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Histologically interpretable clot radiomic features predict treatment outcomes of mechanical thrombectomy for ischemic stroke

  • Diagnostic Neuroradiology
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Abstract

Purpose

Radiomics features (RFs) extracted from CT images may provide valuable information on the biological structure of ischemic stroke blood clots and mechanical thrombectomy outcome. Here, we aimed to identify RFs predictive of thrombectomy outcomes and use clot histomics to explore the biology and structure related to these RFs.

Methods

We extracted 293 RFs from co-registered non-contrast CT and CTA. RFs predictive of revascularization outcomes defined by first-pass effect (FPE, near to complete clot removal in one thrombectomy pass), were selected. We then trained and cross-validated a balanced logistic regression model fivefold, to assess the RFs in outcome prediction. On a subset of cases, we performed digital histopathology on the clots and computed 227 histomic features from their whole slide images as a means to interpret the biology behind significant RF.

Results

We identified 6 significantly-associated RFs. RFs reflective of continuity in lower intensities, scattered higher intensities, and intensities with abrupt changes in texture were associated with successful revascularization outcome. For FPE prediction, the multi-variate model had high performance, with AUC = 0.832 ± 0.031 and accuracy = 0.760 ± 0.059 in training, and AUC = 0.787 ± 0.115 and accuracy = 0.787 ± 0.127 in cross-validation testing. Each of the 6 RFs was related to clot component organization in terms of red blood cell and fibrin/platelet distribution. Clots with more diversity of components, with varying sizes of red blood cells and fibrin/platelet regions in the section, were associated with RFs predictive of FPE.

Conclusion

Upon future validation in larger datasets, clot RFs on CT imaging are potential candidate markers for FPE prediction.

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Data Availability

Data are available on reasonable request. The data are composed of deidentified participant data and can be obtained upon request from Dr Vincent Tutino at vincentt@buffalo.edu.

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Acknowledgements

We acknowledge the assistance of the Multispectral Imaging Suite and Histology Core Laboratory in the Dept. of Pathology & Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. The research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding

The research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo (Adnan H. Siddiqui). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA

    Tatsat R. Patel, Briana A. Santo, Ammad A. Baig, Muhammad Waqas, Andre Monterio, Elad I. Levy, Adnan H. Siddiqui & Vincent M. Tutino

  2. Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA

    Tatsat R. Patel & Vincent M. Tutino

  3. Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA

    Briana A. Santo & Vincent M. Tutino

  4. Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA

    Vincent M. Tutino

  5. Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA

    Tatsat R. Patel, Briana A. Santo, Ammad A. Baig, Muhammad Waqas, Andre Monterio, Elad I. Levy, Adnan H. Siddiqui & Vincent M. Tutino

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  1. Tatsat R. Patel
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Correspondence to Vincent M. Tutino.

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Conflict of interest

TRP: None. BAS: None. AAB: None. MW: None. AM: None. EIL: Consulting fees: Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, Clarion, IRRAS. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events: Medtronic; Payment for expert testimony: for rendering medical/legal opinions as an expert. Support for attending meetings and/or travel: Reimbursement for travel and food for some meetings with the CNS and ABNS. Stock or stock options: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical. AHS: Financial Interest/Investor/Stock Options/Ownership: Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd., Endostream Medical, Ltd, Imperative Care, Inc., Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc., NeuroRadial Technologies, Inc., Neurotechnology Investors, Neurovascular Diagnostics, Inc., PerFlow Medical, Ltd., Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, SongBird Therapy, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viseon, Inc. Consultant/Advisory Board: Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., Cordis, Corindus, Inc., Endostream Medical, Ltd, Imperative Care, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Penumbra, Q’Apel Medical, Inc., Rapid Medical, Rebound Therapeutics Corp., Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc., VasSol, Viz.ai, Inc., W.L. Gore & Associates. National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial. Board membership: Secretary, Society of NeuroInterventional Surgery (SNIS) Board of Directors. Grant Support: clinical and translational science institute grant from the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. VMT: Financial Interest/Investor/Stock Options/Ownership: Neurovascular Diagnostics, Inc., QAS.ai, Inc. Grant Support: Brain Aneurysm Foundation, National Science Foundation Award No. 1746694, NIH NINDS award R43 NS115314-0, clinical and translational science institute grant from the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo.

Ethical approval

This study was approved by the University at Buffalo Human Research Institutional Review Board (study 00002092). We certify that the study was performed in accordance with the ethical standards described in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Patel, T.R., Santo, B.A., Baig, A.A. et al. Histologically interpretable clot radiomic features predict treatment outcomes of mechanical thrombectomy for ischemic stroke. Neuroradiology 65, 737–749 (2023). https://doi.org/10.1007/s00234-022-03109-2

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