Imaging Markers of Brain Frailty and Outcome in Patients With Acute Ischemic Stroke
Imaging Markers of Brain Frailty and Outcome in Patients With Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.120.029841
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发表时间：
2021-03-01
期刊：
影响因子：
8.3
通讯作者：
Thijs, Vincent
中科院分区：
文献类型：
--
作者：
Bu, Ning;Khlif, Mohamed Salah;Thijs, Vincent
背景和目的：脑卒中后的功能结局可能与先前存在的大脑健康有关。一些脑衰弱的影像学标志物已经被描述，包括脑萎缩和小血管疾病的标志物。我们研究了这些影像学指标与急性缺血性脑卒中后功能预后的关系。方法：我们回顾性研究了参与AXIS-2试验（AX200 in缺血性卒中试验）的急性缺血性卒中患者，这是一项粒细胞集落刺激因子与安慰剂的随机对照临床试验。我们使用SPM12中的统一分割算法，从症状发作后9小时内获得的常规基线磁共振成像数据中评估脑实质体积与脑内总体积（即脑实质分数）的比率和脑总体积。血管周围空间增大，白质高信号，腔隙，以及小血管疾病负担，目测评分。测定第90天的功能结局（修正Rankin量表评分）。逻辑回归用于测试脑成像特征与功能结果之间的关联。结果：我们纳入了259例患者，平均年龄为69±12岁，其中46%为女性。脑实质分数增加与获得良好结果的几率较高相关（优势比增加1.078 [95% CI, 1.008-1.153]）。总脑容量和小血管疾病负担与功能结局无关。没有观察到脑实质分数与大血管闭塞之间的相互作用。结论：通过磁共振成像的脑实质分数评估的整体脑健康与缺血性卒中后良好的功能预后相关。注册:URL:。唯一标识符：NCT00927836。
Background and Purpose:Functional outcome after stroke may be related to preexisting brain health. Several imaging markers of brain frailty have been described including brain atrophy and markers of small vessel disease. We investigated the association of these imaging markers with functional outcome after acute ischemic stroke.Methods:We retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial (AX200 in Ischemic Stroke Trial), a randomized controlled clinical trial of granulocyte colony-stimulating factor versus placebo. We assessed the ratio of brain parenchymal volume to total intracerebral volumes (ie, the brain parenchymal fraction) and total brain volumes from routine baseline magnetic resonance imaging data obtained within 9 hours of symptom onset using the unified segmentation algorithm in SPM12. Enlarged perivascular spaces, white matter hyperintensities, lacunes, as well as a small vessel disease burden, were rated visually. Functional outcomes (modified Rankin Scale score) at day 90 were determined. Logistic regression was used to test associations between brain imaging features and functional outcomes.Results:We enrolled 259 patients with a mean age of 69 +/- 12 years and 46 % were female. Increased brain parenchymal fraction was associated with higher odds of excellent outcome (odds ratio per percent increase, 1.078 [95% CI, 1.008-1.153]). Total brain volumes and small vessel disease burden were not associated with functional outcome. An interaction between brain parenchymal fraction and large vessel occlusion on excellent outcome was not observed.Conclusions:Global brain health, as assessed by brain parenchymal fraction on magnetic resonance imaging, is associated with excellent functional outcome after ischemic stroke.Registration:URL: . Unique identifier: NCT00927836.