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CT texture-based radiomics analysis of carotid arteries identifies vulnerable patients: a preliminary outcome study

  • Diagnostic Neuroradiology
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Abstract

Purpose

To assess the potential role of computed tomography (CT) texture analysis (CTTA) in identifying vulnerable patients with carotid artery atherosclerosis.

Methods

In this case-control pilot study, 12 patients with carotid atherosclerosis and a subsequent history of transient ischemic attack or stroke were age and sex matched with 12 control cases with asymptomatic carotid atherosclerosis (follow-up time 103.58 ± 9.2 months). CTTA was performed using a commercially available research software package (TexRAD) by an operator blinded to clinical data. CTTA comprised a filtration-histogram technique to extract features at different scales corresponding to spatial scale filter (fine = 2 mm, medium = 3 mm, coarse = 4 mm), followed by quantification using histogram-based statistical parameters: mean, kurtosis, skewness, entropy, standard deviation, and mean value of positive pixels. A single axial slice was selected to best represent the largest cross-section of the carotid bifurcation or the greatest degree of stenosis, in presence of an atherosclerotic plaque, on each side.

Results

CTTA revealed a statistically significant difference in skewness between symptomatic and asymptomatic patients at the medium (0.22 ± 0.35 vs − 0.18 ± 0.39, p < 0.001) and coarse (0.23 ± 0.22 vs 0.03 ± 0.29, p = 0.003) texture scales. At the fine-texture scale, skewness (0.20 ± 0.59 vs − 0.18 ± 0.58, p = 0.009) and standard deviation (366.11 ± 117.19 vs 300.37 ± 82.51, p = 0.03) were significant before correction.

Conclusion

Our pilot study highlights the potential of CTTA to identify vulnerable patients in stroke and TIA. CT texture may have the potential to act as a novel risk stratification tool in patients with carotid atherosclerosis.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

This pilot study was funded by University of Rome—Sapienza, project “Avvio alla Ricerca.” Some of the co-authors from University College London Hospital/University College London (UCLH/UCL) received a proportion of the funding from the UK’s Department of Health’s National Institute of Health Research, Biomedical Research Centre’s funding scheme.

Author information

Authors and Affiliations

  1. Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada

    Fulvio Zaccagna

  2. Department of Radiological, Oncological and Pathological Sciences, University of Rome - Sapienza, Rome, Italy

    Fulvio Zaccagna, Alessandro Napoli & Iacopo Carbone

  3. Institute of Nuclear Medicine, University College London, London, UK

    Balaji Ganeshan, Ashley M. Groves & Leon J. Menezes

  4. NIHR University College London Hospitals Biomedical Research Centre, London, UK

    Balaji Ganeshan, Ashley M. Groves & Leon J. Menezes

  5. Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, University of Rome — Sapienza, Rome, Italy

    Marcello Arca

  6. Department of Radiological, Oncological and Pathological Sciences, University of Rome—Sapienza, Polo Pontino, I.C.O.T. Hospital, Latina, Italy

    Marco Rengo & Andrea Laghi

  7. Department of Radiology, University of Cambridge, Cambridge, UK

    Leonardo Rundo

  8. Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK

    Leonardo Rundo

Authors
  1. Fulvio Zaccagna
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  2. Balaji Ganeshan
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  3. Marcello Arca
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  4. Marco Rengo
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  8. Andrea Laghi
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  10. Leon J. Menezes
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Fulvio Zaccagna and Balaji Ganeshan. The first draft of the manuscript was written by Fulvio Zaccagna and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fulvio Zaccagna.

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Conflict of interest

Balaji Ganeshan is the Co-Founder/Co-Inventor of TexRAD texture analysis software used in this study and a shareholder (not an employee) of Feedback Plc., a UK-based company which owns, develops, and markets the TexRAD texture analysis software. All the other authors have no relevant financial or non-financial interests to disclose.

Ethical approval

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.

Consent to participate

Informed consent was obtained from all individual participants included in the study as part of previous IRB-approved studies conducted at our institution.

Code availability

We used a proprietary research software algorithm commercially available for research purposes.

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Zaccagna, F., Ganeshan, B., Arca, M. et al. CT texture-based radiomics analysis of carotid arteries identifies vulnerable patients: a preliminary outcome study. Neuroradiology 63, 1043–1052 (2021). https://doi.org/10.1007/s00234-020-02628-0

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