脑小血管病 MRI 特征不能提高对卒中结局的预测。

Cerebral Small Vessel Disease MRI Features Do Not Improve the Prediction of Stroke Outcome.

机构信息

From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France.

出版信息

Neurology. 2021 Jan 26;96(4):e527-e537. doi: 10.1212/WNL.0000000000011208. Epub 2020 Nov 12.

DOI:10.1212/WNL.0000000000011208

PMID:33184231

Abstract

OBJECTIVE

To determine whether the total small vessel disease (SVD) score adds information to the prediction of stroke outcome compared to validated predictors, we tested different predictive models of outcome in patients with stroke.

METHODS

White matter hyperintensity, lacunes, perivascular spaces, microbleeds, and atrophy were quantified in 2 prospective datasets of 428 and 197 patients with first-ever stroke, using MRI collected 24 to 72 hours after stroke onset. Functional, cognitive, and psychological status were assessed at the 3- to 6-month follow-up. The predictive accuracy (in terms of calibration and discrimination) of age, baseline NIH Stroke Scale score (NIHSS), and infarct volume was quantified (model 1) on dataset 1, the total SVD score was added (model 2), and the improvement in predictive accuracy was evaluated. These 2 models were also developed in dataset 2 for replication. Finally, in model 3, the MRI features of cerebral SVD were included rather than the total SVD score.

RESULTS

Model 1 showed excellent performance for discriminating poor vs good functional outcomes (area under the curve [AUC] 0.915), and fair performance for identifying cognitively impaired and depressed patients (AUCs 0.750 and 0.688, respectively). A higher SVD score was associated with a poorer outcome (odds ratio 1.30 [1.07-1.58], = 0.0090 at best for functional outcome). However, adding the total SVD score (model 2) or individual MRI features (model 3) did not improve the prediction over model 1. Results for dataset 2 were similar.

CONCLUSIONS

Cerebral SVD was independently associated with functional, cognitive, and psychological outcomes, but had no clinically relevant added value to predict the individual outcomes of patients when compared to the usual predictors, such as age and baseline NIHSS.

摘要

目的

为了确定总小血管疾病（SVD）评分与验证性预测因子相比是否能提供更多关于中风预后的信息，我们测试了不同的预后预测模型，以评估首次中风患者的预后。

方法

在两个前瞻性数据集（分别包含 428 例和 197 例患者）中，在中风发作后 24 至 72 小时使用 MRI 量化了脑白质高信号、腔隙、血管周围间隙、微出血和萎缩。在 3 至 6 个月的随访中评估了功能、认知和心理状态。在数据集 1 中，通过量化年龄、基线 NIH 中风量表评分（NIHSS）和梗死体积（模型 1）来定量评估年龄、基线 NIHSS 评分（NIHSS）和梗死体积（模型 1）的预测准确性（以校准和区分度为指标），并在模型 2 中加入总 SVD 评分，评估预测准确性的提高。在模型 2 中，也在数据集 2 中建立了这些模型，以进行复制。最后，在模型 3 中，我们纳入了脑 SVD 的 MRI 特征，而不是总 SVD 评分。

结果

模型 1 对区分功能预后良好和预后不良的表现出优异的性能（曲线下面积 [AUC] 0.915），对识别认知障碍和抑郁患者的表现出良好的性能（AUCs 分别为 0.750 和 0.688）。较高的 SVD 评分与较差的预后相关（比值比 1.30 [1.07-1.58]，最佳功能预后为 0.0090）。然而，与模型 1 相比，加入总 SVD 评分（模型 2）或个体 MRI 特征（模型 3）并没有提高预测效果。数据集 2 的结果相似。