CT-based radiomics for differentiating intracranial contrast extravasation from intraparenchymal haemorrhage after mechanical thrombectomy

Abstract

Objective To develop a nonenhanced CT-based radiomic signature for the differentiation of iodinated contrast extravasation from intraparenchymal haemorrhage (IPH) following mechanical thrombectomy. Methods Patients diagnosed with acute ischaemic stroke who underwent mechanical thrombectomy in 4 institutions from December 2017 to June 2020 were included in this retrospective study. The study population was divided into a training cohort and a validation cohort. The nonenhanced CT images taken after mechanical thrombectomy were used to extract radiomic features. The maximum relevance minimum redundancy (mRMR) algorithm was used to eliminate confounding variables. Afterwards, least absolute shrinkage and selection operator (LASSO) logistic regression was used to generate the radiomic signature. The diagnostic performance of the radiomic signature was evaluated by the area under the curve (AUC), accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV). Results A total of 166 intraparenchymal areas of hyperattenuation from 101 patients were used. The areas of hyperattenuation were randomly allocated to the training and validation cohorts at a ratio of 7:3. The AUC of the radiomic signature was 0.848 (95% confidence interval (CI) 0.780–0.917) in the training cohort and 0.826 (95% CI 0.705–0.948) in the validation cohort. The accuracy of the radiomic signature was 77.6%, with a sensitivity of 76.7%, a specificity of 78.9%, a PPV of 85.2%, and a NPV of 68.2% in the validation cohort. Conclusions The radiomic signature constructed based on initial post-operative nonenhanced CT after mechanical thrombectomy can effectively differentiate IPH from iodinated contrast extravasation. Key Points • Radiomic features were extracted from intraparenchymal areas of hyperattenuation on initial post-operative CT scans after mechanical thrombectomy. • The nonenhanced CT-based radiomic signature can differentiate IPH from iodinated contrast extravasation early. • The radiomic signature may help prevent unnecessary rescanning after mechanical thrombectomy, especially in cases where contrast extravasation is highly suggestive.

A CT texture-based nomogram for predicting futile reperfusion in patients with intraparenchymal hyperdensity after endovascular thrombectomy for acute anterior circulation large vessel occlusion

“…Frontiers in Neurology 09 frontiersin.org aspects of stroke, including the diagnosis of stroke lesions (18-20) and cerebral hemorrhage (21,22). In the future, we should intensify our research on CT texture analysis to fully unveil its value and expand its application.…”

A CT-based radiomics nomogram for classification of intraparenchymal hyperdense areas in patients with acute ischemic stroke following mechanical thrombectomy treatment

“…The great potential of radiomics analysis for hemorrhagic heterogeneity has been demonstrated by many studies (Zhang et al, 2019 ; Nawabi et al, 2020 ). To date, only one study applied CT-based radiomics in differentiating intracranial contrast extravasation from hemorrhage after MTB (Chen et al, 2022 ). Chen et al constructed radiomic signature based on initial NECT with AUCs of 0.848 and 0.826 in the training and validation cohort.…”

Application of radiomics in ischemic stroke

“…The differentiation between contrast agent extravasation and post-thrombectomy hemorrhage is often difficult using imaging features; this challenge was addressed in studies by Ma et al 46 and Chen et al 47 By integrating radiomic features and incorporating multiple independent predictive factors, these researchers constructed models that were proficient at distinguishing between hemorrhage and contrast agent extravasation. These models are clinically important because they facilitate the swift identification of aberrant signals in images, thereby helping clinicians to make prompt and accurate decisions and enhancing patient treatment.…”