Guo Yu, Yuan Chengxiu, Su Yuwen, Wang Zhe, Li Songchuan, Wang Bao, Hu Chunhong
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Institute of Neuroimmunology, Jinan, China.
Neuroradiology. 2025 Sep 8. doi: 10.1007/s00234-025-03757-0.
To develop and validate an integrated model based on MR high-resolution vessel wall imaging (HR-VWI) radiomics and clinical features to preoperatively assess periprocedural complications (PC) risk in patients with intracranial atherosclerotic disease (ICAD) undergoing percutaneous transluminal angioplasty and stenting (PTAS).
This multicenter retrospective study enrolled 601 PTAS patients (PC+, n = 84; PC -, n = 517) from three centers. Patients were divided into training (n = 336), validation (n = 144), and test (n = 121) cohorts. All patients underwent preoperative HR-VWI (precontrast T1-weighted [T1] and postcontrast T1-weighted [T1CE] sequences). We extracted 2,396 radiomic features and selected clinical variables via multivariate logistic regression. Radiomics, clinical and integrated model were developed. Model performance was evaluated using areas under the curve (AUC) and DeLong test. Decision Curve Analysis (DCA) was used to evaluate the net benefit of each model.
Age was the sole independent clinical predictor (OR = 1.06, p = 0.001). The integrated model demonstrated favorable predictive performance in the training cohort (AUC: 0.93, 95% CI [0.88, 0.96]), validation cohort (AUC: 0.87, 95% CI [0.74, 0.99]), and test cohort (AUC: 0.87, 95% CI [0.78, 0.95]). It significantly outperformed all clinical models (AUC range: 0.59-0.73; all p < 0.05) and showed performance comparable to the optimal radiomics model (T1-T1CE model; AUC range: 0.80-0.91; all p > 0.05).Notably, the DCA curve indicated that the integrated model achieved the optimal clinical net benefit across the 0-90% threshold range in the test cohort.
The integrated model demonstrates clinical utility for preoperative PC risk stratification in PTAS patients.
开发并验证一种基于磁共振高分辨率血管壁成像（HR-VWI）的放射组学和临床特征的综合模型，以术前评估接受经皮腔内血管成形术和支架置入术（PTAS）的颅内动脉粥样硬化疾病（ICAD）患者围手术期并发症（PC）的风险。
这项多中心回顾性研究纳入了来自三个中心的601例PTAS患者（PC+，n = 84；PC-，n = 517）。患者被分为训练组（n = 336）、验证组（n = 144）和测试组（n = 121）。所有患者均接受术前HR-VWI（对比前T1加权[T1]和对比后T1加权[T1CE]序列）。我们提取了2396个放射组学特征，并通过多变量逻辑回归选择临床变量。开发了放射组学、临床和综合模型。使用曲线下面积（AUC）和DeLong检验评估模型性能。决策曲线分析（DCA）用于评估每个模型的净效益。
年龄是唯一独立的临床预测因素（OR = 1.06，p = 0.001）。综合模型在训练组（AUC：0.93，95%CI[0.88，0.96]）、验证组（AUC：0.87，95%CI[0.74，0.99]）和测试组（AUC：0.87，95%CI[0.78，0.95]）中表现出良好的预测性能。它显著优于所有临床模型（AUC范围：0.59 - 0.73；所有p < 0.05），并且表现与最佳放射组学模型（T1-T1CE模型；AUC范围：0.80 - 0.91；所有p > 0.05）相当。值得注意的是，DCA曲线表明综合模型在测试组的0 - 90%阈值范围内实现了最佳临床净效益。
综合模型在PTAS患者术前PC风险分层中具有临床应用价值。
