Developing a Model for Estimating Infarction Onset Time Based on Computed Tomography Radiomics in Patients with Acute Middle Cerebral Artery Occlusion

Overview

Journal BMC Med Imaging

Publisher Biomed Central

Specialty Radiology

Date 2021 Oct 12

PMID 34635087

Citations 4

Authors

Xuehua Wen

Zhenyu Shu

Yumei Li

Xingfei Hu

Xiangyang Gong

Affiliations

Soon will be listed here.

Abstract

Background: Radiomics 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).

Methods: A 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.

Results: The 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).

Conclusions: The 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.

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References

Mokin M, Primiani C, Siddiqui A, Turk A . ASPECTS (Alberta Stroke Program Early CT Score) Measurement Using Hounsfield Unit Values When Selecting Patients for Stroke Thrombectomy. Stroke. 2017; 48(6):1574-1579. DOI: 10.1161/STROKEAHA.117.016745. View

Brunner F, Tomandl B, Hanken K, Hildebrandt H, Kastrup A . Impact of collateral circulation on early outcome and risk of hemorrhagic complications after systemic thrombolysis. Int J Stroke. 2012; 9(8):992-8. DOI: 10.1111/j.1747-4949.2012.00922.x. View

Donnan G, Fisher M, Macleod M, Davis S . Stroke. Lancet. 2008; 371(9624):1612-23. DOI: 10.1016/S0140-6736(08)60694-7. View

Garcia-Bermejo P, Calleja A, Perez-Fernandez S, Cortijo E, del Monte J, Garcia-Porrero M . Perfusion computed tomography-guided intravenous thrombolysis for acute ischemic stroke beyond 4.5 hours: a case-control study. Cerebrovasc Dis. 2012; 34(1):31-7. DOI: 10.1159/000338778. View

Ortiz-Ramon R, Valdes Hernandez M, Gonzalez-Castro V, Makin S, Armitage P, Aribisala B . Identification of the presence of ischaemic stroke lesions by means of texture analysis on brain magnetic resonance images. Comput Med Imaging Graph. 2019; 74:12-24. PMC: 6553681. DOI: 10.1016/j.compmedimag.2019.02.006. View

Lin J, Li X, Wu G, Chen X, Weng Y, Wang H . White Matter High Signals Interfere with Noncontrast Computed Tomography in the Early Identification of Cerebral Infarction. Cerebrovasc Dis. 2020; 49(2):135-143. DOI: 10.1159/000505807. View

Macellari F, Paciaroni M, Agnelli G, Caso V . Neuroimaging in intracerebral hemorrhage. Stroke. 2014; 45(3):903-8. DOI: 10.1161/STROKEAHA.113.003701. View

Dzialowski I, Klotz E, Goericke S, Doerfler A, Forsting M, von Kummer R . Ischemic brain tissue water content: CT monitoring during middle cerebral artery occlusion and reperfusion in rats. Radiology. 2007; 243(3):720-6. DOI: 10.1148/radiol.2432060137. View

Thomalla G, Rossbach P, Rosenkranz M, Siemonsen S, Krutzelmann A, Fiehler J . Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less. Ann Neurol. 2009; 65(6):724-32. DOI: 10.1002/ana.21651. View

10.

Ebinger M, Galinovic I, Rozanski M, Brunecker P, Endres M, Fiebach J . Fluid-attenuated inversion recovery evolution within 12 hours from stroke onset: a reliable tissue clock?. Stroke. 2009; 41(2):250-5. DOI: 10.1161/STROKEAHA.109.568410. View

11.

Shi Z, Loh Y, Walker G, Duckwiler G . Clinical outcomes in middle cerebral artery trunk occlusions versus secondary division occlusions after mechanical thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI trials. Stroke. 2010; 41(5):953-60. DOI: 10.1161/STROKEAHA.109.571943. View

12.

Yao X, Mao L, Lv S, Ren Z, Li W, Ren K . CT radiomics features as a diagnostic tool for classifying basal ganglia infarction onset time. J Neurol Sci. 2020; 412:116730. DOI: 10.1016/j.jns.2020.116730. View

13.

Tsivgoulis G, Katsanos A, Alexandrov A . Reperfusion therapies of acute ischemic stroke: potentials and failures. Front Neurol. 2014; 5:215. PMC: 4217479. DOI: 10.3389/fneur.2014.00215. View

14.

Tan I, Demchuk A, Hopyan J, Zhang L, Gladstone D, Wong K . CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol. 2009; 30(3):525-31. PMC: 7051470. DOI: 10.3174/ajnr.A1408. View

15.

Cuocolo R, Stanzione A, Ponsiglione A, Romeo V, Verde F, Creta M . Clinically significant prostate cancer detection on MRI: A radiomic shape features study. Eur J Radiol. 2019; 116:144-149. DOI: 10.1016/j.ejrad.2019.05.006. View

16.

Peter R, Korfiatis P, Blezek D, Oscar Beitia A, Stepan-Buksakowska I, Horinek D . A quantitative symmetry-based analysis of hyperacute ischemic stroke lesions in noncontrast computed tomography. Med Phys. 2017; 44(1):192-199. PMC: 5339891. DOI: 10.1002/mp.12015. View

17.

Molina D, Perez-Beteta J, Martinez-Gonzalez A, Martino J, Velasquez C, Arana E . Influence of gray level and space discretization on brain tumor heterogeneity measures obtained from magnetic resonance images. Comput Biol Med. 2016; 78:49-57. DOI: 10.1016/j.compbiomed.2016.09.011. View

18.

Davis S, Donnan G, Parsons M, Levi C, Butcher K, Peeters A . Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol. 2008; 7(4):299-309. DOI: 10.1016/S1474-4422(08)70044-9. View

19.

Koga M, Toyoda K, Kimura K, Yamamoto H, Sasaki M, Hamasaki T . THrombolysis for Acute Wake-up and unclear-onset Strokes with alteplase at 0·6 mg/kg (THAWS) Trial. Int J Stroke. 2014; 9(8):1117-24. PMC: 4660886. DOI: 10.1111/ijs.12360. View

20.

Kim B, Kang H, Kim H, Ahn S, Kim N, Warach S . Magnetic resonance imaging in acute ischemic stroke treatment. J Stroke. 2014; 16(3):131-45. PMC: 4200598. DOI: 10.5853/jos.2014.16.3.131. View