基于影像组学列线图模型预测急性缺血性脑卒中血管内治疗后恶性脑水肿的发生风险OA

Objective To explore the predictive factors of malignant brain edema(MBE)in patients with acute ischemic stroke(AIS)after endovascular therapy(EVT)based on imaging indicators.Methods A total of 480 patients with AIS who underwent EVT at our hospital from August 2020 to August 2024 were enrolled as study subjects.Among them,300 patients in the modeling group were divided into concurrent group(n=76)and non-concurrent group(n=224)according to whether MBE occurred.According to the occurrence of MBE,180 patients in the test group were divided into concurrent group(n=46)and non-concurrent group(n=134).The clinical data of patients were collected.Logistic regression risk model was used to analyze the related factors of MBE after EVT in patients with AIS in the modeling group.The"rms"package of R software was used to construct a nomogram model and verify its clinical efficacy.Results In the modeling group,compared with the non-concurrent group,the patients in the concurrent group were older,the proportion of hypertension and basal cistern disappearance was higher,the Alberta stroke project early CT(ASPECT)score was lower,and the admission NIHSS score was higher.There were significant differences in the location of occlusive vessels and the etiology of ischemic stroke(TOAST)between the concurrent group and the non-concurrent group(P＜0.05).Age,hypertension,basal cistern disappearance,ASPECT score,NIHSS score on admission,and occlusive vascular site were independent influencing factors of MBE in AIS patients after EVT(P＜0.05).The results of ROC curve analysis showed that the AUC of the modeling group was 0.956(95％CI:0.933-0.979),and the calibration curve analysis showed that the C-index of the model was 0.882(95％CI:0.841-0.918).The decision curve showed that after the intervention based on the prediction results of the nomogram,when the risk threshold was greater than 0.08,it could provide more clinical net income;the C-index of MBE was 0.851(95％CI:0.800-0.897).The H-L goodness of fit test was x2=8.011,P=0.432;the DCA curve showed that using this model to predict AIS patients receiving EVT treatment coud obtain higher positive net benefits.Conclusion Age,hypertension,basal cistern disappearance,ASPECT score,admission NIHSS score,and occluded vascular site are of great significance for the early prediction of MBE in patients with AIS after EVT,which can provide decision-making for clinical evaluation and prevention.