Zhang Yuan, Zheng Tingting, Wang Hao, Zhu Jie, Duan Shaofeng, Song Bin
Department of Radiology, Minhang Hospital, Fudan University, Shanghai, China.
GE Healthcare, Shanghai, China.
World Neurosurg. 2025 Jan;193:911-919. doi: 10.1016/j.wneu.2024.10.073. Epub 2024 Nov 15.
Endovascular thrombectomy (EVT) is recommended for acute ischemic stroke due to large-vessel occlusion. However, approximately 50% of patients still experience poor outcomes after the procedure. This study aimed to assess whether a nomogram model that integrates computed tomography angiography radiomics features and clinical variables can predict EVT outcomes in patients with acute ischemic stroke.
A total of 159 patients undergoing EVT were randomly divided into training and validation groups at a 7:3 ratio. A modified Rankin Scale score ≤ 2 at 90 days indicated a favorable outcome. We used univariate and multivariate logistic regression to identify analytic and radiomics predictors and create predictive models. Model performance was evaluated using the area under the curve, Hosmer-Lemeshow test, and decision curve analysis for discrimination, calibration, and clinical utility.
A 19-feature radiomics signature reached an area under the curve of 0.79. Combining it with age, baseline National Institutes of Health Stroke Scale score, diabetes, and statin use increased the area under the curve of the clinical-radiomics nomogram to 0.85. Both decision curve and calibration curve analyses showed strong performance.
Combining a radiomics nomogram with clinical predictors could effectively forecast EVT outcomes in patients with acute anterior circulation large vessel occlusion stroke.
血管内血栓切除术（EVT）被推荐用于治疗由大血管闭塞引起的急性缺血性卒中。然而，仍有大约50%的患者在手术后预后不佳。本研究旨在评估一种整合计算机断层血管造影术影像组学特征和临床变量的列线图模型能否预测急性缺血性卒中患者的EVT预后。
总共159例接受EVT的患者按照7:3的比例随机分为训练组和验证组。90天时改良Rankin量表评分≤2表明预后良好。我们使用单因素和多因素逻辑回归来识别分析性和影像组学预测因素并创建预测模型。使用曲线下面积、Hosmer-Lemeshow检验以及用于鉴别、校准和临床效用的决策曲线分析来评估模型性能。
一个包含19个特征的影像组学特征图谱的曲线下面积达到了0.79。将其与年龄、基线美国国立卫生研究院卒中量表评分、糖尿病和他汀类药物使用情况相结合，使临床-影像组学列线图的曲线下面积增加到0.85。决策曲线分析和校准曲线分析均显示出良好的性能。
将影像组学列线图与临床预测因素相结合能够有效预测急性前循环大血管闭塞性卒中患者的EVT预后。
