PT - JOURNAL ARTICLE AU - Henk van Voorst AU - Agnetha A E Bruggeman AU - Wenjin Yang AU - Jurr Andriessen AU - Elise Welberg AU - Bruna G Dutra AU - Praneeta R Konduri AU - Nerea Arrarte Terreros AU - Jan W Hoving AU - Manon L Tolhuisen AU - Manon Kappelhof AU - Josje Brouwer AU - Nikki Boodt AU - Katinka R van Kranendonk AU - Miou S Koopman AU - Hajo M Hund AU - Menno Krietemeijer AU - Wim H van Zwam AU - Heleen M M van Beusekom AU - Aad van der Lugt AU - Bart J Emmer AU - Henk A Marquering AU - Yvo B W E M Roos AU - Matthan W A Caan AU - Charles B L M Majoie ED - , TI - Thrombus radiomics in patients with anterior circulation acute ischemic stroke undergoing endovascular treatment AID - 10.1136/jnis-2022-019085 DP - 2022 Jul 26 TA - Journal of NeuroInterventional Surgery PG - neurintsurg-2022-019085 4099 - http://jnis.bmj.com/content/early/2022/07/26/jnis-2022-019085.short 4100 - http://jnis.bmj.com/content/early/2022/07/26/jnis-2022-019085.full AB - 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 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.