This study aims to evaluate a quantitative radiomic approach including texture analysis based on HR-MRI to differentiate acute symptomatic plaque from asymptomatic plaque. 158 patients with middle cerebral artery and basilar artery stenosis underwent HR-MRI. The stenosis value, plaque area/burden, lumen area, intraplaque hemorrhage (IPH), contrast enhancement ratio and 109 quantitative radiomic features were extracted. Multivariate logistic analysis and a random forest model were performed. The result was shown that smoking, IPH and enhancement ratio were independently associated with symptomatic plaques. Radiomic features in T2, T1 and CE-T1 images were associated with symptomatic plaques, whose AUC respectively are 0.801,0.835 and 0.846. The combined all radiomic approach had a significantly higher AUC of 0.953. Combination of all features reached an AUC of 0.976, with accuracy of 87.4%. Radiomic analysis accurately distinguished between acutely symptomatic plaques and asymptomatic plaques.
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