Spectral segmentation and radiomic features predict carotid stenosis and ipsilateral ischemic burden from DECT angiography

PURPOSE The purpose of this study is to compare spectral segmentation, spectral radiomic, and singleenergy radiomic features in the assessment of internal and common carotid artery (ICA/CCA) stenosis and prediction of surgical outcome. METHODS Our ethical committee--approved, Health Insurance Portability and Accountability Act (HIPAA)compliant study included 85 patients (mean age, 73 [+ or -] 10 years; male : female, 56 : 29) who underwent contrast-enhanced, dual-source dual-energy CT angiography (DECTA) (Siemens Definition Flash) of the neck for assessing ICA/CCA stenosis. Patients with a prior surgical or interventional treatment of carotid stenosis were excluded. Two radiologists graded the severity of carotid stenosis on DECTA images as mild (70%) stenosis. Thin-section, low- and high-kV DICOM images from the arterial phase acquisition were processed with a dual-energy CT prototype (DTA, eXamine, Siemens Healthineers) to generate spectral segmentation and radiomic features over regions of interest along the entire length (volume) and separately at a single-section with maximum stenosis. Multiple logistic regressions and area under the receiver operating characteristic curve (AUC) were used for data analysis. RESULTS Among 85 patients, 22 ICA/CCAs had normal luminal dimensions and 148 ICA/CCAs had luminal stenosis (mild stenosis: 51, moderate: 38, severe: 59). For differentiating non-severe and severe ICA/CCA stenosis, radiomic features (volume: AUC = 0.94, 95% CI 0.88-0.96; section: AUC = 0.92, 95% CI 0.86-0.93) were significantly better than spectral segmentation features (volume: AUC = 0.86, 95% CI 0.74-0.87; section: AUC = 0.68, 95% CI 0.66-0.78) (P < .001). Spectral radiomic features predicted revascularization procedure (AUC = 0.77) and the presence of ipsilateral intracranial ischemic changes (AUC = 0.76). CONCLUSION Spectral segmentation and radiomic features from DECTA can differentiate patients with different luminal ICA/CCA stenosis grades.