부산대학교 도서관

Keywords: acute ischemic stroke; DWI-FLAIR mismatch; large vessel occlusion; MRI; neuroimaging; radiomics Abstract Background and Purpose Ischemic diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch may be useful in guiding acute stroke treatment decisions given its relationship to onset time and parenchymal viability; however, it relies on subjective grading. Radiomics is an emerging image quantification methodology that may objectively represent continuous image characteristics. We propose a novel radiomics approach to characterize DWI-FLAIR mismatch. Methods Ischemic lesions were visually graded for FLAIR positivity (absent, subtle, obvious) among consecutive large vessel occlusion stroke patients who underwent hyperacute MRI. Radiomic features were extracted from within the lesions on DWI and FLAIR. The DWI-FLAIR mismatch radiomics signature was built with features systematically selected by a cross-validated ElasticNet linear regression model of mismatch. Results We identified 103 patients with mean age 68 ± 16 years; 63% were female. FLAIR hyperintensity was absent in 25%, subtle in 55%, and obvious in 20%. Inter-rater agreement for visual grading was moderate (Î = .58). The radiomics signature of DWI-FLAIR mismatch included native FLAIR histogram kurtosis and local binary pattern-filtered FLAIR gray-level cluster shade; both correlated with visual grading (Ï = -.42, p < .001 and Ï = .40, p < .001, respectively). Conclusions Radiomics can describe DWI-FLAIR mismatch and may provide objective, continuous biomarkers for infarct evolution using clinical-grade images. These novel biomarkers may prove useful for treatment decisions and future research. Article Note: Funding information The National Institute of Neurological Disorders and Stroke supported RWR (R25NS065743) and NSR (R01NS086905, R01NS082285, U19NS115388). The ISITE-ULNE Fundation, Sociétés Françaises de Neuroradiologie et de Radiologie, and Planiol Fundation supported MB. Robert W. Regenhardt and Martin Bretzner contributed equally as co-first authors. Natalia S. Rost and Thabele M. Leslie-Mazwi contributed equally as co-senior authors. Byline: Robert W. Regenhardt, Martin Bretzner, Maria Clara Zanon Zotin, Anna K. Bonkhoff, Mark R. Etherton, Sungmin Hong, Alvin S. Das, Naif M. Alotaibi, Justin E. Vranic, Adam A. Dmytriw, Christopher J. Stapleton, Aman B. Patel, Gregory Kuchcinski, Natalia S. Rost, Thabele M. Leslie-Mazwi