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Penumbra-based radiomics signature as prognostic biomarkers for thrombolysis of acute ischemic stroke patients: a multicenter cohort study

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Abstract

Background and Purpose

This study aimed at developing a radiomics signature (R score) as prognostic biomarkers based on penumbra quantification and to validate the radiomics nomogram to predict the clinical outcomes for thrombolysis for acute ischemic stroke (AIS) patients.

Methods

In total, 168 patients collected from seven centers were retrospectively included. A score of mismatch was defined as MIS. Based on a short-term clinical label, 456 radiomics features were evaluated with feature selection methods. R score was constructed with the selected features. To compare the predictive capabilities of the clinical factors, MIS, and R score, three nomograms were developed and evaluated, according to the short-term clinical assessment on day 7. Finally, the radiomics nomogram was validated by predicting the 3-month clinical outcomes of AIS patients, in an external cohort.

Results

R scores were found to be significantly higher in patients with favorable clinical outcomes in both training and validation datasets. The predictive value of the radiomics nomogram estimating favorable clinical outcomes was modest, with a concordance index (C-index) of 0.695 [95% confidence interval (CI) 0.667–0.723) in an external validation dataset. In addition, the area under curve (AUC) of the radiomics nomogram predicting favorable clinical outcome reached 0.886 (95% CI 0.809–0.963) on day 7 and 0.777 (95% CI 0.666–0.888) at 3 months.

Conclusions

The radiomics signature is an independent biomarker for estimating the clinical outcomes in AIS patients. By improving the individualized prediction of the clinical outcome for AIS patients 3 months after onset, the radiomics nomogram adds more value to the current clinical decision-making process.

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Acknowledgements

The authors would like to acknowledge Pei-Yi Gao from the Beijing Tiantan Hospital for providing the validation dataset collected from the following institutes: the Beijing Tiantan Hospital, the First Affiliated Hospital of Wenzhou Medical University, the Guangdong Hospital of Traditional Chinese Medicine, the Shanghai Pudong New Area People's Hospital and the Tianjin Huanhu Hospital.

Funding

This work was funded by the National Natural Science Foundation for Distinguished Young Scholars of China (81525014), the National Key Research and Development Program of China (2017YFA0104302), the National Natural Science Foundation Innovation Research Group Project (61821002), the Key Research and Development Program of Jiangsu Province (BE2016782), the Natural Science Foundation of Jiangsu Province of China (BK20170704).

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Authors and Affiliations

  1. Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China

    Tian-yu Tang, Yun Jiao, Ying Cui, Deng-ling Zhao, Yi Zhang, Zhi Wang, Xiang-pan Meng, Gao-jun Teng & Sheng-hong Ju

  2. Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China

    Xin-Dao Yin

  3. Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China

    Yun-Jun Yang

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  1. Tian-yu Tang
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Contributions

SHJ was study chair and principal investigator; TYT drafted the initial manuscript, which was reviewed by all the other authors. TYT, SHJ, and GJT designed and carried out the study. TYT, YJ, XPM and WZ analyzed the MR data. YC, SHJ, and GJT provided extensive critical insights and revisions of all drafts of the manuscript. DLZ, ZY, YJY and XDY enrolled patients. YC and DLZ reviewed the image processing results. All authors contributed to the final version of the manuscript.

Corresponding author

Correspondence to Sheng-hong Ju.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The research was conducted according to the principles of the Declaration of Helsinki and the study was approved by the Ethics Committees of all listed hospitals and informed consent was obtained.

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415_2020_9713_MOESM1_ESM.tif

Figure S1: Development and performance of the nomograms.Note: (A) clinical nomogram; (B) MIS nomogram. The nomograms were developed using the training dataset based on the clinical and radiological features. By adding all the corresponding points, the predicted possibility of FCO for an AIS patient was located on the total point axis. SBP=systolic blood pressure; NIHSS = National Institutes of Health Stroke Scale; MIS represents the mismatch ratio between the volume of penumbra and all impaired brain regions after onset. (TIF 1089 kb)

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Tang, Ty., Jiao, Y., Cui, Y. et al. Penumbra-based radiomics signature as prognostic biomarkers for thrombolysis of acute ischemic stroke patients: a multicenter cohort study. J Neurol 267, 1454–1463 (2020). https://doi.org/10.1007/s00415-020-09713-7

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  • DOI: https://doi.org/10.1007/s00415-020-09713-7

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