Prognostic value of radiomics-based hyperdense middle cerebral artery sign for patients with acute ischemic stroke after thrombectomy strategy.

Background and purpose: The purpose of this study was to evaluate the prognostic value of radiomics-based hyperdense middle cerebral artery sign (HMCAS) for patients with acute ischemic stroke (AIS) after mechanical thrombectomy (MT) and to establish prediction models to identify patients who may benefit more from MT. Methods: In this retrospective study, a total of 102 consecutive patients who presented with HMCAS on non-contrast computed tomography (NCCT) at admission and underwent MT in our hospital between January 2019 and December 2020 were recruited. Among them, 46 experienced favorable outcomes (modified Rankin Scale [mRS] ≤ 2) at 3 months of follow-up. All patients were categorized into two sets, namely, the training set ( Results: The prediction model established using CFs before MT includes baseline National Institutes of Health Stroke Scale (NIHSS) and neutrophil-to-lymphocyte ratio (NLR) [AUC [95% confidence interval (CI)] = 0.596 (0.312-0.881)]. A total of 1,389 RFs were extracted from each hyperdense territory and 8 RFs were left to build the radiomics model [RM; AUC (95%CI) = 0.798 (0.598-0.998)]. The model using preoperative CFs and RFs showed good performance [AUC (95%CI) = 0.817 (0.625-1.000)]. The models using post-operative CFs alone [AUC (95%CI) = 0.856 (0.685-1.000)] or post-operative CFs with RFs [AUC (95%CI) = 0.894 (0.757-1.000)] also showed good discrimination. Conclusion: The radiomics-based HMCAS might be a promising tool to predict the prognoses of patients with AIS after MT.