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Prediction of poor outcome in stroke patients using radiomics analysis of intraparenchymal and intraventricular hemorrhage and clinical factors

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Abstract

Purpose

To build three prognostic models using radiomics analysis of the hemorrhagic lesions, clinical variables, and their combination, to predict the outcome of stroke patients with spontaneous intracerebral hemorrhage (sICH).

Materials and methods

Eighty-three sICH patients were included. Among them, 40 patients (48.2%) had poor prognosis with modified Rankin scale (mRS) of 5 and 6 at discharge, and the prognostic model was built to differentiate mRS ≤ 4 vs. 5 + 6. The region of interest (ROI) of intraparenchymal hemorrhage (IPH) and intraventricular hemorrhage (IVH) were separately segmented. Features were extracted using PyRadiomics, and the support vector machine was applied to select features and build radiomics models based on IPH and IPH + IVH. The clinical models were built using multivariate logistic regression, and then the radiomics scores were combined with clinical variables to build the combined model.

Results

When using IPH, the AUC for radiomics, clinical, and combined model was 0.78, 0.82, and 0.87, respectively. When using IPH + IVH, the AUC was increased to 0.80, 0.84, and 0.90, respectively. The combined model had a significantly improved AUC compared to the radiomics by DeLong test. A clinical prognostic model based on the ICH score of 0–1 only achieved AUC of 0.71.

Conclusions

The combined model using the radiomics score derived from IPH + IVH and the clinical factors could achieve a high accuracy in prediction of sICH patients with poor outcome, which may be used to assist in making the decision about the optimal care.

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Data availability

The complete data are available from the corresponding author on a reasonable request.

Abbreviations

AUC:

Area under the ROC curve

ClM:

Clinical model

CoM:

Combined model

CT:

Computed tomography

GCS:

Glasgow coma scale

HE:

Hematoma expansion

ICH:

Intracerebral hemorrhage

IPH:

Intraparenchymal hemorrhage

IVH:

Intraventricular hemorrhage

mRS:

Modified Rankin scale

NCCT:

Noncontrast computed tomography

NIHSS:

National Institute of Health Stroke Scale

RaM:

Radiomics model

ROC:

Receiver operating characteristic

ROI:

Region of interest

RS:

Radiomics score

sICH:

Spontaneous intracerebral hemorrhage

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Authors and Affiliations

  1. Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan

    Te-Chang Wu

  2. Department of Medical Sciences Industry, Chang Jung Christian University, Tainan, Taiwan

    Te-Chang Wu

  3. Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, CA, USA

    Yan-Lin Liu, Jeon-Hor Chen, Yang Zhang & Min-Ying Su

  4. Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan

    Jeon-Hor Chen

  5. Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

    Chung-Han Ho

  6. Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Chung-Han Ho

  7. Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Yang Zhang

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  1. Te-Chang Wu
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  2. Yan-Lin Liu
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Contributions

Te-Chang Wu: conceptualization, data curation, methodology and writing—original draft; Yan-Lin Liu: investigation, software, visualization and writing—original draft; Jeon-Hor Chen: conceptualization, methodology and writing—review and editing; Chung-Han Ho: formal analysis; Yang Zhang: investigation, software; Min-Ying Su: conceptualization, methodology and writing—review and editing.

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Correspondence to Te-Chang Wu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective study was approved by the Institutional Review Board of our hospital, Chi-Mei Medical Center (Date 2018–09-21/ No 10709–010). The requirement to obtain informed consent was waived due to its retrospective nature.

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Wu, TC., Liu, YL., Chen, JH. et al. Prediction of poor outcome in stroke patients using radiomics analysis of intraparenchymal and intraventricular hemorrhage and clinical factors. Neurol Sci 44, 1289–1300 (2023). https://doi.org/10.1007/s10072-022-06528-4

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