Dual‐Energy CT‐Based Assessment of Thrombotic Heterogeneity for Predicting Stroke Source and Response to Machine Thrombectomy: A Step Toward Visualization Thrombus Treatment

Abstract The viability of using thrombus heterogeneity (TH) data derived from dual‐energy CT (DECT) as a visual thrombotic biomarker is unclear. The first aim of this study is to develop a quantitative measure of TH on DECT and test its performance for predicting the stroke source (cardiogenic vs. non‐cardiogenic) and clinical outcomes (functional status assessed by the modified Rankin Scale score at 90 days) following machine thrombectomy (MT). The second aim is to associate thrombus subregions with the thrombus composition to facilitate visualization of thrombus constituents. Radiomics data are extracted from the whole thrombus and subregions in CT/DECT to construct predictive models. The performances of all models are evaluated and compared in the validation and comparative cohorts. Histopathologic analysis is performed to correlate the subregion data with the actual thrombus composition. This study included 221 and 255 participants who underwent DECT and CT examinations, respectively. DECT outperformed CT in predicting stroke source and clinical outcomes, with the TH‐related models showing the highest performance in the validation and comparative cohorts. Thrombus composition is correlated with the different CT/DECT‐based subregions, with DECT‐habitat_c showing the strongest association. Thrombus subregion analyses may help visualize the related constituents.