Abstract
BackgroundRadiomics analysis is a newly emerging quantitative image analysis technique. The aim of this study was to extract a radiomics signature from the computed tomography (CT) imaging to determine the infarction onset time in patients with acute middle cerebral artery occlusion (MCAO).MethodsA total of 123 patients with acute MCAO in the M1 segment (85 patients in the development cohort and 38 patients in the validation cohort) were enrolled in the present study. Clinicoradiological profiles, including head CT without contrast enhancement and computed tomographic angiography (CTA), were collected. The time from stroke onset (TFS) was classified into two subcategories: ≤ 4.5 h, and > 4.5 h. The middle cerebral artery (MCA) territory on CT images was segmented to extract and score the radiomics features associated with the TFS. In addition, the clinicoradiological factors related to the TFS were identified. Subsequently, a combined model of the radiomics signature and clinicoradiological factors was constructed to distinguish the TFS ≤ 4.5 h. Finally, we evaluated the overall performance of our constructed model in an external validation sample of ischemic stroke patients with acute MCAO in the M1 segment.ResultsThe area under the curve (AUC) of the radiomics signature for discriminating the TFS in the development and validation cohorts was 0.770 (95% confidence interval (CI): 0.665–0.875) and 0.792 (95% CI: 0.633–0.950), respectively. The AUC of the combined model comprised of the radiomics signature, age and ASPECTS on CT in the development and validation cohorts was 0.808 (95% CI: 0.701–0.916) and 0.833 (95% CI: 0.702–0.965), respectively. In the external validation cohort, the AUC of the radiomics signature was 0.755 (95% CI: 0.614–0.897), and the AUC of the combined model was 0.820 (95% CI: 0.712–0.928).ConclusionsThe CT-based radiomics signature is a valuable tool for discriminating the TFS in patients with acute MCAO in the M1 segment, which may guide the use of thrombolysis therapy in patients with indeterminate stroke onset time.
Highlights
Stroke represents as a common cause of death and disability worldwide [1]
The present study aims to extract a radiomics signature from computed tomography (CT) images, and construct a combined model of the radiomics signature and clinicoradiological characteristics for discriminating the time from stroke onset (TFS) after acute middle cerebral artery occlusion (MCAO)
The inclusion criteria were, as follows: (1) patients who presented with symptoms and/or signs related to ischemic stroke and with a record of stroke onset time; (2) cranial CT and computed tomographic angiography (CTA) within 24 h after symptom onset were available; (3) a diagnosis of MCAO in the M1 segment, and ischemic infarction in the territory of the middle cerebral artery (MCA) was confirmed by neuroimaging
Summary
Stroke represents as a common cause of death and disability worldwide [1]. Reperfusion therapies for acute ischemic stroke mainly include the use of systemicWen et al BMC Med Imaging (2021) 21:147 intravenous thrombolytics and mechanical thrombectomy using different stent retrievers or thromboaspiration devices [2]. Reperfusion therapies for acute ischemic stroke mainly include the use of systemic. The treatment with intravenous tissue plasminogen activator (tPA) remains the fastest and easiest way to initiate acute stroke reperfusion treatment, and should continue to be the first-line treatment for patients with acute ischemic stroke within 4.5 h from onset [2]. Computed tomography (CT) is less time-consuming than MRI. It is necessary to develop a new approach that can identify the subtle changes in ischemic lesions, which may facilitate the discrimination of the time from stroke onset (TFS). The aim of this study was to extract a radiomics signature from the computed tomography (CT) imaging to determine the infarction onset time in patients with acute middle cerebral artery occlusion (MCAO)
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