomics.
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HvV and AAEB contributed equally.
Collaborators on behalf of the MR CLEAN Registry collaborators. All group authors and affiliations are shown in online supplemental file 2.
Contributors HvV, AAEB: Planning, conceptual thinking, data collection and excecution. WY, JA, EW, BGD, PRK, NAT, JWH, MLT, MK, JB, NB, KRvK, MSK. Data collection, annotation, and proof reading. HMH, MK, WHvZ, HMMvB, AvdL, BJE, HAM, YBWEMR, MWAC, CBLMM: Reading and revision. BJE, HAM, YBWEMR, MWAC, CBLMM: Supervision. HvV is the guarantor.
Funding The MR CLEAN Registry was partly funded by the TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam UMC.
Competing interests Amsterdam UMC received funds from Stryker for consultations by CBLMM and YBWEMR. Unrelated to this study, Amsterdam UMC received grants from the Netherlands Organization for Health Research and Development, Health Holland Top Sector LSH and Nicolab. Dr Dippel and AvdL report unrestricted grants from Stryker, Penumbra, Medtronic, Cerenovus, Thrombolytic Science, LLC, Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, and Health Holland Top Sector Life Sciences & Health for research, paid to institution. Maastricht University Medical Center received funds from Stryker, Cerenovus, Nicolab and Philips for consultation by WHvZ. NAT received funding from the AMC Medical Research. PRK is funded by INSIST: a European Union’s Horizon 2020 research and innovation program. YBWEMR is minor shareholder of Nicolab. HAM is co-founder and shareholder of Nicolab. CBLMM reports a grant from the TWIN Foundation. Unrelated to this study, CBLMM is a minor shareholder of Nicolab and reports grants from CVON/Dutch Heart Foundation, European Commission, Health Evaluation Netherlands, and Stryker, all paid to institution.
Provenance and peer review Not commissioned; externally peer reviewed.
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