RT Journal Article SR Electronic T1 Thrombus radiomics in patients with anterior circulation acute ischemic stroke undergoing endovascular treatment JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP neurintsurg-2022-019085 DO 10.1136/jnis-2022-019085 A1 Henk van Voorst A1 Agnetha A E Bruggeman A1 Wenjin Yang A1 Jurr Andriessen A1 Elise Welberg A1 Bruna G Dutra A1 Praneeta R Konduri A1 Nerea Arrarte Terreros A1 Jan W Hoving A1 Manon L Tolhuisen A1 Manon Kappelhof A1 Josje Brouwer A1 Nikki Boodt A1 Katinka R van Kranendonk A1 Miou S Koopman A1 Hajo M Hund A1 Menno Krietemeijer A1 Wim H van Zwam A1 Heleen M M van Beusekom A1 Aad van der Lugt A1 Bart J Emmer A1 Henk A Marquering A1 Yvo B W E M Roos A1 Matthan W A Caan A1 Charles B L M Majoie A1 , YR 2022 UL http://jnis.bmj.com/content/early/2022/07/26/jnis-2022-019085.abstract 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.