Radiomics versus Conventional Assessment to Identify Symptomatic Participants at Carotid Computed Tomography Angiography

<b><i>Introduction:</i></b> Carotid computed tomography angiography (CTA) is routinely used for evaluating the atherosclerotic process. Radiomics allows the extraction of imaging markers of lesion heterogeneity and spatial complexity. These quantitative features can be used as the input for machine learning (ML). Therefore, in this study, we aimed to evaluate the diagnostic performance of radiomics-based ML assessment of carotid CTA data to identify symptomatic patients with carotid artery atherosclerosis. <b><i>Methods:</i></b> In this retrospective study, participants with carotid artery atherosclerosis who underwent carotid CTA and brain magnetic resonance imaging from May 2010 to December 2017 were studied. The participants were grouped into symptomatic and asymptomatic groups according to their recent symptoms (determination of ipsilateral ischemic stroke). Eight conventional plaque features and 2,107 radiomics parameters were extracted from carotid CTA images. A radiomics-based ML model was fitted on the training set, and the radiomics-based ML model and conventional assessment were compared using the area under the curve (AUC) to identify symptomatic participants. <b><i>Results:</i></b> After excluding participants with other stroke sources, 120 patients with 148 carotid arteries were analyzed. Of these 148 carotid arteries, 34 (22.97%) were classified into the symptomatic group. Plaque ulceration (odds ratio [OR] = 0.257; 95% confidence interval [CI], 0.094–0.698) and plaque enhancement (OR = 0.305; 95% CI, 0.094–0.988) were associated with the symptomatic status. Twenty radiomics parameters were chosen to be inputs in the radiomics-based ML model. In the identification of symptomatic participants, the discriminatory value of the radiomics-based ML model was significantly higher than that of the conventional assessment (AUC = 0.858 vs. AUC = 0.706, <i>p</i> = 0.021). <b><i>Conclusion:</i></b> Radiomics-based ML analysis improves the discriminatory power of carotid CTA in the identification of recent ischemic symptoms in patients with carotid artery atherosclerosis.