Introduction Approximately 30% of stroke are cryptogenic¹. The composition of clots can provide valuable insights into the possible etiology. No-invasive imaging such as radiomics can aid in assessing clot composition by studying very detailed imaging properties at a voxel level².

Aim of Study Identify the radiomic profile of clot composition and its correlation with histology.

Methods Patients with large vessel occlusion who underwent mechanical thrombectomy were included, and the extracted clots were analyzed using Micro-computed tomography (Micro-CT) imaging. Histological analysis was performed to obtain the percentage of red blood cells (RBCs) and fibrin (FB) within the clots. Histological slides were meticulously matched with corresponding areas on micro-CT images. Regions containing RBCs and FB were manually segmented using 3D Slicer. Radiomic features (RFs) were extracted for each region of interest. Student’s t-test and Pearson correlation were performed between RFs and clot composition.

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Abstract P114 Figure 1

Pipeline of the clots analysis. A) Large vessel occlusion of left middle cerebral artery visualized on diagnostic angiogram. B) Processing of the clot. C) Micro-CT imaging of the sample. D) Histological plaque matched to the corresponding micro-CT slide

Results 130 RFs were extracted from ten clot specimens. Ten RFs (9 first-order and 1 second-order RFs) were different between RBCs and FB (p-value < 0.05). One strong positive correlation and 7 strong negative correlations were found between RFs and the percentage of RBCs. Similarly, 12 strong positive correlations and 37 strong negative correlations were observed between RFs and FB composition.

Conclusion Radiomics can potentially determine if a clot is primary composed of RBCs or FB.