Seyman Estelle Emanuelle, Sadeh-Gonik Udi, Berman Phillip, Blum Itay, Shendler Genady, Nathan Bornstein, Rothschild Ofer, Molad Jeremy, Ben Assayag Einor, Hallevi Hen
Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Neurol. 2023 Jul 18;14:1218077. doi: 10.3389/fneur.2023.1218077. eCollection 2023.
Vascular calcifications are a hallmark of atherosclerosis, and in the coronary arteries are routinely used as a prognostic marker. Calcifications of intracranial vessels (ICC) are frequently observed on non-contrast CT (NCCT) and their effect on post-stroke cognitive impairment (PSCI) remains unclear. Our aim was to explore the association of ICC with prospective long-term cognitive function and advanced MRI-measures in a large prospective cohort of cognitively intact mild stroke survivors.
Data from the Tel-Aviv brain acute stroke cohort (TABASCO) study [ClinicalTrials.gov #NCT01926691] were analyzed. This prospective cohort study ( = 575) aimed to identify predictors of PSCI, in cognitively intact mild stroke survivors. A quantitative assessment of the intracranial calcium content - The ICC score (ICCS) was calculated semi-automatically on NCCT using a validated calcium quantification application. Participants underwent a 3 T-MRI and prospective comprehensive cognitive clinical and laboratory assessments at enrollment, 6, 12, and 24-months.
Data were available for 531 participants (67.4 years, 59.5% males). The incidence of PSCI at two-years doubled in the high ICCS group (26% vs. 13.7%, < 0.001). The high ICCS group had significantly greater small-vessel-disease (SVD) tissue changes and reduced microstructural-integrity assessed by Diffusion-Tensor-Imaging (DTI) maps ( < 0.05 for all). In multivariate analysis, a higher ICCS was independently associated with brain atrophy manifested by lower normalized white and gray matter, hippocampal and thalamic volumes ( = -0.178, = -0.2, = -0.137, = -0.157; < 0.05) and independently predicted PSCI (OR 1.83, 95%CI 1.01-3.35).
Our findings suggest that the ICCS, which is a simple and readily available imaging marker on NCCT, is associated with brain atrophy, microstructural damage, the extent of SVD, and may predict PSCI. This finding has implications for identifying individuals at risk for PSCI and implementing targeted interventions to mitigate this risk.
血管钙化是动脉粥样硬化的一个标志，在冠状动脉中常被用作预后标志物。颅内血管钙化（ICC）在非增强CT（NCCT）上经常被观察到，但其对卒中后认知障碍（PSCI）的影响仍不清楚。我们的目的是在一个大型的认知功能正常的轻度卒中幸存者前瞻性队列中，探讨ICC与前瞻性长期认知功能及先进MRI测量指标之间的关联。
对来自特拉维夫脑急性卒中队列（TABASCO）研究[ClinicalTrials.gov #NCT01926691]的数据进行分析。这项前瞻性队列研究（n = 575）旨在确定认知功能正常的轻度卒中幸存者中PSCI的预测因素。使用经过验证的钙定量应用程序在NCCT上半自动计算颅内钙含量的定量评估值——ICC评分（ICCS）。参与者在入组时、6个月、12个月和24个月时接受了3T-MRI检查以及前瞻性全面的认知临床和实验室评估。
531名参与者（67.4岁，59.5%为男性）的数据可用。高ICCS组两年时PSCI的发生率翻倍（26%对13.7%，P < 0.001）。高ICCS组有明显更大的小血管疾病（SVD）组织变化，并且通过扩散张量成像（DTI）图评估的微观结构完整性降低（所有P < 0.05）。在多变量分析中，较高的ICCS与脑萎缩独立相关，表现为较低的标准化白质和灰质、海马体和丘脑体积（β = -0.178，β = -0.2，β = -0.137，β = -0.157；P < 0.05），并且独立预测PSCI（OR 1.83，95%CI 1.01 - 3.35）。
我们的研究结果表明，ICCS作为NCCT上一种简单且易于获得 的影像学标志物，与脑萎缩、微观结构损伤、SVD的程度相关，并且可能预测PSCI。这一发现对于识别PSCI风险个体以及实施有针对性的干预措施以降低这种风险具有重要意义。
