{"authors":[{"id":null,"fullName":"Dimitrios Rallios","name":"Dimitrios","surname":"Rallios","rank":1,"pid":{"id":{"scheme":"orcid_pending","value":"0009-0007-5639-0705"},"provenance":null}},{"id":"orcid_______::c949abdc3c5bd4ebd879a22d9a5ed73d","fullName":"Adam Hilbert","name":"Adam","surname":"Hilbert","rank":2,"pid":{"id":{"scheme":"orcid","value":"0000-0003-3447-5453"},"provenance":null}},{"id":null,"fullName":"Charles Majoie","name":"Charles","surname":"Majoie","rank":3,"pid":null},{"id":null,"fullName":"Wim Van H. van Zwam","name":"Wim Van H.","surname":"van Zwam","rank":4,"pid":null},{"id":null,"fullName":"Aad van der Lugt","name":"Aad","surname":"van der Lugt","rank":5,"pid":null},{"id":null,"fullName":"Martin Bendszus","name":"Martin","surname":"Bendszus","rank":6,"pid":null},{"id":null,"fullName":"Susanne Bonekamp","name":"Susanne","surname":"Bonekamp","rank":7,"pid":null},{"id":null,"fullName":"Peter Vajkoczy","name":"Peter","surname":"Vajkoczy","rank":8,"pid":null},{"id":null,"fullName":"Orhun U. 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However, collateral grading is rater-dependent and error-prone. We developed an automated cerebrovascular radiomics pipeline to establish objective collateral scoring on computed tomography angiography (CTA).</jats:p>                   </jats:sec>                   <jats:sec>                     <jats:title>Materials and methods</jats:title>                     <jats:p>                       We retrospectively analyzed admission CTAs from 343 LVO patients in the MR CLEAN trial, split into training/validation (                       <jats:italic>n</jats:italic>                        = 274) and testing (                       <jats:italic>n</jats:italic>                        = 69) sets. Vessel regions of interest were segmented using nnU-Net models trained on 40 arterial tree CTAs and 125 multiclass circle of Willis (CoW) cases. Radiomics features were extracted from vascular regions. Predictive features were identified, and a random forest classifier was trained to distinguish sufficient (&gt; 50%) from insufficient (≤ 50%) collateral status according to the Tan score system. Performance was compared to the atlas-based middle cerebral artery (MCA) mask model and validated on an external cohort of 140 acute LVO patients.                     </jats:p>                   </jats:sec>                   <jats:sec>                     <jats:title>Results</jats:title>                     <jats:p>                       Segmentation models accurately annotated cerebral arteries (95th percentile Hausdorff distance 4.49, Dice similarity coefficient 0.83) and CoW segments (2.27 and 0.81, respectively). After feature selection, 6 top features were identified for vessel-tree radiomics, 98 for MCA mask-based radiomics, and 32 for a combined vessel-tree/CoW model. Vessel-tree outperformed MCA mask model on both internal (area under the receiver operating characteristic curve (AUROC): 0.88                       <jats:italic>versus</jats:italic>                       0.82) and external (AUROC: 0.83                       <jats:italic>versus</jats:italic>                       0.66) test sets. Adding CoW features further improved performance, achieving 0.87 AUROC.                     </jats:p>                   </jats:sec>                   <jats:sec>                     <jats:title>Conclusion</jats:title>                     <jats:p>We presented a fully automated generalizable CTA radiomics approach for objective collateral scoring in acute LVO.</jats:p>                   </jats:sec>                   <jats:sec>                     <jats:title>Relevance statement</jats:title>                     <jats:p>This study introduces a fully automated CTA cerebrovascular radiomics pipeline that objectively assesses collateral status in patients with acute ischemic stroke. Combining vessel-tree and circle of Willis features improved collateral score prediction accuracy and generalizability, supporting more reliable, data-driven decision-making in acute large vessel occlusion management.</jats:p>                   </jats:sec>                   <jats:sec>                     <jats:title>Key Points</jats:title>                     <jats:p>                       <jats:list list-type=\"bullet\">                         <jats:list-item>                           <jats:p>Collateral circulation status informs prognosis and guides treatment in acute stroke, but grading is rater-dependent; our pipeline standardizes collateral assessment.</jats:p>                         </jats:list-item>                         <jats:list-item>                           <jats:p>We propose a CTA radiomics approach, trained and validated on multicenter data, externally tested on an independent cohort, demonstrating high effectiveness and generalizability.</jats:p>                         </jats:list-item>                         <jats:list-item>                           <jats:p>Automated and reliable collateral scoring has the potential to reduce inter-rater variability, improve workflow efficiency, and support individualized treatment decisions.</jats:p>                         </jats:list-item>                       </jats:list>                     </jats:p>                   </jats:sec>                   <jats:sec>                     <jats:title>Graphical Abstract</jats:title>                   </jats:sec>"],"publicationDate":"2026-03-16","publisher":"Springer Science and Business Media LLC","embargoEndDate":null,"sources":["Crossref","Eur Radiol Exp"],"formats":null,"contributors":null,"coverages":null,"bestAccessRight":{"code":"c_abf2","label":"OPEN","scheme":"http://vocabularies.coar-repositories.org/documentation/access_rights/"},"container":{"name":"European Radiology Experimental","issnPrinted":null,"issnOnline":"2509-9280","issnLinking":null,"ep":null,"iss":null,"sp":null,"vol":"10","edition":null,"conferencePlace":null,"conferenceDate":null},"documentationUrls":null,"codeRepositoryUrl":null,"programmingLanguage":null,"contactPeople":null,"contactGroups":null,"tools":null,"size":null,"version":null,"geoLocations":null,"id":"doi_dedup___::5286dd73bc4deeb14e759955a34d0b86","originalIds":["680","10.1186/s41747-026-00680-8","50|doiboost____|5286dd73bc4deeb14e759955a34d0b86","41838258","oai:pubmedcentral.nih.gov:12992882","50|od_______267::8422551f74ecf4a279ebd858209fb45f","oai:pure.eur.nl:openaire_cris_publications/be60a7c3-88c5-4d15-94d1-8ec4e88f1c49","50|dris___01177::a7d9d5a5b98541f1e7231514f968c4d4","50|dris___02436::320602eb3db6474839b67ef9629835e8","oai:cris.maastrichtuniversity.nl:openaire_cris_publications/942e1e57-eb9e-452b-9db0-ecce0c9e3e9b"],"pids":[{"scheme":"doi","value":"10.1186/s41747-026-00680-8"},{"scheme":"pmid","value":"41838258"}],"dateOfCollection":null,"lastUpdateTimeStamp":null,"indicators":{"citationImpact":{"citationCount":0.0,"influence":2.2251732E-9,"popularity":2.7165745E-9,"impulse":0.0,"citationClass":"C5","influenceClass":"C5","impulseClass":"C5","popularityClass":"C5"}},"projects":[{"id":"corda_____he::ce128033e62567a22f7f08cdfde244b9","code":"101057263","acronym":"VALIDATE","title":"V A L I D A T E  - 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