Kent David M, Leung Lester Y, Zhou Yichen, Luetmer Patrick H, Kallmes David F, Nelson Jason, Fu Sunyang, Zheng Chengyi, Liu Hongfang, Chen Wansu
From the Predictive Analytics and Comparative Effectiveness Center (D.M.K., J.N.) and Department of Neurology (L.Y.L.), Tufts Medical Center, Boston, MA; Department of Research and Evaluation (Y.Z., C.Z., W.C.), Kaiser Permanente Southern California, Pasadena; and Department of Radiology (P.H.L., D.F.K.) and Division of Digital Health Services, Department of Health Sciences Research (S.F., H.L.), Mayo Clinic, Rochester, MN.
Neurology. 2021 Sep 28;97(13):e1313-e1321. doi: 10.1212/WNL.0000000000012602. Epub 2021 Aug 10.
Silent cerebrovascular disease (SCD), comprising silent brain infarction (SBI) and white matter disease (WMD), is commonly found incidentally on neuroimaging scans obtained in routine clinical care. Their prognostic significance is not known. We aimed to estimate the incidence of and risk increase in future stroke in patients with incidentally discovered SCD.
Patients in the Kaiser Permanente Southern California (KPSC) health system aged ≥50 years, without prior ischemic stroke, transient ischemic attack (TIA), or dementia/Alzheimer disease receiving a head CT or MRI between 2009 and 2019 were included. SBI and WMD were identified by natural language processing (NLP) from the neuroimage report.
Among 262,875 individuals receiving neuroimaging, NLP identified 13,154 (5.0%) with SBI and 78,330 (29.8%) with WMD. The incidence of future stroke was 32.5 (95% confidence interval [CI] 31.1, 33.9) per 1,000 patient-years for patients with SBI: 19.3 (95% CI 18.9, 19.8) for patients with WMD and 6.8 (95% CI 6.7, 7.0) for patients without SCD. The crude hazard ratio (HR) associated with SBI was 3.40 (95% CI 3.25 to 3.56) and for WMD 2.63 (95% CI 2.54 to 2.71). With MRI-discovered SBI, the adjusted HR was 2.95 (95% CI 2.53 to 3.44) for those <65 years of age and 2.15 (95% CI 1.91 to 2.41) for those ≥65. With CT scan, the adjusted HR was 2.48 (95% CI 2.19 to 2.81) for those <65 and 1.81 (95% CI 1.71 to 1.91) for those ≥65. The adjusted HR associated with a finding of WMD was 1.76 (95% CI 1.69 to 1.82) and was not modified by age or imaging modality.
Incidentally discovered SBI and WMD are common and associated with increased risk of subsequent symptomatic stroke, representing an important opportunity for stroke prevention.
无症状脑血管疾病（SCD），包括无症状脑梗死（SBI）和白质病变（WMD），在常规临床护理中进行的神经影像学扫描时常常被偶然发现。其预后意义尚不清楚。我们旨在评估偶然发现SCD的患者未来发生卒中的发生率及风险增加情况。
纳入2009年至2019年间在南加州凯撒永久医疗集团（KPSC）医疗系统中年龄≥50岁、无既往缺血性卒中、短暂性脑缺血发作（TIA）或痴呆/阿尔茨海默病且接受头部CT或MRI检查的患者。通过自然语言处理（NLP）从神经影像报告中识别SBI和WMD。
在接受神经影像学检查的262,875例个体中，NLP识别出13,154例（5.0%）患有SBI，78,330例（29.8%）患有WMD。SBI患者未来卒中的发生率为每1000患者年32.5例（95%置信区间[CI] 31.1, 33.9）；WMD患者为19.3例（95% CI 18.9, 19.8）；无SCD的患者为6.8例（95% CI 6.7, 7.0）。与SBI相关的粗危险比（HR）为3.40（95% CI 3.25至3.56），与WMD相关的为2.63（95% CI 2.54至2.71）。对于MRI发现的SBI，年龄<65岁者调整后的HR为2.95（95% CI 2.53至3.44），年龄≥65岁者为2.15（95% CI 1.91至2.41）。对于CT扫描，年龄<65岁者调整后的HR为2.48（95% CI 2.19至2.
