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Background  Radiomics analysis is a newly emerging quantitative image analysis technique. The aim of this study was to extract a radiomics signature from the computed tomography (CT) imaging to determine the infarction onset time in patients with acute middle cerebral artery occlusion (MCAO).    Methods  A total of 123 patients with acute MCAO in the M1 segment (85 patients in the development cohort and 38 patients in the validation cohort) were enrolled in the present study. Clinicoradiological profiles, including head CT without contrast enhancement and computed tomographic angiography (CTA), were collected. The time from stroke onset (TFS) was classified into two subcategories: ≤ 4.5 h, and > 4.5 h. The middle cerebral artery (MCA) territory on CT images was segmented to extract and score the radiomics features associated with the TFS. In addition, the clinicoradiological factors related to the TFS were identified. Subsequently, a combined model of the radiomics signature and clinicoradiological factors was constructed to distinguish the TFS ≤ 4.5 h. Finally, we evaluated the overall performance of our constructed model in an external validation sample of ischemic stroke patients with acute MCAO in the M1 segment.    Results  The area under the curve (AUC) of the radiomics signature for discriminating the TFS in the development and validation cohorts was 0.770 (95% confidence interval (CI): 0.665–0.875) and 0.792 (95% CI: 0.633–0.950), respectively. The AUC of the combined model comprised of the radiomics signature, age and ASPECTS on CT in the development and validation cohorts was 0.808 (95% CI: 0.701–0.916) and 0.833 (95% CI: 0.702–0.965), respectively. In the external validation cohort, the AUC of the radiomics signature was 0.755 (95% CI: 0.614–0.897), and the AUC of the combined model was 0.820 (95% CI: 0.712–0.928).    Conclusions  The CT-based radiomics signature is a valuable tool for discriminating the TFS in patients with acute MCAO in the M1 segment, which may guide the use of thrombolysis therapy in patients with indeterminate stroke onset time.

Developing a model for estimating infarction onset time based on computed tomography radiomics in patients with acute middle cerebral artery occlusion