Andres Gudino1, Carlos Dier1, Martin Cabarique1, Elena Sagues1, Gustavo Chiriboga1, Alexander Van Dam1, Shubhangi Setia1, Sebastian Sanchez Herrera2, Navami Shenoy1, Edgar Samaniego1
1University of Iowa, 2Yale University
Objective:
Characterize clots biological composition in non-contrast computed tomography (NCCT) images.
Background:
Clots composition could provide insights of the etiology in acute ischemic stroke (AIS). Radiomics is a non-invasive imaging tool that can characterize images at a voxel-by-voxel level. We correlated the histology of clots from patients with large vessel occlusion (LVO) with specific radiomic features (RFs)to characterize clot composition.
Design/Methods:
Ten clots retrieved from mechanical thrombectomy were imaged using micro-computed tomography (micro-CT) and histologically analyzed. RFs from each clot were extracted with 3D-Slicer and were correlated with different clot components determined by histology. NCCT and computed tomography angiography images were co-registered with the corresponding slices obtained from histology. A large cohort of 426 patient with NCCT obtained at the time of presentation were then analyzed.
Results:
In micro-CT, total energy (TE), joint average (JA) and large dependence high gray level emphasis (LDHGLE) were associated to RBCs (p<0.001, p 0.003, and p<0.002, respectively). Fibrin's RFs included minimum (p .005). TE, JA and LDHGLE were correlated with clots composed by 70% RBCs (Rho 0.654 and 0.652, respectively). Minimum was strongly correlated (Rho 0.795) with clots with >80% of fibrin. TE (Rho 0.687) JA (0.809) and LDHGLE (rho 0.657) were correlated between micro-CT and NCCT. Minimum values were negatively correlated (Rho -0.851). TE (sensitivity 0.750, specificity 0.800) and LDHGLE (sensitivity 0.750, specificity 0.800) were accurate to determine RBCs composition in NCCT. Mnimum (sensitivity: 0.500, specificity: 0.400) was not accurate for fibrin determination. 145 of 426 patients NCCT images were finally analyzed. 50 patients have a stroke of cardioembolic origin, 45 due to large artery atherosclerosis (LAA) and 50 were cryptogenic. Radiomics analysis showed that, 35 (75%) cardioembolic, 12 (27%) of LAA and 25 (50%) of cryptogenic AIS were mainly composed of RBCs.
Conclusions:
RFs are sensitive and specific to determine clots rich in RBCs composition in NCCT.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.