Radiomics signature and deep learning signature of intrathrombus and perithrombus for prediction of malignant cerebral edema after acute ischemic stroke: a multicenter CT study

Objectives To accurately assess the predictive ability of radiomics and deep learning (DL) features in intrathrombus and perithrombus regions for the risk of malignant cerebral edema (MCE) after acute ischemic stroke (AIS). Materials and methods A retrospective study was conducted, enrolling 406 AIS patients who underwent admission CT before endovascular thrombectomy (EVT). Center A patients were randomly divided (7:3) into training/testing sets; Centers B and C formed the external validation cohort. Regions of interest (ROIs) of thrombus and perithrombus were manually delineated and automatically expanded in margin by one pixel. Four hundred twenty-eight radiomic features were extracted from CT images of intrathrombus and perithrombus regions, and 128 DL features were obtained by inputting these images into a VGG16 architecture. Following features fusion, least absolute shrinkage and selection operator (LASSO) regression was employed for dimensionality reduction. Eleven machine learning classifiers were used for model development. Models’ performance was evaluated using Matthews correlation coefficient (MCC) and area under the receiver operating characteristic curve (AUC), with AUC differences tested using DeLong’s method. Results MCE occurred in 49 patients (12.1%). In the validation cohort, the logistic regression (LR) models demonstrated discriminative performance with perithrombus (LR-peri: MCC = 0.857, AUC = 0.891), intrathrombus, (LR-intra: MCC = 0.328, AUC = 0.626), and combined (LR-combined: MCC = 0.41, AUC = 0.869) models. The LR-combined model exhibited a significantly superior predictive capacity to that of LR-intra ( p < 0.05). Conclusion Perithrombus features enhance MCE prediction after AIS, enabling optimized medical resource allocation. Clinical relevance statement Emphasis is placed on the critical significance of radiomics extracted from the area in and around the thrombus in predicting MCE after AIS, which has far-reaching significance for improving patient prognosis.