Identification of high-risk plaque features in intracranial atherosclerosis: initial experience using a radiomic approach

Zhang Shi,David Saloner,Xia Tian,Chao Chen,Wenjia Peng,Jianping Lu,Andrew J Degnan,Chengcheng Zhu,Xuefeng Zhang,Tao Jiang,Luguang Chen,Qi Liu,Jing Li

doi:10.1007/s00330-018-5395-1

Zhang Shi, David Saloner + Show 11 more

Open Access

https://doi.org/10.1007/s00330-018-5395-1

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Abstract

ObjectivesTo evaluate a quantitative radiomic approach based on high-resolution magnetic resonance imaging (HR-MRI) to differentiate acute/sub-acute symptomatic basilar artery plaque from asymptomatic plaque.MethodsNinety-six patients with basilar artery stenosis underwent HR-MRI between January 2014 and December 2016. Patients were scanned with T1- and T2-weighted imaging, as well as T1 imaging following gadolinium-contrast injection (CE-T1). The stenosis value, plaque area/burden, lumen area, minimal luminal area (MLA), intraplaque haemorrhage (IPH), contrast enhancement ratio and 94 quantitative radiomic features were extracted and compared between acute/sub-acute and asymptomatic patients. Multi-variate logistic analysis and a random forest model were used to evaluate the diagnostic performance.ResultsIPH, MLA and enhancement ratio were independently associated with acute/subacute symptoms. Radiomic features in T1 and CE-T1 images were associated with acute/subacute symptoms, but the features from T2 images were not. The combined IPH, MLA and enhancement ratio had an area under the curve (AUC) of 0.833 for identifying acute/sub-acute symptomatic plaques, and the combined T1 and CE-T1 radiomic approach had a significantly higher AUC of 0.936 (p = 0.01). Combining all features achieved an AUC of 0.974 and accuracy of 90.5%.ConclusionsRadiomic analysis of plaque texture on HR-MRI accurately distinguished between acutely symptomatic and asymptomatic basilar plaques.Key Points• High-resolution magnetic resonance imaging can assess basilar artery atherosclerotic plaque.• Radiomic features in T1 and CE-T1 images are associated with acute symptoms.• Radiomic analysis can accurately distinguish between acute symptomatic and asymptomatic plaque.• The highest accuracy may be achieved by combining radiomic and conventional features.

Highlights

Increasing evidence supports the presentation of intracranial atherosclerotic disease (ICAD) as a major source of ischaemic cerebrovascular events worldwide, in Asian, African American and Hispanic populations [1, 2]
High-resolution magnetic resonance imaging (HR-MRI) of intracranial vessel walls facilitates the reliable, non-invasive characterisation of intracranial plaque, with clinical studies supporting its utility in ischaemic stroke risk estimation and ex vivo work validating its ability to classify plaque features [5, 7,8,9,10,11,12,13]
Multivariate logistic regression analysis showed that intraplaque haemorrhage (IPH) [odds ratio (OR) = 17.803; 95% confidence intervals (CIs), 2.093151.472], minimal luminal area (MLA) (OR = 1.515; 95% CI, 1.123-2.043) and enhancement ratio (OR = 71.979; 95% CI, 3.840-1349.211) were independent predictors of acute/sub-acute symptoms, and the area under the curve (AUC) of the receiver operating characteristic (ROC) curves was 0.638, 0.650 and Gender Male Female

Summary

Introduction

Increasing evidence supports the presentation of intracranial atherosclerotic disease (ICAD) as a major source of ischaemic cerebrovascular events worldwide, in Asian, African American and Hispanic populations [1, 2]. Due to the phenomenon of positive remodelling, in which an artery compensates for plaque growth by expansion of the outer wall, leaving the luminal diameter relatively unaffected, these angiographic methods have underestimated ICAD plaque burden, and an autopsy study attributed up to 27% of fatal ischaemic strokes to intracranial plaque with mild to moderate (30-75%) stenosis [6]. High-resolution magnetic resonance imaging (HR-MRI) of intracranial vessel walls facilitates the reliable, non-invasive characterisation of intracranial plaque, with clinical studies supporting its utility in ischaemic stroke risk estimation and ex vivo work validating its ability to classify plaque features [5, 7,8,9,10,11,12,13]. Prior work supports the improved accuracy of HR-MRI over MRA in assessing basilar artery stenosis and its usefulness in guiding endovascular interventions [18,19,20,21,22]

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