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Research ArticleNEUROVASCULAR/STROKE IMAGING

Combinations of Clinical Factors, CT Signs, and Radiomics for Differentiating High-Density Areas after Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

Duchang Zhai, Yuanyuan Wu, Manman Cui, Yan Liu, Xiuzhi Zhou, Dongliang Hu, Yuancheng Wang, Shenghong Ju, Guohua Fan and Wu Cai
American Journal of Neuroradiology December 2024, DOI: https://doi.org/10.3174/ajnr.A8434
Duchang Zhai
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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  • ORCID record for Duchang Zhai
Yuanyuan Wu
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Manman Cui
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Yan Liu
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Xiuzhi Zhou
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Dongliang Hu
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Yuancheng Wang
bDepartment of Radiology (Y. Wang, S.J.), Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China.
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Shenghong Ju
bDepartment of Radiology (Y. Wang, S.J.), Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China.
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Guohua Fan
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Wu Cai
aFrom the Department of Radiology (D.Z., Y. Wu., M.C., Y.L., X.Z., D.H., G.F., W.C.), The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Abstract

BACKGROUND AND PURPOSE: Clinically, hemorrhagic transformation (HT) after mechanical thrombectomy (MT) is a common complication. This study aimed to investigate the value of clinical factors, CT signs, and radiomics in the differential diagnosis of high-density areas (HDAs) in the brain after MT in patients with acute ischemic stroke with large-vessel occlusion (AIS-LVO).

MATERIALS AND METHODS: A total of 156 eligible patients with AIS-LVO in Center I from December 2015 to June 2023 were retrospectively enrolled and randomly divided into training (n = 109) and internal validation (n = 47) sets at a ratio of 7:3. The data of 63 patients in Center II were collected as an external validation set. According to the diagnostic criteria, the patients in the 3 data sets were divided into an HT group and a non-HT group. The clinical and imaging data from Centers I and II were used to construct a clinical factor and CT-sign model, a radiomics model, and a combined model by logistic regression. Receiver operating characteristic analysis was used to evaluate the diagnostic efficacy of each model in the 3 data sets.

RESULTS: Clinical blood glucose and the maximum cross-sectional area on CT were associated with the HT or non-HT of the HDA according to multivariate logistic regression analyses (P < .05). Among the 3 models, the combined model had the highest diagnostic efficiency, with area under the curve values of 0.895, 0.882, and 0.820 in the 3 data sets, which were significantly greater than the area under the curve values of the radiomics model (0.887, 0.898, 0.798) and clinical factor and CT-sign model (0.831, 0.744, 0.684).

CONCLUSIONS: The combined model based on radiomics had the best performance, indicating that radiomics features can be used as imaging biomarkers to aid in the clinical judgment of the nature of HDA after MT.

ABBREVIATIONS:

AIS-LVO
acute ischemic stroke with large-vessel occlusion
Areamax
maximum cross-sectional area
AUC
area under the curve
DCA
decision curve analysis
D-D
D-dimer
DECT
dual-energy CT
DPT
door-to-puncture time
HDA
high-density area
HT
hemorrhagic transformation
ICE
iodine contrast extravasation
IOM
iodine overlay map
LASSO
least absolute shrinkage and selection operator
LR
logistic regression
MT
mechanical thrombectomy
PLT
platelet
ROC
receiver operating characteristic
TG
total cholesterol triglyceride
VNC
virtual noncontrast

Footnotes

  • D. Zhai and Y. Wu contributed equally to this work.

  • This study was supported by the Project of State Key Laboratory of Radiation Medicine and Protection, Soochow University (GZK12024025, 12024013, 1202136), Suzhou Clinical Key Disease Diagnosis and Treatment Technology Special Project (LCZX202309), “National Tutor System” Training Program for Health Youth Key Talents in Suzhou (Qngg2021006), Gusu Talent Program (GSWS2021025), Suzhou Municipal Science and Technology Development Project (SKY2022049, SKY2022011), “Technological Innovation” Project of CNNC Medical Industry Co. Ltd (ZHYLYB2021006, ZHYLYB2021001), “Image Medical Star” Project of Suzhou Medical Association (2022YX-M05), Project of Nuclear Technology Medical Application Supported by Discipline Construction of Second Affiliated Hospital of Soochow University (XKTJ-HRC20210010) and The Second Affiliated Hospital of Soochow University Pre-Research Fund Project (SDFEYLC2342).

  • Disclosure forms provided by the authors are available with the full text and PDF of this article at www.ajnr.org.

  • © 2024 by American Journal of Neuroradiology
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Cite this article
Duchang Zhai, Yuanyuan Wu, Manman Cui, Yan Liu, Xiuzhi Zhou, Dongliang Hu, Yuancheng Wang, Shenghong Ju, Guohua Fan, Wu Cai
Combinations of Clinical Factors, CT Signs, and Radiomics for Differentiating High-Density Areas after Mechanical Thrombectomy in Patients with Acute Ischemic Stroke
American Journal of Neuroradiology Dec 2024, DOI: 10.3174/ajnr.A8434

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Combinations of Clinical Factors, CT Signs, and Radiomics for Differentiating High-Density Areas after Mechanical Thrombectomy in Patients with Acute Ischemic Stroke
Duchang Zhai, Yuanyuan Wu, Manman Cui, Yan Liu, Xiuzhi Zhou, Dongliang Hu, Yuancheng Wang, Shenghong Ju, Guohua Fan, Wu Cai
American Journal of Neuroradiology Dec 2024, DOI: 10.3174/ajnr.A8434
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