From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.).
Radiology. 2022 Jul;304(1):145-152. doi: 10.1148/radiol.210419. Epub 2022 Mar 29.
Background White matter hyperintensity (WMH) has been linked to poor clinical outcomes after acute ischemic stroke. Purpose To assess whether the WMH burden on pretreatment MRI scans is associated with an increased risk for symptomatic intracranial hemorrhage (sICH) or poor functional outcome in patients with acute ischemic stroke treated with endovascular thrombectomy (EVT). Materials and Methods In this retrospective study, consecutive patients treated with EVT for anterior circulation acute ischemic stroke at a comprehensive stroke center (where MRI was the first-line pretreatment imaging strategy; January 2015 to December 2017) were included and analyzed. WMH volumes were assessed with semiautomated volumetric analysis at fluid-attenuated inversion recovery MRI by readers who were blinded to clinical data. The associations of WMH burden with sICH and 3-month functional outcome (modified Rankin Scale [mRS] score) were assessed. Results A total of 366 patients were included (mean age, 69 years ± 19 [SD]; 188 women [51%]). Median total WMH volume was 3.61 cm (IQR, 1.10-10.83 cm). Patients demonstrated higher mRS scores with increasing WMH volumes (odds ratio [OR], 1.020 [95% CI: 1.003, 1.037] per 1.0-cm increase for each mRS point increase; = .018) after adjustment for patient and clinical variables. There were no significant associations between WMH severity and 90-day mortality (OR, 1.007 [95% CI: 0.990, 1.024]; = .40) or the occurrence of sICH (OR, 1.001 [95% CI: 0.978, 1.024]; = .94). Conclusion Higher white matter hyperintensity burden was associated with increased risk for poor 3-month functional outcome after endovascular thrombectomy for large-vessel occlusive stroke. © RSNA, 2022 See also the editorial by Mossa-Basha and Zhu in this issue.
背景 脑白质高信号（WMH）与急性缺血性卒中后临床结局不良有关。目的 评估急性缺血性卒中患者接受血管内血栓切除术（EVT）治疗时，预处理 MRI 扫描上的 WMH 负荷是否与症状性颅内出血（sICH）风险增加或功能结局不良相关。材料与方法 在这项回顾性研究中，纳入了在综合卒中中心接受 EVT 治疗的前循环急性缺血性卒中连续患者（MRI 是一线预处理成像策略；2015 年 1 月至 2017 年 12 月），并进行了分析。WMH 体积通过在液体衰减反转恢复 MRI 上使用半自动化容积分析进行评估，分析者对临床数据进行了盲法处理。评估了 WMH 负荷与 sICH 和 3 个月功能结局（改良 Rankin 量表[mRS]评分）的相关性。结果 共纳入 366 例患者（平均年龄 69 岁±19 岁[标准差]；188 例女性[51%]）。中位总 WMH 体积为 3.61cm（IQR，1.10-10.83cm）。校正患者和临床变量后，WMH 体积越大，mRS 评分越高（OR，每增加 1.0cm 增加 1.020[95%CI：1.003，1.037]，P=.018）。WMH 严重程度与 90 天死亡率（OR，1.007[95%CI：0.990，1.024]；P=.40）或 sICH 发生率（OR，1.001[95%CI：0.978，1.024]；P=.94）均无显著相关性。结论 在接受大血管闭塞性卒中 EVT 治疗的患者中，WMH 负荷越高，3 个月功能结局不良的风险越高。
