CT Texture Analysis of Acute Ischemic Stroke: Prediction of Hemorrhagic Transformation After Thrombolysis

Background: Hemorrhagic transformation is a major complication after thrombolysis in acute ischemic stroke, and its risk assessment based on baseline non-contrast CT (NCCT) remains limited. This study aims to evaluate the role of CT-based texture analysis of the infarcted region on baseline NCCT in characterizing tissue vulnerability to hemorrhagic transformation. Methods: This retrospective single-center study included 50 patients with supratentorial acute ischemic stroke treated with thrombolysis. All patients underwent baseline NCCT and follow-up CT at 24 h and were divided into those with hemorrhagic transformation (n = 33) and those without (n = 17). Texture analysis was performed using MaZda software, and feature selection was conducted using the Fisher coefficient. Discriminatory ability was assessed using receiver operating characteristic analysis. Results: Gray-level and run-length non-uniformity features were significantly lower in patients with hemorrhagic transformation (p < 0.001). These parameters yielded AUCs of 0.94–0.97, highlighting their potential as exploratory imaging biomarkers. Conclusions: CT-based texture analysis of baseline NCCT may provide additional quantitative information associated with subsequent hemorrhagic transformation. However, given the small sample size, single-center design and absence of external validation, these findings should be interpreted as exploratory and hypothesis-generating.