Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University (N.B.).
Dementia Theme (M.S.K., A.B.), The Florey Institute of Neuroscience and Mental Health.
Stroke. 2021 Mar;52(3):1004-1011. doi: 10.1161/STROKEAHA.120.029841. Epub 2021 Jan 28.
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.
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.
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.
Global brain health, as assessed by brain parenchymal fraction on magnetic resonance imaging, is associated with excellent functional outcome after ischemic stroke. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00927836.
卒中后的功能结局可能与预先存在的脑健康状况有关。已有多种脑脆弱性的影像学标志物被描述，包括脑萎缩和小血管疾病标志物。我们研究了这些影像学标志物与急性缺血性卒中后功能结局的关系。
我们回顾性研究了 AXIS-2 试验（AX200 缺血性卒中试验）中招募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总颅内体积（即脑实质分数）和总脑体积的比值。通过视觉评估扩大的血管周围间隙、脑白质高信号、腔隙和小血管疾病负担。90 天的功能结局（改良 Rankin 量表评分）通过逻辑回归来检验脑影像学特征与功能结局之间的关系。
我们纳入了 259 名平均年龄为 69±12 岁的患者，其中 46%为女性。脑实质分数增加与良好结局的可能性更高相关（每增加 1%的比值比，1.078[95%CI，1.008-1.153]）。总脑体积和小血管疾病负担与功能结局无关。脑实质分数与大血管闭塞对良好结局的交互作用不明显。
磁共振成像上的脑实质分数评估的整体脑健康状况与缺血性卒中后的良好功能结局相关。注册：网址：https://www.clinicaltrials.gov。唯一标识符：NCT00927836。
