The role of CT texture analysis in predicting the clinical outcomes of acute ischemic stroke patients undergoing mechanical thrombectomy

Objectives To evaluate the performance of CT-based texture analysis (TA) for predicting clinical outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Methods This single-center, retrospective study contained 64 consecutive patients with AIS who underwent MT for large anterior circulation occlusion between December 2016 and January 2020. Patients were divided into 2 groups according to the modified Rankin scale (mRS) scores at 3 months as good outcome (mRS ≤ 2) and bad outcome (mRS > 2). Two observers examined the early ischemic changes for TA on baseline non-contrast CT images independently. Demographic, clinical, periprocedural, and texture variables were compared between the groups and ROC curves were made. Logistic regression analysis was used and a model was created to determine the independent predictors of a bad outcome. Results Sixty-four patients (32 female, 32 male; mean age 63.03 ± 14.42) were included in the study. Fourteen texture parameters were significantly different between patients with good and bad outcomes. The long-run high gray-level emphasis (LRHGE), which is a gray-level run-length matrix (GLRLM) feature, showed the highest sensitivity (80%) and specificity (70%) rates to predict disability. The GLRLM_LRHGE value of > 4885.0 and the time from onset to puncture of > 237.5 mi were found as independent predictors of the bad outcome. The diagnostic rate was 80.0% when using the combination of the GLRLM_LRHGE and the time from onset to puncture cutoff values. Conclusion CT-based TA might be a promising modality to predict clinical outcome after MT in patients with AIS. Key Points • The gray-level run-length matrix parameters displayed higher diagnostic performance among the texture features. • The long-run high gray-level emphasis showed the highest sensitivity and specificity rates for predicting a bad outcome in stroke patients undergoing mechanical thrombectomy. • The gray-level run-length matrix_long-run high gray-level emphasis value of > 4885.0 (OR = 11.06; 95% CI = 2.51 – 48.77; p = 0.001) and the time from onset to puncture of > 237.5 min (OR = 8.55; 95% CI = 1.96 – 37.21; p = 0.004) were found as independent predictors of the bad outcome.