Spatial radiomics nomogram predicts 90-day unfavorable outcomes in stroke (AUC 0.894/0.874)

A nomogram integrating infarct location, radiomics, and clinical factors predicted 90-day unfavorable outcome after acute ischemic stroke with AUC 0.894 in training and 0.874 in external validation. Infarct location added value beyond radiomics alone (0.793 vs 0.767, p<0.01).

• Retrospective multicenter study: 3,502 patients for training, 421 for external validation; location-based model outperformed radiomics-based model (AUC 0.793 vs 0.767).
• SHAP analysis highlighted superior corona radiata, internal capsule, and precentral gyrus as key prognostic regions. Nomogram integrates Radscore, Locscore, age, NIHSS, and infarct volume.
• Limitations: retrospective design, single external validation cohort; lacks prospective validation.

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