Integrating cross-sectional imaging data into functional outcome prediction models for acute ischemic stroke of the anterior circulation

• Automated image analysis replaces radiological scoring in functional outcome prediction • The information contained in CTA and NCCT is not complementary to commonly acquired tabular data • Adding NCCT to a CTA image processing model does not improve performance • Performance of imaging based models reaches a plateau after 750 cases In acute ischemic stroke, large vessel occlusions of the anterior circulation are increasingly treated with endovascular therapy (EVT). The efficacy of this therapy depends on adequate treatment selection. Treatment decisions can be based on predictions of functional outcome. Most existing studies predict functional outcomes using clinical parameters. We set out to study functional outcome prediction performance by integrating imaging in a multimodal setting. Using a multi-center dataset containing 2927 patients, we compare the functional outcome prediction performances of clinical baseline models, including the clinically validated MR PREDICTS decision tool, image-based models with deep learning networks, and a multimodal approach combining clinical and imaging information. The predicted outcome measure is dichotomized modified Rankin Scale score 90 days after EVT. We perform sanity checks, hyperparameter optimization, and comparisons of effectiveness of using CTA, NCCT, or both images as input. Our experiments show that information extracted from CTA or NCCT images does not significantly improve the performance, as quantified using AUC, of functional outcome prediction methods compared to a baseline model. The multimodal approach may replace radiologically derived biomarkers, as its performance is non-inferior. Few-shot image Classification Based on Class-irrelevant Feature Decoupling Graph Neural Network