T2-FLAIR Radiomics During the Lucid Interval Predicts Delayed Encephalopathy After Carbon Monoxide Poisoning

Acute-phase T2-FLAIR radiomics improved risk stratification for delayed encephalopathy after CO poisoning: AUC 0.876, sensitivity 0.80, specificity 0.84 in held-out testing. Deep white matter was the dominant signal source. Retrospective; not externally validated.

• Retrospective study; 201 of 786 adults with acute CO poisoning had acute-phase T2-FLAIR MRI and were split chronologically into training and held-out test sets — only ~25% of the full cohort had usable imaging, limiting generalizability.
• 8/9 atlas-guided deep white matter bundles showed significant radiomic differences after false-discovery-rate correction; a secondary pallidal texture phenotype was linked specifically to a urinary-incontinence subphenotype in DEACMP patients.
• No external or prospective validation; single-institution retrospective design; the authors explicitly frame T2-FLAIR radiomics as a 'research-stage' tool, not yet ready for clinical deployment.

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