Abstract
Objectives
Carotid artery stenting (CAS) is an established treatment for local stenosis. The most common complication is new ipsilateral ischemic lesions (NIILs). This study aimed to develop models considering lesion morphological and compositional features, and radiomics to predict NIILs.
Materials and methods
One hundred and forty-six patients who underwent brain MRI and high-resolution vessel wall MR imaging (hrVWI) before and after CAS were retrospectively recruited. Lumen and outer wall boundaries were segmented on hrVWI as well as atherosclerotic components. A traditional model was constructed with patient clinical information, and lesion morphological and compositional features. Least absolute shrinkage and selection operator algorithm was performed to determine key radiomics features for reconstructing a radiomics model. The model in predicting NIILs was trained and its performance was tested.
Results
Sixty-one patients were NIIL-positive and eighty-five negative. Volume percentage of intraplaque hemorrhage (IPH) and patients’ clinical presentation (symptomatic/asymptomatic) were risk factors of NIILs. The traditional model considering these two features achieved an area under the curve (AUC) of 0.778 and 0.777 in the training and test cohorts, respectively. Twenty-two key radiomics features were identified and the model based on these features achieved an AUC of 0.885 and 0.801 in the two cohorts. The AUCs of the combined model considering IPH volume percentage, clinical presentation, and radiomics features were 0.893 and 0.842 in the training and test cohort respectively.
Conclusions
Compared with traditional features (clinical and compositional features), the combination of traditional and radiomics features improved the power in predicting NIILs after CAS.
Key Points
• Volume percentage of IPH and symptomatic events were independent risk factors of new ipsilateral ischemic lesions (NIILs).
• Radiomics features derived from carotid artery high-resolution vessel wall imaging had great potential in predicting NIILs after CAS.
• The combination model with radiomics and traditional features further improved the diagnostic performance than traditional features alone.
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Abbreviations
- AUC :
-
Area under the curve
- CAS:
-
Carotid artery stenting
- CEA:
-
Carotid endarterectomy
- CI:
-
Confidence interval
- DWI :
-
Diffusion-weighted imaging
- hrVWI:
-
High-resolution vessel wall imaging
- IPH:
-
Intraplaque hemorrhage
- LASSO:
-
Least absolute shrinkage and selection operator
- LoG:
-
Laplacian of Gaussian
- MRI:
-
Magnetic resonance imaging
- NIILs:
-
New ipsilateral ischemic lesions
- OR:
-
Odds ratio
- TOF:
-
Time of flight
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Funding
This study was supported by the National Key Research, Development Program of China (No. 2018YFC1312301; No. 2018YFC1312900); the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014); and the DRAGON project (101005122).
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Institutional review board approval was obtained (Project ID No. B2020-400R by the Ethics Committee of Zhongshan Hospital, Shanghai, China).
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The scientific guarantor of this publication is Jiang Lin and Zhongzhao Teng.
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Dr. Teng is the chief scientist of Tenoke Ltd., Cambridge and Nan**g. **gsan Medical Science and Technology, Ltd., China. Other authors do not any conflict of interest to declare.
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Qingwei Zhang and Ranying Zhang contributed to the statistical analysis.
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Ranying Zhang, Qingwei Zhang, and Aihua Ji share equal authorship.
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Zhang, R., Zhang, Q., Ji, A. et al. Prediction of new cerebral ischemic lesion after carotid artery stenting: a high-resolution vessel wall MRI-based radiomics analysis. Eur Radiol 33, 4115–4126 (2023). https://doi.org/10.1007/s00330-022-09302-4
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DOI: https://doi.org/10.1007/s00330-022-09302-4