Journal article
Clot Composition Profiling in Large Vessel Occlusion Stroke Via Radiomics
Annals of neurology, Vol.99(5), pp.1179-1188
05/2026
DOI: 10.1002/ana.78160
PMCID: PMC13092787
PMID: 41542736
Appears in UI Libraries Support Open Access
Abstract
Clot composition may offer insights into the mechanism of ischemic stroke. Radiomics, a noninvasive imaging technique, enables tissue characterization through radiomic features (RFs). We aimed to evaluate clot composition using radiomics on non-contrast computed tomography (NCCT).
In the first phase, we conducted a prospective study comparing RFs with histopathology in thrombi retrieved via mechanical thrombectomy (MT). Thrombi were imaged using micro-computed tomography (micro-CT) and analyzed histologically. Matched micro-CT and histological slices identified red blood cells (RBCs) and fibrin-rich regions. RFs were extracted, and multivariate logistic regression identified features associated with each component. Spearman's correlation was used to assess associations between RFs and percentage composition. The same clots were localized on pre-MT NCCT, and RFs were extracted. Micro-CT and NCCT RFs were correlated to enable histology-informed interpretation. Receiver operating characteristic analysis evaluated the ability of NCCT RFs to discriminate clot composition. In the second phase, radiomics was applied to a retrospective NCCT dataset from patients with ischemic stroke with varying etiologies.
Ten thrombi were analyzed using micro-CT. Total energy (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.20-1.54, p < 0.001) and large dependence high gray level emphasis (OR = 1.18, 95% CI = 1.07-1.32, p = 0.01) were associated with RBCs and correlated with >70% RBCs composition on NCCT (Rho = 0.752 and Rho = 0.815). Subsequently, 150 NCCT scans were analyzed, including 50 cardioembolic, 50 large artery atherosclerosis (LAA), and 50 cryptogenic strokes. Radiomic analysis indicated RBCs-predominant composition in 72% of cardioembolic, 30% of LAA, and 50% of cryptogenic clots.
Radiomics is a promising, noninvasive technique for characterizing clot composition. ANN NEUROL 2026.
Details
- Title: Subtitle
- Clot Composition Profiling in Large Vessel Occlusion Stroke Via Radiomics
- Creators
- Andres Gudino - University of IowaElena Sagues - University of IowaCarlos Dier - University of IowaDiego Ojeda - UConn HealthSamantha Saenz-Hinojosa - University of Iowa, NeurologySebastian Sanchez - Yale UniversityAriel Vargas - Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USALinder Wendt - University of IowaMaria Belen Torres - University of Iowa, NeurologyEmily Garces - Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USAAlex Hanson - University of IowaNavami Shenoy - University of IowaConnor Aamot - University of IowaSusan A Walsh - University of IowaAnil K Chauhan - University of IowaGowri Anil-Peethambar - University of IowaSantiago Ortega-Gutierrez - University of IowaJay Kinariwala - University of IowaMohamed Elshikh - University of IowaAmir Shaban - University of IowaEnrique C Leira - University of IowaOsorio Lopes Abath Neto - University of Iowa, PathologyMalik Ghannam - University of IowaEdgar A Samaniego - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Annals of neurology, Vol.99(5), pp.1179-1188
- DOI
- 10.1002/ana.78160
- PMID
- 41542736
- PMCID
- PMC13092787
- NLM abbreviation
- Ann Neurol
- ISSN
- 1531-8249
- eISSN
- 1531-8249
- Publisher
- Wiley
- Grant note
- Department of Radiology Small Animal Imaging Core (SAIC) at the University of IowaNIH grant: 520 1S10ODO18503 01, CSS-CNV-23-001 National Center for Advancing Translational Sciences of the NIH: UM1TR004403
The authors would like to thank the Department of Radiology Small Animal Imaging Core (SAIC) at the University of Iowa. Imaging acquisition on the micro-CT scanner was supported by the NIH grant 520 1S10ODO18503 01. This study was supported by the grant CSS-CNV-23-001 awarded by Johnson and Johnson - Neuro. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the NIH under Award Number UM1TR004403.
- Language
- English
- Electronic publication date
- 01/16/2026
- Date published
- 05/2026
- Academic Unit
- Neurology; Radiology; Hematology, Oncology, and Blood & Marrow Transplantation; Epidemiology; Pathology; Iowa Neuroscience Institute; Neurosurgery; Internal Medicine
- Record Identifier
- 9985121596602771
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