Quantitative Analysis of White Matter Hyperintensities as a Predictor of 1-Year Risk for Ischemic Stroke Recurrence.

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2024-10-01 Epub Date: 2024-08-13 DOI:10.1007/s40120-024-00652-3

Yi Sun, Wenping Xia, Ran Wei, Zedong Dai, Xilin Sun, Jie Zhu, Bin Song, Hao Wang

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引用次数: 0

Abstract

Introduction: This study evaluates the role of quantitative characteristics of white matter hyperintensities (WMHs) in predicting the 1-year recurrence risk of ischemic stroke.

Methods: We conducted a retrospective analysis of 1061 patients with ischemic stroke from January 2018 to April 2021. WMHs were automatically segmented using a cluster-based method to quantify their volume and number of clusters (NoC). Additionally, two radiologists independently rated periventricular and deep WMHs using the Fazekas scale. The cohort was divided into a training set (70%) and a testing set (30%). We employed Cox proportional hazards models to develop predictors based on quantitative WMH characteristics, Fazekas scores, and clinical factors, and compared their performance using the concordance index (C-index).

Results: A total of 180 quantitative variables related to WMHs were extracted. A higher NoC in deep white matter and brainstem, advanced age (> 90 years old), specific stroke subtypes, and absence of discharge antiplatelets showed stronger associations with the risk of ischemic stroke recurrence within 1 year. The nomogram incorporating quantitative WMHs data showed superior discrimination compared to those based on the Fazekas scale or clinical factors alone, with C-index values of 0.709 versus 0.647 and 0.648, respectively, in the testing set. Notably, a combined model including both WMHs and clinical factors achieved the highest predictive accuracy, with a C-index of 0.735 in the testing set.

Conclusion: Quantitative assessment of WMHs provides a valuable neuro-imaging tool for enhancing the prediction of ischemic stroke recurrence risk.

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白质过度密集的定量分析可预测缺血性中风 1 年后的复发风险。

简介：本研究评估了白质增厚（WMH）的定量特征在预测缺血性脑卒中 1 年复发风险中的作用：本研究评估了白质高密度（WMH）的定量特征在预测缺血性卒中 1 年复发风险中的作用：我们对2018年1月至2021年4月期间的1061名缺血性脑卒中患者进行了回顾性分析。采用基于簇的方法自动分割 WMH，量化其体积和簇数（NoC）。此外，两名放射科医生使用法泽卡斯量表独立评定了室周和深部 WMH。队列分为训练集（70%）和测试集（30%）。我们采用 Cox 比例危险模型，根据定量 WMH 特征、Fazekas 评分和临床因素建立预测因子，并使用一致性指数（C-index）比较其性能：结果：共提取了180个与WMH相关的定量变量。深部白质和脑干中较高的 NoC、高龄（大于 90 岁）、特定卒中亚型以及未服用出院抗血小板药物与缺血性卒中 1 年内复发的风险有更强的相关性。与仅基于 Fazekas 量表或临床因素的提名图相比，包含定量 WMHs 数据的提名图显示出更高的区分度，在测试集中，C 指数值分别为 0.709 对 0.647 和 0.648。值得注意的是，包含 WMHs 和临床因素的组合模型的预测准确率最高，在测试集中的 C 指数为 0.735：结论：WMHs 定量评估为提高缺血性卒中复发风险预测提供了一种有价值的神经影像工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology and Therapy CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

8.10%

发文量

103

审稿时长

6 weeks

期刊介绍： Aims and Scope Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice. Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. 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