Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Neurology, Tufts Medical Center, Boston, Massachusetts, USA.
Cerebrovasc Dis. 2023;52(1):117-122. doi: 10.1159/000524723. Epub 2022 Jun 27.
Covert cerebrovascular disease (CCD) includes white matter disease (WMD) and covert brain infarction (CBI). Incidentally discovered CCD is associated with increased risk of subsequent symptomatic stroke. However, it is unknown whether the severity of WMD or the location of CBI predicts risk.
The aim of this study was to examine the association of incidentally discovered WMD severity and CBI location with risk of subsequent symptomatic stroke.
This retrospective cohort study includes patients aged ≥50 years old in the Kaiser Permanente Southern California health system who received neuroimaging for a nonstroke indication between 2009 and 2019. Incidental CBI and WMD were identified via natural language processing of the neuroimage report, and WMD severity was classified into grades.
A total of 261,960 patients received neuroimaging; 78,555 patients (30.0%) were identified to have incidental WMD and 12,857 patients (4.9%) to have incidental CBI. Increasing WMD severity is associated with an increased incidence rate of future stroke. However, the stroke incidence rate in CT-identified WMD is higher at each level of severity compared to rates in MRI-identified WMD. Patients with mild WMD via CT have a stroke incidence rate of 24.9 per 1,000 person-years, similar to that of patients with severe WMD via MRI. Among incidentally discovered CBI patients with a determined CBI location, 97.9% are subcortical rather than cortical infarcts. CBI confers a similar risk of future stroke, whether cortical or subcortical or whether MRI- or CT-detected.
Increasing severity of incidental WMD is associated with an increased risk of future symptomatic stroke, dependent on the imaging modality. Subcortical and cortical CBI conferred similar risks.
隐匿性脑血管病（CCD）包括脑白质病变（WMD）和隐匿性脑梗死（CBI）。偶然发现的 CCD 与随后发生症状性卒中的风险增加相关。然而，WMD 的严重程度或 CBI 的部位是否能预测风险尚不清楚。
本研究旨在探讨偶然发现的 WMD 严重程度和 CBI 部位与随后发生症状性卒中风险的关系。
这是一项回顾性队列研究，纳入了 Kaiser Permanente Southern California 健康系统中年龄≥50 岁的患者，他们在 2009 年至 2019 年间因非卒中原因接受了神经影像学检查。通过神经影像报告的自然语言处理识别偶然的 CBI 和 WMD，并将 WMD 严重程度分为等级。
共有 261960 例患者接受了神经影像学检查；78555 例（30.0%）患者被确定为偶然存在 WMD，12857 例（4.9%）患者为偶然存在 CBI。WMD 严重程度的增加与未来卒中发生率的增加相关。然而，与 MRI 确定的 WMD 相比，CT 确定的 WMD 各严重程度水平的卒中发生率更高。通过 CT 确定的轻度 WMD 患者的卒中发生率为 24.9/1000 人年，与 MRI 确定的重度 WMD 患者相似。在偶然发现的 CBI 患者中，有确定的 CBI 部位的患者中，97.9%为皮质下而非皮质梗死。CBI 无论位于皮质还是皮质下，无论是 MRI 还是 CT 检测到，都具有相似的未来卒中风险。
偶然发现的 WMD 严重程度的增加与未来症状性卒中风险增加相关，这取决于影像学检查方式。皮质下和皮质 CBI 具有相似的风险。
