Outcome Assessment in Stroke Using Multiparametric MRI: Integrating Infarct Location, Radiomics, and Global Brain Frailty.
Authors
Affiliations (11)
Affiliations (11)
- Department of Medical Imaging, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
- Department of Radiology, Shenzhen Xinhua Hospital, Shenzhen, China.
- Department of Medical Imaging, Nanjing Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu, China.
- Department of Medical Imaging, Nanjing Jinling Hospital, XuZhou Medical University, Nanjing, Jiangsu, China.
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China.
- Department of Radiology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China.
- Department of Radiology, Third Afliated Hospital of Soochow University, Changzhou, Jiangsu, China.
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
- Farber Institute for Neuroscience, Department of Neurology, Thomas Jefferson University, Philadelphia, United States.
Abstract
Accurate assessment of 90-day functional outcomes after anterior circulation large vessel occlusion (LVO) stroke remains challenging. Conventional models relying on a single data dimension have limited assessment power, suggesting that a multidimensional integration strategy could enhance evaluations. To develop and validate an interpretable machine learning model that integrates radiomics, infarct location, brain frailty, and clinical variables for assessing 90-day functional outcomes in LVO stroke. Retrospective. 1051 patients with anterior circulation LVO stroke (mean age 63 ± 13 years; 722 males) from five centers (2018-2023). Eight hundred and seventy-five patients from four centers formed the training (n = 612) and internal validation (n = 263) cohorts, while 176 from the fifth center comprised the external validation cohort. T1-weighted spin-echo imaging (T1WI), T2-weighted spin-echo imaging (T2WI), T2-weighted fluid-attenuated inversion recovery (FLAIR) imaging, and diffusion-weighted echo-planar imaging (DWI). Infarct volume and radiomic features were extracted from DWI. Infarct location was assessed using the Alberta Stroke Program Early CT Score. Brain frailty was evaluated using cortical/subcortical atrophy, white matter hyperintensity (WMH), and old infarcts. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for feature selection. Chi-square, Fisher's exact, t-test, Mann-Whitney U, area under the receiver operating characteristic curve (AUC), DeLong test, decision curve analysis, calibration curves, sensitivity, specificity, positive predictive value, negative predictive value, F1 score. Significance level p < 0.05. The fused model outperformed all single-dimension models (ΔAUC = 0.12-0.22), achieving AUCs of 0.87 (training), 0.84 (internal validation), and 0.86 (external validation). The fused model achieved a sensitivity and a specificity of 0.80 in the external validation cohort. Features with the highest mean absolute Shapley Additive Explanations (SHAP) values included lentiform nucleus lesion burden (SHAP = 0.083), WMH (SHAP = 0.080), and lesion burden in the M6 region (posterior middle cerebral artery territory; SHAP = 0.061). Integration of infarct location, brain frailty, radiomics, and clinical features improved the 90-day outcome assessment in anterior circulation LVO stroke, providing an interpretable tool for personalized prognosis. 2.