Skip to main content
Erschienen in: Journal of Neurology 5/2020

01.02.2020 | Original Communication

Penumbra-based radiomics signature as prognostic biomarkers for thrombolysis of acute ischemic stroke patients: a multicenter cohort study

verfasst von: Tian-yu Tang, Yun Jiao, Ying Cui, Deng-ling Zhao, Yi Zhang, Zhi Wang, Xiang-pan Meng, Xin-Dao Yin, Yun-Jun Yang, Gao-jun Teng, Sheng-hong Ju

Erschienen in: Journal of Neurology | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Background and Purpose

This study aimed at developing a radiomics signature (R score) as prognostic biomarkers based on penumbra quantification and to validate the radiomics nomogram to predict the clinical outcomes for thrombolysis for acute ischemic stroke (AIS) patients.

Methods

In total, 168 patients collected from seven centers were retrospectively included. A score of mismatch was defined as MIS. Based on a short-term clinical label, 456 radiomics features were evaluated with feature selection methods. R score was constructed with the selected features. To compare the predictive capabilities of the clinical factors, MIS, and R score, three nomograms were developed and evaluated, according to the short-term clinical assessment on day 7. Finally, the radiomics nomogram was validated by predicting the 3-month clinical outcomes of AIS patients, in an external cohort.

Results

R scores were found to be significantly higher in patients with favorable clinical outcomes in both training and validation datasets. The predictive value of the radiomics nomogram estimating favorable clinical outcomes was modest, with a concordance index (C-index) of 0.695 [95% confidence interval (CI) 0.667–0.723) in an external validation dataset. In addition, the area under curve (AUC) of the radiomics nomogram predicting favorable clinical outcome reached 0.886 (95% CI 0.809–0.963) on day 7 and 0.777 (95% CI 0.666–0.888) at 3 months.

Conclusions

The radiomics signature is an independent biomarker for estimating the clinical outcomes in AIS patients. By improving the individualized prediction of the clinical outcome for AIS patients 3 months after onset, the radiomics nomogram adds more value to the current clinical decision-making process.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
2.
Zurück zum Zitat Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL, American Heart Association Stroke C (2018) 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49(3):e46–e110. https://doi.org/10.1161/STR.0000000000000158 CrossRefPubMed Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL, American Heart Association Stroke C (2018) 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49(3):e46–e110. https://​doi.​org/​10.​1161/​STR.​0000000000000158​ CrossRefPubMed
4.
Zurück zum Zitat Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, Kleinig TJ, Wijeratne T, Curtze S, Dewey HM, Miteff F, Tsai CH, Lee JT, Phan TG, Mahant N, Sun MC, Krause M, Sturm J, Grimley R, Chen CH, Hu CJ, Wong AA, Field D, Sun Y, Barber PA, Sabet A, Jannes J, Jeng JS, Clissold B, Markus R, Lin CH, Lien LM, Bladin CF, Christensen S, Yassi N, Sharma G, Bivard A, Desmond PM, Yan B, Mitchell PJ, Thijs V, Carey L, Meretoja A, Davis SM, Donnan GA, Investigators E (2019) Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. New Engl J Med 380(19):1795–1803. https://doi.org/10.1056/NEJMoa1813046 CrossRefPubMed Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, Kleinig TJ, Wijeratne T, Curtze S, Dewey HM, Miteff F, Tsai CH, Lee JT, Phan TG, Mahant N, Sun MC, Krause M, Sturm J, Grimley R, Chen CH, Hu CJ, Wong AA, Field D, Sun Y, Barber PA, Sabet A, Jannes J, Jeng JS, Clissold B, Markus R, Lin CH, Lien LM, Bladin CF, Christensen S, Yassi N, Sharma G, Bivard A, Desmond PM, Yan B, Mitchell PJ, Thijs V, Carey L, Meretoja A, Davis SM, Donnan GA, Investigators E (2019) Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. New Engl J Med 380(19):1795–1803. https://​doi.​org/​10.​1056/​NEJMoa1813046 CrossRefPubMed
5.
Zurück zum Zitat Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, Cheripelli B, Cho T-H, Fazekas F, Fiehler J (2018) MRI-guided thrombolysis for stroke with unknown time of onset. New Engl J Med 379(7):611–622CrossRef Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, Cheripelli B, Cho T-H, Fazekas F, Fiehler J (2018) MRI-guided thrombolysis for stroke with unknown time of onset. New Engl J Med 379(7):611–622CrossRef
6.
Zurück zum Zitat Astrup J, Siesjo BK, Symon L (1981) Thresholds in cerebral ischemia - the ischemic penumbra. Stroke 12(6):723–725CrossRef Astrup J, Siesjo BK, Symon L (1981) Thresholds in cerebral ischemia - the ischemic penumbra. Stroke 12(6):723–725CrossRef
7.
Zurück zum Zitat Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, Investigators E (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. New Engl J Med 359(13):1317–1329. https://doi.org/10.1056/NEJMoa0804656 CrossRefPubMed Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, Investigators E (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. New Engl J Med 359(13):1317–1329. https://​doi.​org/​10.​1056/​NEJMoa0804656 CrossRefPubMed
9.
Zurück zum Zitat Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, Barber PA, Bladin C, De Silva DA, Byrnes G, Chalk JB, Fink JN, Kimber TE, Schultz D, Hand PJ, Frayne J, Hankey G, Muir K, Gerraty R, Tress BM, Desmond PM, Investigators E (2008) Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 7(4):299–309. https://doi.org/10.1016/S1474-4422(08)70044-9 CrossRefPubMed Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, Barber PA, Bladin C, De Silva DA, Byrnes G, Chalk JB, Fink JN, Kimber TE, Schultz D, Hand PJ, Frayne J, Hankey G, Muir K, Gerraty R, Tress BM, Desmond PM, Investigators E (2008) Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 7(4):299–309. https://​doi.​org/​10.​1016/​S1474-4422(08)70044-9 CrossRefPubMed
10.
Zurück zum Zitat Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, Wilder MJ, Lutsep HL, Czartoski TJ, Bernstein RA, Chang CW, Warach S, Fazekas F, Inoue M, Tipirneni A, Hamilton SA, Zaharchuk G, Marks MP, Bammer R, Albers GW, Investigators Ds (2012) MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11(10):860–867. https://doi.org/10.1016/S1474-4422(12)70203-X CrossRefPubMedPubMedCentral Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, Wilder MJ, Lutsep HL, Czartoski TJ, Bernstein RA, Chang CW, Warach S, Fazekas F, Inoue M, Tipirneni A, Hamilton SA, Zaharchuk G, Marks MP, Bammer R, Albers GW, Investigators Ds (2012) MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11(10):860–867. https://​doi.​org/​10.​1016/​S1474-4422(12)70203-X CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50:211. https://doi.org/10.1161/str.0000000000000211 CrossRef Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50:211. https://​doi.​org/​10.​1161/​str.​0000000000000211​ CrossRef
13.
Zurück zum Zitat Campbell BCV, Majoie C, Albers GW, Menon BK, Yassi N, Sharma G, van Zwam WH, van Oostenbrugge RJ, Demchuk AM, Guillemin F, White P, Davalos A, van der Lugt A, Butcher KS, Cherifi A, Marquering HA, Cloud G, Macho Fernandez JM, Madigan J, Oppenheim C, Donnan GA, Roos Y, Shankar J, Lingsma H, Bonafe A, Raoult H, Hernandez-Perez M, Bharatha A, Jahan R, Jansen O, Richard S, Levy EI, Berkhemer OA, Soudant M, Aja L, Davis SM, Krings T, Tisserand M, San Roman L, Tomasello A, Beumer D, Brown S, Liebeskind DS, Bracard S, Muir KW, Dippel DWJ, Goyal M, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Collaborators H (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol 18(1):46–55. https://doi.org/10.1016/S1474-4422(18)30314-4 CrossRefPubMed Campbell BCV, Majoie C, Albers GW, Menon BK, Yassi N, Sharma G, van Zwam WH, van Oostenbrugge RJ, Demchuk AM, Guillemin F, White P, Davalos A, van der Lugt A, Butcher KS, Cherifi A, Marquering HA, Cloud G, Macho Fernandez JM, Madigan J, Oppenheim C, Donnan GA, Roos Y, Shankar J, Lingsma H, Bonafe A, Raoult H, Hernandez-Perez M, Bharatha A, Jahan R, Jansen O, Richard S, Levy EI, Berkhemer OA, Soudant M, Aja L, Davis SM, Krings T, Tisserand M, San Roman L, Tomasello A, Beumer D, Brown S, Liebeskind DS, Bracard S, Muir KW, Dippel DWJ, Goyal M, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Collaborators H (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol 18(1):46–55. https://​doi.​org/​10.​1016/​S1474-4422(18)30314-4 CrossRefPubMed
20.
21.
Zurück zum Zitat Wu O, Ostergaard L, Weisskoff RM, Benner T, Rosen BR, Sorensen AG (2003) Tracer arrival timing-insensitive technique for estimating flow in MR perfusion-weighted imaging using singular value decomposition with a block-circulant deconvolution matrix. Magn Reson Med 50(1):164–174CrossRef Wu O, Ostergaard L, Weisskoff RM, Benner T, Rosen BR, Sorensen AG (2003) Tracer arrival timing-insensitive technique for estimating flow in MR perfusion-weighted imaging using singular value decomposition with a block-circulant deconvolution matrix. Magn Reson Med 50(1):164–174CrossRef
23.
Zurück zum Zitat Lansberg MG, Lee J, Christensen S, Straka M, De Silva DA, Mlynash M, Campbell BC, Bammer R, Olivot JM, Desmond P, Davis SM, Donnan GA, Albers GW (2011) RAPID automated patient selection for reperfusion therapy: a pooled analysis of the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) Study. Stroke 42(6):1608–1614. https://doi.org/10.1161/STROKEAHA.110.609008 CrossRefPubMedPubMedCentral Lansberg MG, Lee J, Christensen S, Straka M, De Silva DA, Mlynash M, Campbell BC, Bammer R, Olivot JM, Desmond P, Davis SM, Donnan GA, Albers GW (2011) RAPID automated patient selection for reperfusion therapy: a pooled analysis of the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) Study. Stroke 42(6):1608–1614. https://​doi.​org/​10.​1161/​STROKEAHA.​110.​609008 CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Newson R (2006) Confidence intervals for rank statistics: Somers’ D and extensions. Stata J 6(3):309–334CrossRef Newson R (2006) Confidence intervals for rank statistics: Somers’ D and extensions. Stata J 6(3):309–334CrossRef
27.
Zurück zum Zitat De Long ER, De Long DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837–845CrossRef De Long ER, De Long DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837–845CrossRef
29.
Zurück zum Zitat Gumbinger C, Reuter B, Stock C, Sauer T, Wietholter H, Bruder I, Rode S, Kern R, Ringleb P, Hennerici MG, Hacke W, Schlaganfall AG (2014) Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials. BMJ 348:g3429. https://doi.org/10.1136/bmj.g3429 CrossRefPubMedPubMedCentral Gumbinger C, Reuter B, Stock C, Sauer T, Wietholter H, Bruder I, Rode S, Kern R, Ringleb P, Hennerici MG, Hacke W, Schlaganfall AG (2014) Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials. BMJ 348:g3429. https://​doi.​org/​10.​1136/​bmj.​g3429 CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Qiu W, Kuang H, Nair J, Assis Z, Najm M, McDougall C, McDougall B, Chung K, Wilson AT, Goyal M, Hill MD, Demchuk AM, Menon BK (2019) Radiomics-based intracranial thrombus features on CT and CTA predict recanalization with intravenous alteplase in patients with acute ischemic stroke. AJNR Am J Neuroradiol 40(1):39–44. https://doi.org/10.3174/ajnr.A5918 CrossRefPubMedPubMedCentral Qiu W, Kuang H, Nair J, Assis Z, Najm M, McDougall C, McDougall B, Chung K, Wilson AT, Goyal M, Hill MD, Demchuk AM, Menon BK (2019) Radiomics-based intracranial thrombus features on CT and CTA predict recanalization with intravenous alteplase in patients with acute ischemic stroke. AJNR Am J Neuroradiol 40(1):39–44. https://​doi.​org/​10.​3174/​ajnr.​A5918 CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Ecass AN, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G, Group Er-PS (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375(9727):1695–1703. https://doi.org/10.1016/S0140-6736(10)60491-6 CrossRefPubMed Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Ecass AN, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G, Group Er-PS (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375(9727):1695–1703. https://​doi.​org/​10.​1016/​S0140-6736(10)60491-6 CrossRefPubMed
Metadaten
Titel
Penumbra-based radiomics signature as prognostic biomarkers for thrombolysis of acute ischemic stroke patients: a multicenter cohort study
verfasst von
Tian-yu Tang
Yun Jiao
Ying Cui
Deng-ling Zhao
Yi Zhang
Zhi Wang
Xiang-pan Meng
Xin-Dao Yin
Yun-Jun Yang
Gao-jun Teng
Sheng-hong Ju
Publikationsdatum
01.02.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Neurology / Ausgabe 5/2020
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-09713-7

Weitere Artikel der Ausgabe 5/2020

Journal of Neurology 5/2020 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Neu im Fachgebiet Neurologie

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.