Integration of Conventional and Radiomic Features From FDG PET/MRI for Multimodal Prediction of

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundThe aim of this study was to evaluate an integrated fluorine‐18 fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (PET/MRI) model combining conventional and radiomic features for the noninvasive identification of symptomatic extracranial carotid atherosclerotic plaques.MethodsA total of 200 patients with advanced carotid plaques (78 symptomatic, 122 asymptomatic) underwent hybrid fluorine‐18 fluorodeoxyglucose PET/MRI.

Six MRI morphological features (intraplaque hemorrhage, lipid‐rich necrotic core, ruptured fibrous cap, calcification, surface ulceration, and plaque enhancement) and 3 PET metabolic parameters—metabolic uptake, maximum standardized uptake value, and target‐to‐background ratio—were evaluated. A total of 1991 radiomics were extracted from each of the MRI and PET images, respectively.

For each modality, 3 types of models were developed: conventional, radiomics, and combined (incorporating conventional and radiomic features). Diagnostic performance was evaluated using multivariate logistic regression and a linear support vector classifier.ResultsIn MRI‐based analysis, surface ulceration and plaque enhancement emerged as independent predictors of symptomatic plaques.

In PET‐based analysis, standardized uptake value and metabolic uptake were identified as significant independent predictors.