{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:59:25Z","timestamp":1792511965740,"version":"4.5.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To establish and validate a model based on hyperdense middle cerebral artery sign (HMCAS) radiomics features for predicting hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) after endovascular treatment (EVT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with AIS who presented with HMCAS on non-contrast computed tomography (NCCT) at admission and underwent EVT at three comprehensive hospitals between June 2020 and January 2024 were recruited for this retrospective study. A radiomics model was constructed using the HMCAS radiomics features most strongly associated with HT. In addition, clinical and radiological independent factors associated with HT were identified. Subsequently, a combined model incorporating radiomics features and independent risk factors was developed via multivariate logistic regression and presented as a nomogram. The models were evaluated via receiver operating characteristic curve, calibration curve, and decision curve analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 118 patients, 71 (60.17%) developed HT. The area under the curve (AUC) of the radiomics model was 0.873 (95% CI 0.797\u20130.935) in the training cohort and 0.851 (95%CI 0.721\u20130.942) in the test cohort. The Alberta Stroke Program Early CT score (ASPECTS) was the only independent predictor among 24 clinical and 4 radiological variables. The combined model further improved the predictive performance, with an AUC of 0.911 (95%CI 0.850\u20130.960) in the training cohort and 0.877 (95%CI 0.753\u20130.960) in the test cohort. Decision curve analysis demonstrated that the combined model had greater clinical utility for predicting HT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HMCAS-based radiomics is expected to be a reliable tool for predicting HT risk stratification in AIS patients after EVT.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1492089","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T05:11:33Z","timestamp":1734930693000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The value of radiomics-based hyperdense middle cerebral artery sign in predicting hemorrhagic transformation in acute ischemic stroke patients undergoing endovascular treatment"],"prefix":"10.3389","volume":"15","author":[{"given":"Chundan","family":"Gong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Jing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"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","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"585","DOI":"10.23736\/S0390-5616.20.05141-3","article-title":"Risk factors and functional outcome were associated with hemorrhagic transformation after mechanical thrombectomy for acute large vessel occlusion stroke","volume":"67","author":"Li","year":"2023","journal-title":"J Neurosurg Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1136\/neurintsurg-2018-014080","article-title":"Predictors and impact of hemorrhagic transformations after endovascular thrombectomy in patients with acute large vessel occlusions","volume":"11","author":"Lee","year":"2019","journal-title":"J Neurointerv Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/s0140-6736(98)08020-9","article-title":"Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian acute stroke study investigators","volume":"352","author":"Hacke","year":"1998","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The Heidelberg bleeding classification","volume":"46","author":"von","year":"2015","journal-title":"Stroke"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1159\/000460265","article-title":"Hemorrhagic transformations after Thrombectomy: risk factors and clinical relevance","volume":"43","author":"Kaesmacher","year":"2017","journal-title":"Cerebrovasc Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1136\/neurintsurg-2018-014141","article-title":"Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion","volume":"11","author":"van","year":"2019","journal-title":"J NeuroIntervent Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1148\/rg.2019190142","article-title":"CT for treatment selection in acute ischemic stroke: a code stroke primer","volume":"39","author":"Potter","year":"2019","journal-title":"Radiographics"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"117618","DOI":"10.1016\/j.jns.2021.117618","article-title":"Hyperdense middle cerebral artery sign and response to combination of mechanical Thrombectomy plus intravenous thrombolysis in acute stroke patients","volume":"429","author":"Mowla","year":"2021","journal-title":"J Neurol Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1161\/STROKEAHA.114.007036","article-title":"Sensitivity and specificity of the hyperdense artery sign for arterial obstruction in acute ischemic stroke","volume":"46","author":"Mair","year":"2015","journal-title":"Stroke"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1161\/STROKEAHA.121.035425","article-title":"Clinical and imaging indicators of hemorrhagic transformation in acute ischemic stroke after endovascular Thrombectomy","volume":"53","author":"Tian","year":"2022","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.1007\/s00415-022-11500-5","article-title":"Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study","volume":"270","author":"Kang","year":"2023","journal-title":"J Neurol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s13244-020-00887-2","article-title":"Radiomics in medical imaging-\"how-to\" guide and critical reflection","volume":"11","author":"van Timmeren","year":"2020","journal-title":"Insights Imaging"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13244-023-01399-5","article-title":"A clinical-radiomics model based on noncontrast computed tomography to predict hemorrhagic transformation after stroke by machine learning: a multicenter study","volume":"14","author":"Ren","year":"2023","journal-title":"Insights Imaging"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"858","DOI":"10.3390\/brainsci12070858","article-title":"Prediction model of hemorrhage transformation in patient with acute ischemic stroke based on multiparametric MRI Radiomics and machine learning","volume":"12","author":"Meng","year":"2022","journal-title":"Brain Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"20220439","DOI":"10.1259\/bjr.20220439","article-title":"Prediction of hemorrhagic transformation via pre-treatment CT radiomics in acute ischemic stroke patients receiving endovascular therapy","volume":"96","author":"Wen","year":"2023","journal-title":"Br J Radiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2469","DOI":"10.1016\/j.acra.2022.12.032","article-title":"Computed tomography angiography-based Thrombus Radiomics for predicting the time since stroke onset","volume":"30","author":"Cheng","year":"2023","journal-title":"Acad Radiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3174\/ajnr.A5918","article-title":"Radiomics-based intracranial Thrombus features on CT and CTA predict recanalization with intravenous Alteplase in patients with acute ischemic stroke","volume":"40","author":"Qiu","year":"2019","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2488","DOI":"10.1161\/STROKEAHA.120.030334","article-title":"Clot-based Radiomics predict a mechanical Thrombectomy strategy for successful recanalization in acute ischemic stroke","volume":"51","author":"Hofmeister","year":"2020","journal-title":"Stroke"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1037204","DOI":"10.3389\/fneur.2022.1037204","article-title":"Prognostic value of radiomics-based hyperdense middle cerebral artery sign for patients with acute ischemic stroke after thrombectomy strategy","volume":"13","author":"Li","year":"2023","journal-title":"Front Neurol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"359","DOI":"10.3390\/jcdd10090359","article-title":"Textural analysis of the Hyperdense artery sign in patients with acute ischemic stroke predicts the outcome of Thrombectomy","volume":"10","author":"M\u0103rginean","year":"2023","journal-title":"J Cardiovasc Dev Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment","volume":"24","author":"Adams","year":"1993","journal-title":"Stroke"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2650","DOI":"10.1161\/STROKEAHA.113.001972","article-title":"Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement","volume":"44","author":"Zaidat","year":"2013","journal-title":"Stroke"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.3174\/ajnr.A3044","article-title":"Hemorrhage\/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance","volume":"33","author":"Parrilla","year":"2012","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"525","DOI":"10.3174\/ajnr.A1408","article-title":"CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct","volume":"30","author":"Tan","year":"2009","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1161\/STROKEAHA.118.024247","article-title":"Thrombus imaging characteristics and outcomes in acute ischemic stroke patients undergoing endovascular treatment","volume":"50","author":"Dutra","year":"2019","journal-title":"Stroke"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1016\/S0140-6736(00)02237-6","article-title":"Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS study group. Alberta stroke Programme early CT score","volume":"355","author":"Barber","year":"2000","journal-title":"Lancet"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1016\/j.radcr.2018.04.017","article-title":"Bilateral hyperdense middle cerebral arteries: Stroke sign or not","volume":"13","author":"Vogler","year":"2018","journal-title":"Radiol Case Rep"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1159\/000506971","article-title":"The Hyperdense middle cerebral artery sign in drip-and-ship models of acute stroke management","volume":"10","author":"Jodaitis","year":"2020","journal-title":"Cerebrovasc Dis Extra"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3D slicer as an image computing platform for the quantitative imaging network","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn Reson Imaging"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2316","DOI":"10.1056\/NEJMoa2000120","article-title":"Thrombectomy for stroke in the public health care system of Brazil","volume":"382","author":"Martins","year":"2020","journal-title":"N Engl J Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e02116","DOI":"10.1002\/brb3.2116","article-title":"Hyperdense middle cerebral artery sign in large cerebral infarction","volume":"11","author":"Hou","year":"2021","journal-title":"Brain Behav"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"655","DOI":"10.3174\/ajnr.A6009","article-title":"Clot burden score and early ischemia predict intracranial hemorrhage following endovascular therapy","volume":"40","author":"Yogendrakumar","year":"2019","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1002717","DOI":"10.3389\/fnins.2022.1002717","article-title":"Radiomics-based infarct features on CT predict hemorrhagic transformation in patients with acute ischemic stroke","volume":"16","author":"Xie","year":"2022","journal-title":"Front Neurosci"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1413795","DOI":"10.3389\/fneur.2024.1413795","article-title":"Constructing machine learning models based on non-contrast CT radiomics to predict hemorrhagic transformation after stoke: a two-center study","volume":"15","author":"Zhang","year":"2024","journal-title":"Front Neurol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1492089\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T05:11:36Z","timestamp":1734930696000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1492089\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":36,"alternative-id":["10.3389\/fneur.2024.1492089"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1492089","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]},"article-number":"1492089"}}