Identification of high-risk plaque features in intracranial atherosclerosis: initial experience using a radiomic
Zhang Shi1, Chengcheng Zhu2, Andrew J Degnan3
1Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
Insights
High-resolution magnetic resonance imaging (HR-MRI) with radiomic analysis accurately differentiates symptomatic from asymptomatic basilar artery plaques. Combining radiomic features with conventional imaging markers significantly improves diagnostic performance.
Area of Science:
- Neuroimaging
- Cardiovascular Imaging
- Radiology
- Artificial Intelligence in Medicine
Background:
- Basilar artery atherosclerotic plaque poses a risk for stroke.
- Differentiating symptomatic from asymptomatic plaque is crucial for risk stratification.
- High-resolution magnetic resonance imaging (HR-MRI) offers detailed plaque visualization.
Purpose of the Study:
- To evaluate a quantitative radiomic approach using HR-MRI.
- To differentiate acute/sub-acute symptomatic basilar artery plaque from asymptomatic plaque.
- To assess the diagnostic performance of radiomic features compared to conventional imaging markers.
Main Methods:
- Ninety-six patients with basilar artery stenosis underwent HR-MRI (T1-weighted, T2-weighted, contrast-enhanced T1-weighted [CE-T1]).
- Quantitative radiomic features, along with conventional markers like intraplaque haemorrhage (IPH) and minimal luminal area (MLA), were extracted.
- Multivariate logistic analysis and a random forest model were employed to evaluate diagnostic performance.
Main Results:
- Intraplaque haemorrhage (IPH), minimal luminal area (MLA), and contrast enhancement ratio were associated with acute symptoms.
- Radiomic features from T1 and CE-T1 images, but not T2 images, correlated with acute symptoms.
- A combined radiomic approach using T1 and CE-T1 images achieved a significantly higher area under the curve (AUC) of 0.936 compared to conventional markers (AUC 0.833). Combining all features yielded an AUC of 0.974 with 90.5% accuracy.
Conclusions:
- Radiomic analysis of plaque texture on HR-MRI accurately distinguishes between acutely symptomatic and asymptomatic basilar plaques.
- The combination of radiomic features and conventional imaging markers provides superior diagnostic performance.
- This quantitative radiomic approach holds promise for improved risk stratification in patients with basilar artery stenosis.
Objectives:
To 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.
Methods:
Ninety-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.
Results:
IPH, 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%.
Conclusions:
Radiomic 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.
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