This is the first preliminary study to develop prediction models for aneurysm rupture risk using radiomics analysis based on follow-up magnetic resonance angiography (MRA) images. We selected 103 follow-up images from 18 unruptured aneurysm (UA) cases and 10 follow-up images from 10 ruptured aneurysm (RA) cases to build the prediction models. A total of 486 image features were calculated, including 54 original features and 432 wavelet-based features, within each aneurysm region in the MRA

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... for the texture patterns. We randomly divided the 103 UA data into 50 training and 53 testing data and separated the 10 RA data into 1 test and 9 training data to be increased to 54 using a synthetic minority oversampling technique. We selected 11 image features associated with UAs and RAs from 486 image features using the least absolute shrinkage and the selection operator logistic regression and input them into a support vector machine to build the rupture prediction models. An imbalanced adjustment training and test strategy was developed. The area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were 0.971, 0.948, 0.700, and 0.953, respectively. This prediction model with non-invasive MRA images could predict aneurysm rupture risk for SAH prevention.