This study aims to evaluate a radiomic approach including texture analysis based on HR-MRI to differentiate acute symptomatic plaque from asymptomatic plaque. 94 patients with basilar artery stenosis underwent HR-MRI. The stenosis value, plaque area/burden, lumen area, intraplaque hemorrhage (IPH), contrast enhancement ratio and 94 quantitative radiomic features were extracted. Multivariate logistic analysis and a random forest model were performed. Results: IPH and enhancement ratio were independently associated with acute symptoms. Radiomic features in T1 and CE-T1 images were associated with acute symptoms. The combined T1 and CE-T1 radiomic approach had a significantly higher AUC of 0.940. Conclusion: Radiomic analysis accurately distinguished between acutely symptomatic plaques and asymptomatic plaques.
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