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Neuroimaging biomarkers that predict the edema after acute stroke may help clinicians provide targeted therapies and minimize the risk of secondary injury. In this study, we applied pretherapy MRI radiomics features from infarction and cerebrospinal fluid (CSF) to predict edema after acute ischemic stroke. MRI data were obtained from a prospective, endovascular thrombectomy (EVT) cohort that included 389 patients with acute stroke from two centers (dataset 1,  n  = 292; dataset 2,  n  = 97), respectively. Patients were divided into edema group (brain swelling and midline shift) and non-edema group according to CT within 36 h after therapy. We extracted the imaging features of infarct area on diffusion weighted imaging (DWI) (abbreviated as DWI), CSF on fluid-attenuated inversion recovery (FLAIR) (CSF FLAIR ) and CSF on DWI (CSF DWI ), and selected the optimum features associated with edema for developing models in two forms of feature sets (DWI + CSF FLAIR  and DWI + CSF DWI ) respectively. We developed seven ML models based on dataset 1 and identified the most stable model. External validations (dataset 2) of the developed stable model were performed. Prediction model performance was assessed using the area under the receiver operating characteristic curve (AUC). The Bayes model based on DWI + CSF FLAIR  and the RF model based on DWI + CSF DWI  had the best performances (DWI + CSF FLAIR : AUC, 0.86; accuracy, 0.85; recall, 0.88; DWI + CSF DWI : AUC, 0.86; accuracy, 0.84; recall, 0.84) and the most stability (RSD% in DWI + CSF FLAIR  AUC: 0.07, RSD% in DWI + CSF DWI  AUC: 0.09), respectively. External validation showed that the AUC of the Bayes model based on DWI + CSF FLAIR  was 0.84 with accuracy of 0.77 and area under precision-recall curve (auPRC) of 0.75, and the AUC of the RF model based on DWI + CSF DWI  was 0.83 with accuracy of 0.81 and the auPRC of 0.76. The MRI radiomics features from infarction and CSF may offer an effective imaging biomarker for predicting edema.

MRI Radiomics Features From Infarction and Cerebrospinal Fluid for Prediction of Cerebral Edema After Acute Ischemic Stroke